Referred otalgia as a presenting symptom: frequency and causes

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Muthanna Medical Journal
Volume 6, Issue 1, June 2019, Pages 37-45
http://dx.doi.org/10.18081/2410-4590/2019-30-37

Research Article

 Ahmed Fadhil Hasan¹*, Duraid Ahmed Mahmood², Jafaar Muhsen Khalaf²

* Correspondence author: hamadafh2003@yahoo.com
¹Al shafaa general hospital, Basrah, Iraq
²Al sadr teaching hospital, Basrah, Iraq
Received 02 January 2019, Accepted 29 March 2019, Available online 07 April 2019
This is article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2019 AH

Abstract

Ear pain or Otalgia is an important patient presenting symptom to ENT clinic, that may reflect
an underlying serious problem in or outside the ear because of the complex innervations which
is derived from different neural segments (V, VII, IX, X Cranial nerves, C2 and C3 Cervical
plexus). The term Referred Otalgia applied when the ear examination is normal, so it is
important to search for the secondary cause in other structures like pharynx, larynx, teeth, TM,
nose, sinuses, salivary glands, neck, and rarely thoracic structures like esophagus, bronchus
and heart. The aim of the study is to identify the frequency and causes of referred Otalgia as
a presenting symptom (not associated symptom) in patients visiting ENT clinic in Basrah, Iraq.
A prospective study of 400 patients presenting to the ENT clinic from September 2013 to
October 2015 with ear pain only, i.e those patients whose chief complaint includes sore throat,
nasal obstruction, toothache or other symptoms and associated with ear pain. Those undergo
surgery in pharynx, larynx or nose are excluded from the study. all patients are subjected to
full history and ENT examination, in addition to examination of Temporo-mandibular joint
(TMJ) and neck. Some patients were sent for audiological and radiological assessment
according to the finding in the examination and some had maxillofacial or orthopedic
consultation. From all patients, 91 were found to have referred Otalgia (22.75%). More than
half of them were between 16-40 years of age (51.6%). Female were found to be more affected
than male (65.9%). Right ear was found to be affected slightly more than left ear (42.9%). The
study also found that the most common cause of referred Otalgia is TMJ dysfunction (48.4%).
In conclusion; Ear pain or Otalgia is an important presenting symptom to ENT clinic with more
than one fifth of those patients having referred pain, the commonest cause of referred Otalgia
is TMJ dysfunction which constitutes about half of cases, most causes of referred Otalgia are
related to the trigeminal nerve especially mandibular division, this is may be due to its length
and numerous tributaries supplying structures in the head and neck region.

Keywords: Referred; Pain; Otalgia; Presenting; Symptom
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