A Study on Clinical Profile of Non-Otogenic Otalgia

Abstract

Background: The ear is unique in that no other structure in the body of comparable size has such a unique sensory nerve supply. The sensory nerve supply of the ear is through a combination of four cranial nerves (Cranial nerves V, VII, IX, and X) and two superior cervical plexus nerves (C2 and C3). Presumably, this complex innervation is an excellent survival tool, and any pain perceived in that area causes a heightened sense of alarm. The differential diagnosis is specifically related to the sensory innervations of the ear, and therefore it is required that otolaryngologists have relevant knowledge of the complex neuroanatomic innervation of the external and middle ear. Among all causes of referred otalgia, dental pathology, which transmits referred pain via a branch of the trigeminal nerve, is the most common source of non-otogenic pain. Ear pain can be because of pathologies in the ear or in the surrounding head and neck region. As there is no single, simple algorithm for determining the cause of otalgia and due to complex innervation of the ear frequently the clinicians get puzzled and the cause remains obscure.

Aim: The aim of the study was to identify the various possible non-otogenic causes and their various characteristics which will help in better evaluation of patients.
Material and Method: This study was a cross-sectional study on patients who had presented to the ENT department. All patients over five years of age, both male and female and presenting with earache were selected. Patients having aural pathology to account for pain, having previous surgery on the affected ear, or having hemi facial pain or vague sensation of aural fullness were excluded from the analysis. A total of 150 patients presenting with earache were examined. The procedure was explained and Informed consent was obtained. Detailed history taking & clinical examination ensued. Laboratory investigations, imaging studies, and endoscopic examinations were carried out as and when indicated.

Results: There were 150 patients who presented with earache in our ENT OPD. Out of 150 patients, 70 patients had definite otogenic causes of otalgia and they were excluded from the study. The remaining 80 patients were evaluated and were included in the present study. The most common non-otogenic cause was found to be temporomandibular dysfunction (41.2%). Other causes in descending order of frequency were cervical spondylosis (20.0%), dental caries (10.0%), pharyngitis (6.25%), Eagle’s syndrome (6.25%), impacted molar (5.0%), carcinoma oropharynx (5.0%), acute tonsillitis, peri tonsillitis, glossopharyngeal neuralgia, Bell’s palsy psychogenic (1.25%). There were 2 cases of malignancies, one along the posterior third tongue other along the tonsil lingual sulcus which was biopsied and confirmed histologically.

Conclusion: In this study, the most common cause is odontogenic followed by cervical lesions. Sometimes an isolated ear pain could be the telltale sign of an early upper aero digestive tract malignancy. Neuralgic pain can also present with ear pain. So, in patients presenting with ear pain examination of dentition and cervical spine should be done in addition to the routine ear, nose, throat, and neck examination. Most cases are presented in the 5th and 6th decade. There are no many differences in presentation in both sexes and laterality.

Keywords: Referred otalgia, Temporomandibular joint dysfunction, Cervical spondylosis.