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Papillary thyroid cancer. Axial CT scan demonstrates a hypoattenuated mass centered in the thyroid isthmus. Although most thyroid cancers are subclinical, some may present with pain or dysphagia. Because the sensory innervation to the thyroid gland is via the superior and recurrent laryngeal nerves, there have been documented cases of thyroid pathology manifesting as ear pain.
Source publication
Pain referred to the ear is a well-documented phenomenon, which can be due to a multitude of disease processes. With the recent and rapid progression of CT and MR imaging technology, radiologists have played an increasing role in solving this potentially difficult diagnostic dilemma. Essentially any pathology residing within the sensory net of cran...
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This study reports the case of an acoustic shock injury (ASI), which did not result in a significant hearing loss, but was followed by manifold chronic symptoms both within (tinnitus, otalgia, tingling in the ear, tension in the ear, and red tympanum) and outside the ears (blocked nose, pain in the neck/temporal region). We suggest that these sympt...
Citations
... consequently this phenomenon can be considered "referred or non-otogenic otalgia" (9,10). Up to 50% of cases with otlagia are considered as non-otogenic type (8,11). ...
Otalgia is a very common symptom induced by a wide variety of diseases. Depending on the location of the pathology, otalgia is categorized into primary and secondary types. In primary otalgia, the main source of the pain is located within the ear. On the contrary, secondary or referred otalgia is defined as a disorder which the underlying pathology is outside of the ear complex giving rise to the sensation of pain in the ear. Multiple etiologies have been reported to produce secondary otalgia including
temporomandibular joint dysfunctions, cervical spine pathologies, laryngitis, pharyngitis and tonsillitis. In this study, we present a 57-year-old man with referred otalgia, associated to rotator cuff tendon tear and acromioclavicular joint osteoarthritis, which is uncommon and atypical.
... Benign and malignant lesions within the oral cavity may result in patient-reported otalgia. 8,9 The trigeminal nerve (CN V) supplies sensation to both the ear and the mucosal surfaces of the oral cavity. This shared pathway results in infection and inflammatory disorders of the oral cavity manifesting clinically with otalgia, such as aphthous ulceration and malignancy. ...
... This shared pathway results in infection and inflammatory disorders of the oral cavity manifesting clinically with otalgia, such as aphthous ulceration and malignancy. 9 Careful examination of the mucous membranes of the oral cavity should be undertaken for all patients presenting with otalgia. As these lesions are readily visible on examination of the oral cavity, no further imaging is required for these lesions. ...
Objective:
To provide family physicians and general otolaryngologists with a practical, evidence-based, and comprehensive approach to the management of patients presenting with suspected referred otalgia.
Sources of information:
The approach described is a review based on the authors' clinical practices along with research and clinical review articles published between 2000 and 2020. MEDLINE and PubMed were searched using the terms otalgia, referred otalgia, and secondary otalgia. Current guidelines for the management of referred otalgia were also reviewed.
Main message:
Otalgia is defined as pain localized to the ear. It is one of the most common head and neck presentations in primary care, otolaryngology, and emergency medicine. Secondary otalgia arises from nonotologic pathology and represents nearly 50% of otalgia cases. Otalgia in the absence of other otologic symptoms is highly indicative of a secondary cause. A thorough assessment of patients presenting with referred otalgia requires an understanding of the possible causes of this condition, including dental and oral mucosal pathologies, temporomandibular joint disorders, cervical spine pathology, sinusitis, upper airway infection, and reflux, as well as head and neck malignancy. This paper aims to highlight the most common causes of referred otalgia, their presentations, and initial options for assessment and management.
Conclusion:
The prevalence of referred otalgia makes this an important condition for family physicians to be able to assess, manage, and triage based on patient presentation and examination. Understanding the common causes of referred otalgia will help reduce wait times for specialist assessment and allow ease and speed of access to management options for patients in community clinics.
... Lésions aux muqueuses buccales. Des lésions bénignes et malines dans la cavité buccale peuvent amener le patient à signaler une otalgie 8,9 . Le nerf du trijumeau (NC V) transmet la sensation à la fois à l'oreille et aux surfaces muqueuses de la cavité buccale. ...
... Le nerf du trijumeau (NC V) transmet la sensation à la fois à l'oreille et aux surfaces muqueuses de la cavité buccale. Cette voie partagée fait en sorte que l'infection et les troubles inflammatoires de la cavité buccale se manifestent cliniquement par une otalgie, comme l'ulcération aphteuse et les cancers 9 . Un examen attentif des membranes muqueuses de la cavité buccale devrait être effectué chez tous les patients souffrant d'otalgie. ...
... Referred ear pain can occur due to the involvement of the 5th (mainly in oral cancers), more commonly by the 9th and 10th cranial nerves [12]. We found a significant association between otalgia and tumor localization: hypopharyngeal cancers caused ear pain the most frequently. ...
Introduction: Head and neck cancers represent a major health problem in Hungary. With their high incidence and mortality rates, Hungary is one of the world leaders in these indicators. The length of patient delay, defined as time from onset of symptoms to first medical consultation, is unknown in Hungarian patients with head and neck cancer. We aimed to use a representative sample of the Hungarian head and neck cancer patient population to determine patient delay according to disease localization and stage and to identify correlations with other clinical parameters.
Methods: In our retrospective study, we reviewed patient documentation. For the inclusion, the patients had to be diagnosed with malignant tumors of the oral cavity, oropharynx, hypopharynx or larynx at the Department Head and Neck Surgery of Semmelweis University between 2012 and 2017.
Results: We identified 236 patients who met the inclusion criteria. The median delay was 9.5 weeks (range 0–209 weeks) and the mean delay of patients was 17.57 weeks (SD 23.67). There was a significant difference in patient delay data by location. Among glottic cancers, the most common diagnosis was an early stage (67%), compared with other localizations, including most commonly the oropharynx (81%) and hypopharynx (80%), where a locoregionally advanced stage was more frequent.
Discussion: Compared to data from different countries, the delay of Hungarian patients with head and neck cancer is significantly longer, which may contribute to the high mortality in Hungary. Screening and patient education in high-risk groups could contribute to earlier diagnosis and thus improve prognosis.
... Referred otalgia also known as secondary otalgia is a referred pain due to the glossopharyngeal nerve innervation of the tonsils and pharynx. This pain is then referred to the medial aspect of the tympanic membrane via the Jacobson's nerve [10,11]. In tonsillitis the tonsils are erythematous and often bilateral. ...
Peritonsillar and intratonsillar abscesses are one of the not too frequent emergencies encountered by the ENT fraternity. The palatine tonsils which form part of the Waldeyer’s ring is situated in the oropharynx between the anterior and posterior pillars. Tonsillitis refers to inflammation of the tonsils whereas peritonsillitis refers to the different stages of disease process, either cellulitis with or without an abscess collection within the surrounding soft tissue of the tonsils. Peritonsillar abscess is often unilateral while peritonsillitis may be bilateral in 20% of cases whereas intratonsillar abscess is rare with an incidence of 7%. The shared symptoms of peritonsillitis and intratonsillar abscess includes fever, trismus, deviation of uvula and referred pain. These shared symptoms have placed many physician in a dilemma, often resulting in an intratonsillar abscess to be missed. The complications include retropharyngeal abscess, parapharyngeal abscess, mediastinitis and upper airway obstruction. The medical therapy consists of intravenous antibiotics and intravenous fluids. A needle aspiration is useful when a diagnosis is uncertain. Aspiration of pus is diagnostic confirming a peritonsillar abscess from a peritonsillar cellulitis. Incision and drainage can be performed for intratonsillar abscess not responding to treatment or a failed needle aspiration which is preferably performed under general anesthesia for children. Elective tonsillectomy should be indicated for patients with recurrent peritonsillar abscess. CT contrast is useful to identify complications arising mainly in retropharyngeal or parapharyngeal abscess and to know its extension, spread and drainage approaches.
... 5 Berdasarkan asal timbulnya keluhan nyeri, otalgia bisa dibagi menjadi 2 kategori utama yakni primer dan sekunder atau disebut juga "referred otalgia". 6 Nyeri yang penyebabnya berasal dari telinga disebut sebagai otalgia primer sedangkan nyeri yang penyebabnya berasal dari luar telinga disebut otalgia sekunder. 7,8 Dalam penelitian oleh Adegbiji, dkk. ...
Cotton bud merupakan salah satu alat yang kerap digunakan untuk membersihkan telinga. Penggunaan cotton bud dapat mengganggu mekanisme pembersihan serumen secara alami serta dapat menyebabkan trauma dan rasa nyeri pada telinga. Tujuan penelitian ini adalah untuk mengetahui hubungan frekuensi dan jumlah penggunaan cotton bud untuk toilet telinga terhadap derajat keluhan nyeri pada telinga berdasarkan VAS. Penelitian ini menggunakan rancangan penelitian observasional analitik yang menggunakan pendekatan cross-sectional. Subjek penelitian ini adalah mahasiswa Fakultas Kedokteran Universitas Lambung Mangkurat Angkatan 2019-2021. Penelitian ini menggunakan teknik purposive sampling yang dilakukan secara daring, didapatkan sampel sebanyak 30 responden. Hasil penelitian ini adalah frekuensi dan jumlah penggunaan cotton bud yang terbanyak yakni masing-masing 1-2 kali per minggu (73,3%) dan 1-2 batang (56,7%) setiap kali toilet telinga. Hasil analisis data menggunakan uji Kolmogorov-Smirnov, dapat diambil kesimpulan bahwa tidak terdapat hubungan antara frekuensi penggunaan cotton bud (p=1,000) dan jumlah penggunaan cotton bud (p=0,670) terhadap derajat keluhan nyeri.
... It is considered as a first symptom soon after the malignancy affecting head and neck region [5]. Computed tomography (CT) and magnetic resonance imaging (MRI) are important diagnostic tests to evaluate the cause of referred otalgia, if there is no finding on physical examination [6,7]. ...
Aim: To find out the most frequent head and neck sites of origin of referred otalgia. Study Design: Descriptive cross-sectional. Place and Duration of Study: Study was conducted at the ENT department of Bahawal Victoria hospital Bahawalpur during January 2019 to December 2019. Methodology: About 500 patients with ear ache were examined and after exclusion 150 were finally analyzed. Detailed history of the patient and clinical examination were done along with radio imaging and endoscopic studies wherever needed. Diagnosis of referred otalgia was made after having normal ear examination along with pathology lying at different head and neck region which share common sensory innervation. For analysis SPSS version-20 was used. Results: The mean age of the study participants was 28.23 ±13 years. The majority of participants were having otalgia of tonsillar origin followed by dental origin and pharyngitis with 31.3%, 23.3% and 16% respectively. Very few of them having otalgia originating from hypopharyngeal carcinoma and laryngeal carcinoma i.e. 3.3% and 2% respectively. While only 4.7% of otalgia were of unknown origin. Female participants were having higher frequency of otalgia which is originated from diseases of temporomandibular joint, hypopharyngeal carcinoma and otalgia of unknown origin in comparison to male participants but differences were insignificant. Otalgia originated from tonsillar and dental causes and due to pharyngitis were most common among the younger age group but having non-significant p-value. Conclusion: It has been concluded that the patients presenting with ear pain, have sometimes no underlying ear pathology. If the ear examination is normal then it is important to examine all other sites of head and neck which share sensory innervation with the ear including teeth, tonsils, pharynx, larynx, nose and paranasal sinuses to find out the exact cause of referred otalgia.
... These nerves enter the spinal tract nucleus near the medulla and their stimulation can cause a sensation of laryngeal obstruction based on the convergence-projection theory. 12 This theory suggests that the central nervous system cannot differentiate between stimuli that converge in a common sensory pathway. Therefore, the anatomic convergence of cardiac nerve fibres and somatic afferents from the larynx in central pathways is likely to be responsible for the perception of cardiac ischemic pain as a sensation of laryngeal obstruction. ...
A rare case of a 62-year-old woman with an atypical cardiac symptom of sensation of laryngeal obstruction as a manifestation of acute coronary syndrome is described. Initially, the patient showed unremarkable test results and was diagnosed with laryngopharyngitis and discharged from hospital. However, 24 hours later she returned to the hospital with an abnormal electrocardiogram (ECG) and elevated blood troponin levels and was diagnosed with ST-segment elevation myocardial infarction (STEMI). She developed heart failure, cardiogenic shock and died. Clinicians should be aware that patients with an unexplained sensation of laryngeal obstruction should be considered for the presence of MI within their differential diagnosis since this may be the only symptom in some patients with life-threatening cardiac ischemia.
... The results from our study are similar to another study conducted by Chen et al., which shows that in recent decades the development of CT and MRI technology has helped in identifying the cervical lesions causing otalgia which contributes to about 12.5% of the cases. 9 In our study 10% of the cases are due to TMJ disorder caused otalgia, due to the affected complex synovial system, articulating ligaments and masticatory muscles which in par goes with a study done by Shalender Sharma et al. 10 ...
... Es por ello que las patologías que surgen en las zonas inervadas por tales nervios pueden dar lugar a una OR 1,3 . Aunque los mecanismos son un tanto controvertidos, la teoría más aceptada es la proyección convergente, que establece que múltiples nervios convergen en una única vía neural compartida, por lo que el sistema nervioso central es incapaz de diferenciar el origen de la estimulación 6,7 . Dada la relevancia de este tema y lo complejo que puede ser enfrentarse a ella, el objetivo de esta revisión es otorgar herramientas al lector para comprender los distintos procesos involucrados en su desarrollo, conocer las patologías más relevantes relacionadas y, de esta forma, entregar al clínico una pauta de cómo enfrentar este motivo de consulta frecuente, que puede llegar a ser un verdadero desafío diagnóstico 2,8 . ...
... En los niños, la otalgia primaria es la más común 7,9 , pero en los adultos la secundaria es más frecuente, alcanzando en algunas series sobre un 50% de las causas 5,6,10,11 . Si analizamos la otalgia por género en adultos, la otalgia primaria es más frecuente en hombres y la otalgia secundaria es más frecuente en mujeres 7,12 , siendo también más frecuente en este género la patología temporomandibular y las neuralgias 6,7 . En algunas revisiones se determina que la causa más frecuente de OR es la patología dental 9,13 . ...
... Se describe que la otalgia estará presente en un 56,8% en los carcinomas nasofaríngeos, 26,0% de los cánceres de hipofaringe y un 16,7% de las lesiones malignas de la orofaringe 5 . Paparella describió un caso de carcinoma avanzado de esófago que se presentó únicamente con otalgia 6 . Los factores de riesgo para sospechar neoplasias incluyen el consumo de alcohol y el cigarrillo, y la edad sobre 50 años 3,6 . ...
Otalgia is a common reason for consultation in otolaryngology and can be classified into two types: primary or secondary otalgia. Primary otalgia is a consequence of an otological disease while secondary otalgia arises from pathological processes that originate in other structures different than the ears, but share common neuronal pathways. These pathways involve cranial nerves V, VII, IX and X and cervical nerves C2 and C3. The most common causes of secondary otalgia are musculoskeletal pathology such as temporomandibular joint dysfunction and myofascial syndrome, dental pathology and oropharyngeal infections. To find the etiology of secondary otalgia, in most cases a medical history and physical examination will be sufficient, however there is a group of patients with risk factors that may require additional studies. The objective of this review is to give the reader tools to understand the different processes involved in secondary otalgia, know the most relevant related pathologies and thus give the clinician a guide to deal with this problem.
