Association of anatomical features of the petrotympanic fissure and presence of foramen of Huschke with otalgia and tinnitus.

The petrotympanic fissure (PTF) and foramen of Huschke (FH) are anatomical structures in the temporal bone that can connect the temporomandibular joint (TMJ) and the ear. The purpose of this retrospective study was to investigate the association between PTF morphology and otalgia and tinnitus, as well as the prevalence of the FH and otological symptoms, using cone beam computed tomography (CBCT). CBCT images from 114 patients presenting with symptoms of a temporomandibular disorder were examined retrospectively. The PTF was classified into three subtypes (open, semi-open, closed) and the presence of the FH was identified. Symptoms of otalgia and tinnitus were obtained from the patient files. The FH was observed in 12.3% of patients examined, and in 12.0% of those with otalgia and 18.9% of those with tinnitus. There was no significant association between the PTF subtypes or the presence of the FH and otalgia or tinnitus (all P > 0.05). The PTF subtype and presence of the FH alone do not appear to contribute to otalgia or tinnitus in patients with temporomandibular disorders.

Diagnosing acute mastoiditis in a Pediatric Emergency Department: a retrospective review.

Background and aim Acute mastoiditis (AM) is a common complication of acute otitis media in children. There is currently no consensus on criteria for diagnosis. Head CT is the most frequent diagnostic tool used in the ED although the increasing awareness on the use of ionized radiations in children has questioned the use of CT imaging versus solely using clinical criteria. Our research aimed to understand if CT imaging was essential in making a diagnosis of AM. Methods We retrospectively analyzed medical records from pediatric patients who accessed our Pediatric Emergency Department (ED) between January 2014 and December 2020, with a clinical suspicion of AM. We reviewed clinical symptoms upon presentation, head CT and lab values (white blood cell count or WBC, C-Reactive Protein or CRP) when done, presence of complications and discharge diagnosis. A multilogistic regression model was specified to establish the role of clinical features and of CT in the diagnosis of AM based on 77 patients. Results Otalgia (OR= 5.01; 95% CI= 1.52-16.51), protrusion of the auricle (OR= 8.42; 95% CI= 1.37-51.64) and hyperemia (OR= 4.07; 95% CI= 1.09-15.23) of the mastoid were the symptoms strongly associated with a higher probability of AM. In addition to clinical features, the adjusted OR conferred by head CT was 3.09 (95% CI = 0.92-10.34). Conclusions Clinical signs were most likely predictive of AM in our sample when compared to Head CT. Most common symptoms were protrusion of the auricle, hyperemia or swelling behind the ear and otalgia.

[A female patient with earache, polyuria and polydipsia]. / Eine Patientin mit Ohrenschmerzen Polyurie und Polydipsie.

INTRODUCTION: Langerhans cell histiocytosis is a rare inflammatory bone marrow neoplasia that frequently affects bone, lung, skin and pituitary gland. Due to its broad spectrum of clinical presentation, an appropriate diagnosis might be difficult. HISTORY: A 54-year-old female patient complained of pain in her right ear for 5 months. On account of similar complaints, a mastoidectomy had already been performed 3 years ago. Histology at that time revealed nonspecific inflammation. Furthermore, she reported excessive thirst. FINDINGS AND DIAGNOSIS: Computed tomography of the temporal bones showed osteolysis in the mastoid. Magnetic resonance imaging and bone scintigraphy assessed these changes as uncharacteristically inflammatory. Polydipsia proved to be a symptom of central diabetes insipidus in the water deprivation test. Finally, remastoidectomy provided histologic evidence of Langerhans cell histiocytosis. THERAPY AND COURSE: Besides systemic chemotherapy with cytarabine, the patient also received denosumab and desmopressin. CONCLUSION: Langerhans cell histiocytosis involving cranial bones is often associated with diabetes Insipidus. Knowledge about the distinctive constellation may lead to a more rapid diagnosis and improved prognosis.

Otoneurological assessment and quality of life of individuals with complaints of dizziness and temporomandibular disorders: a case-control study.

OBJECTIVES: To evaluate the impact of temporomandibular disorders on the quality of life of patients with dizziness. METHODS: An observational, case-control study evaluated 60 individuals with dizziness (20 cases and 40 controls), who were matched for gender and age. The individuals underwent to anamnesis, overall physical and otoneurological examination, tonal and vocal audiometry and impedanciometry, video head impulse test and the dizziness handicap inventory questionnaire. RESULTS: The otoscopy was normal for all patients. There was an association between the presence of temporomandibular disorders and aural fullness (p < 0.01) and otalgia (p < 0.01). Audiometry was normal in 90% of the patients in the case group, with a significant association between temporomandibular disorders and normal audiometry (p < 0.01). The video head impulse test findings were normal in 66% of the patients in the case group and 45% of the control group, and there was no association between having temporomandibular disorders and vestibular alterations at the video head impulse test (p = 0.12). There were significant differences in total dizziness handicap inventory and in the functional and emotional domains (p < 0.01), with higher scores in the control group. CONCLUSION: Aural fullness and otalgia symptoms are associated with temporomandibular disorders in patients with dizziness, and there is an association between normal complementary audiological tests and temporomandibular disorders. Vestibular alterations are not associated with temporomandibular disorders. However, patients with dizziness and without temporomandibular disorders showed greater quality of life impairment. LEVEL OF EVIDENCE: 3: Original case-control study.

Otogenic Lateral Sinovenous Thrombosis in Children: A Case Series from a Single Centre and Narrative Review.

AIM: We aimed to describe otogenic lateral sinovenous thrombosis (OLST), a rare, potentially life-threatening complication of otomastoiditis. METHODS: Children diagnosed with OLST in a tertiary-care Hospital from 2014 to 2019 was retrospectively selected. Clinical and radiological features, timing of diagnosis, treatment and outcome are reported. RESULTS: Seven children (5 males) were studied. Fever and neurological symptoms (headache, lethargy, diplopia, dizziness and papilledema) were always present. Otalgia and/or otorrhea were found in 6 children; none had signs of mastoiditis. Diagnosis was reached after 7 days (median) from clinical onset. Brain CT-scan was performed in 5 children being diagnostic for 3. Venography-MRI detected OLST and mastoiditis in all cases without parenchymal lesions. Treatment was based on intravenous rehydration, antibiotic and low-molecular weight heparin; acetazolamide was added in 3 children. Mastoidectomy and ventriculoperitoneal-shunting were selectively performed. Patients were discharged after 26 days (median). Follow-up neuroimaging showed sinus recanalization after a median time of 6 months. CONCLUSION: A multidisciplinary approach is needed to optimize diagnostic-therapeutic protocols of pediatric OLST.

Seno preauricular, diferentes tecnicas quirúrgicas / Preauriculares Sinus, different surgical techniques

El seno preauricular es una malformación congénita que se presenta como un pequeño orificio en el oído externo, usualmente cercano al borde anterior de la rama ascendente del hélix. La mayoría son asintomáticos y no requieren tratamiento, sin embargo, una vez infectados se vuelven inflamaciones dolorosas, con secreción fétida que presentan exacerbaciones agudas recurrentes. Objetivo: brindar información actualizada sobre las ventajas de las diferentes técnicas quirúrgicas utilizadas para resolver en forma adecuada este problema congénito. Material y Métodos : el presente estudio se realizó mediante una búsqueda comprensiva de artículos con menos de 10 años de publicación en las bases de datos de MEDLINE/PubMed, Google Académico e HINARI. Se seleccionaron un total de 20 artículos, en español e inglés, entre ellos trabajos originales y metanálisis sobre el tema. Conclusión : la técnica suprauricular ha demostrado, en términos estadísticos, una tasa de recurrencia menor que la técnica clásica de sinectomía...(AU)

Isolated Deep Ear Canal Pain: Possible Role of Auricular Branch of Vagus Nerve-Case Illustrations with Cadaveric Correlation.

Glossopharyngeal, nervus intermedius, and vagus neuralgias can all present with ear pain. However, to our knowledge, there have been no reports of otalgia as the only symptom of vagus neuralgia. The seventh, ninth, and tenth cranial nerves have many interneural connections, and the exact anatomy and pathophysiology of these neuralgias are often not clear. Moreover, symptoms due to involvement of any of these nerves can be difficult to attribute solely to 1 of them. The overlapping sensory innervation of the external auditory canal can lead to misdiagnosis in patients suffering from otalgia. This report presents a case of pure otalgia due to vascular compression of the vagus nerve (VN) and considers the microanatomic differences between glossopharyngeal and nervus intermedius neuralgia via cadaveric dissections. We report 2 cases of external auditory canal pain that continued following microvascular treatment of trigeminal neuralgia. Intraoperatively and at secondary operation, the posterior inferior cerebellar artery was found to be adherent and to penetrate between the fibers of the VN. Following microvascular treatment of the VN, the pain resolved. CONCLUSION: This is the first report of vagus neuralgia presenting solely with ear pain. Surgeons should be aware that primary external auditory canal pain can be due to vagus neuralgia via its auricular branch and that such patients can be misdiagnosed with glossopharyngeal or nervus intermedius neuralgias.

Why do patients with fibromyalgia complain of ear-related symptoms? Ear-related symptoms and otological findings in patients with fibromyalgia.

While fibromyalgia is frequently associated with ear-related symptoms such as feeling of ear fullness, earache, and tinnitus, the pathogenesis of these ear-related symptoms in fibromyalgia patients is unknown. Here, we focused on clarifying the pathogenesis of ear fullness, a particularly common symptom observed in fibromyalgia patients. Twenty patients diagnosed with fibromyalgia on outpatient psychosomatic treatment complaining of ear-related symptoms answered our questionnaire and underwent neurotological examination, including pure tone audiometry and Eustachian tube function testing. While ear-related symptoms were significantly exacerbated after onset of fibromyalgia, we noted no correlation between the presence or absence of feeling of ear fullness and abnormal findings on neurotological examination. Given our findings, we suspect that onset of ear fullness may be associated not with abnormal findings in the middle and inner ear function tests but with other causes, such as central desensitization.

The concurrency of temporal tendinitis with TMD.

Temporomandibular disorder (TMD) is a type of orofacial pain that can originate from a number of craniofacial mandibular structures. These include the TM joints, the muscles of mastication, related nerves, tendons, ligaments, bones and teeth. Symptoms include impaired jaw function, TM joint noises and pain, limited opening, often with jaw deviations or deflections to the affected side. Temporal tendinitis is a disorder of the fibrous insertion of the temporalis muscle tendons on the coronoid process of the mandible that is characterized by both inflammation and degeneration. Sometimes, temporal tendinitis can be the primary disease entity, but the authors found that it frequently coexists with TMD. This retrospective study was undertaken to determine the prevalence of temporal tendinitis with TMD. The charts of 449 patients diagnosed with TMD were reviewed to determine the incidences of temporal tendinitis. The referred pain sites and their incidences were also determined.

Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients.

The aim of this study was to determine the prevalence of signs and symptoms of temporomandibular disorders (TMD) and otologic symptoms in patients with and without tinnitus. The influence of the level of depression was also addressed. The tinnitus group was comprised of 100 patients with tinnitus, and control group was comprised of 100 individuals without tinnitus. All subjects were evaluated using the research diagnostic criteria for temporomandibular disorders (RDC/TMD) to determine the presence of TMD and depression level. Chi-square, Spearman Correlation and Mann-Whitney tests were used in statistical analysis, with a 5% significance level. TMD signs and symptoms were detected in 85% of patients with tinnitus and in 55% of controls (P≤0·001). The severity of pain and higher depression levels were positively associated with tinnitus (P≤0·001). It was concluded that tinnitus is associated with TMD and with otalgia, dizziness/vertigo, stuffy sensations, hypoacusis sensation and hyperacusis, as well as with higher depression levels.

Temporomandibular joint development and functional disorders related to clinical otologic symptomatology.

Temporomandibular disorders (TMDs) are a form of musculoskeletal pain of the temporomandibular joint (TMJ) and/or masticatory muscles of nonspecific etiology. In this study, the relationship between embryonic and anatomic-topographic similarities of the TMJ and the ear was analyzed, i.e. secondary otologic symptoms that can be closely connected to TMJ disorder. Nonspecific otologic symptoms are not primary diagnostic symptoms of TMD, but may cause diagnostic confusion due to patients' inability to correctly locate the origin of pain. The most common otologic symptoms that can be related to TMDs are otalgia, tinnitus and vertigo. Otorhinolaryngologists have to differentiate between primary otologic symptoms and those caused by TMJ disorders. In TMD diagnosis, manual techniques are used to determine the arthrogenic or myogenic form, whereas in the diagnosis of arthrogenic disorders magnetic resonance imaging is indicated as the highly specific imaging method ofjoint disk and osteoarthritic changes. Symptomatic treatments for TMD as well as the etiologic diagnosis of the pain require multidisciplinary cooperation between dentists and medical specialists.

Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media.

OBJECTIVE: To assess the effectiveness of a homeopathic ear drop for treatment of otalgia in children with acute otitis media (AOM). METHODS: Children with AOM were enrolled in the study at the time of diagnosis and randomized to receive either standard therapy alone or standard therapy plus a homeopathic ear drop solution that was to be used on as needed basis for up to 5 days. Parents of children in both treatment groups rated the severity of 5 AOM symptoms twice daily for 5 days in a symptom diary. A symptom score was computed for each assessment with lower scores denoting less severe symptoms. Parents of children randomized to receive ear drops also recorded information regarding symptoms being treated and response to treatment. RESULTS: A total of 119 eligible children were enrolled in the study; symptom diaries were received from 94 (79%). Symptom scores tended to be lower in the group of children receiving ear drops than in those receiving standard therapy alone; these differences were significant at the second and third assessments (P = 0.04 and P = 0.003, respectively). In addition, the rate of symptom improvement was faster in children in the ear drop group compared with children in standard therapy alone group (P = 0.002). The most common reason for administration of ear drops was ear pain, recorded for 93 doses; improvement was noted after 78.4% of doses for this indication. There were no significant side effects related to use of the ear drops. CONCLUSIONS: This study suggests that homeopathic ear drops were moderately effective in treating otalgia in children with AOM and may be most effective in the early period after a diagnosis of AOM. Pediatricians and other primary health care providers should consider homeopathic ear drops a useful adjunct to standard therapy.

Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure.

BACKGROUND: Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed. CASE PRESENTATIONS: We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days. CONCLUSION: Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.

Myiasis of the external and middle ear.

Aural myiasis is a rare otolaryngological disease typically seen in poor hygienic conditions and medically disabled patients. We present a case of aural myiasis in a healthy woman who had no apparent risk factors for infestation and required extensive surgical intervention. We also discuss the literature of documented otolaryngological cases of myiasis and effective therapies. In our patient, symptoms of otalgia, otorrhea, and tinnitus resolved after multiple attempts at extraction resulted in successful eradication of larvae. The patient required tympanoplasty to reconstruct the damaged external and middle ear. Physicians should have a clinical suspicion of aural myiasis in patients with a travel history and an atypical presentation of acute otalgia and otorrhea.

Red ear syndrome--chronic pain syndrome of low prevalence.

A case is described of a 72-year-old woman that presented to our outpatient neurology clinic complaining of relapsing attacks of severe pain in and around the left ear and ipsilateral side of the face, accompanied by objectively visible cutaneous erythema with burning sensation throughout the attack. There was no alteration in her neurologic status. Comprehensive tests were done to exclude the possible primary diseases. The findings were within the limits of physiological values. Attempts at treating the pain with various analgesics and a combination of analgesics and first generation anticonvulsants did not prove effective. The pain was slightly relieved with pregabalin in maximum dosage. Because of various potential pathophysiological mechanisms, literature does not indicate any unique potential treatment approach, and some patients are resistant to any kind of therapy.

Comparative audiometric evaluation of temporomandibular disorder patients with otological symptoms.

OBJECTIVES: The purpose of this study was to assess the audiological status of temporomandibular disorder (TMD) patients with otological symptoms and to make comparisons with that of a control group of subjects without TMD and otological symptoms. METHODS: 25 TMD patients with otological symptoms and 20 age and gender matched controls, 45 subjects in total, were included in the study. All subjects underwent a series of audiological tests that included pure-tone audiometry, impedance test and reflex tympanometry. The audiological parameters recorded in the two groups were compared statistically by means of unpaired t tests and corrected according to Bonferroni in the case of repeated tests. RESULTS: The pure-tone thresholds at frequencies 125, 250, 500Hz, and 6kHz showed significant differences between the TMD patients and control subjects after the Bonferroni correction (p<0.007). Compliance peaks demonstrated significant differences when the TMD and control groups were compared (p<0.05). CONCLUSIONS: The findings indicate that TMD patients with otological complaints have hearing impairment at low frequencies and also perhaps, at high frequencies.

Exploratory tympanotomy revealing incus discontinuity and stapedial otosclerosis as a cause of conductive hearing loss.

OBJECTIVE: To describe a unilateral progressive conductive hearing loss caused by incus discontinuity (without erosion of the long process of the incus), and otosclerosis with fixation of the stapedial footplate. STUDY DESIGN: Case report. SETTING: Department of Otolaryngology, Head and Neck Surgery of the University of Rochester Medical Center, which is a regional tertiary referral center. PATIENT: A 54-year-old woman with multiple otologic complaints including tympanic membrane perforations, otalgia, tinnitus, and hearing loss. Audiography demonstrated 100% speech discrimination bilaterally and a significant conductive right-sided hearing loss. INTERVENTION: The patient underwent a stapedectomy, during which a discontinuity between the long process of the incus and the stapes with no bony erosion was identified. The stapedectomy was completed and an ossicular piston prosthesis was inserted to reestablish ossicular continuity with the tympanic membrane. MAIN OUTCOME MEASURE: Improved subjective hearing confirmed objectively by audiography. CONCLUSION: This is the third reported case of an unusual combination of otosclerosis and ossicular discontinuity, and the first such case report in a patient without head trauma. In addition, it adds a unique item to the differential diagnosis of the pathologic features implicated in an ear with a conductive deficit and normal tympanogram.