Referred otalgia as a presenting symptom: frequency and causes


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.