The frequency of involvement of head & neck sites in referred otalgia – An experience at a tertiary care hospital

OBJECTIVE: To determine the frequency of involvement of distant head & neck sites which share sensory innervations with the ear in referred otalgia. METHODS: This prospective study was conducted in the Department of ENT at Hayatabad Medical Complex, Peshawar, during the period from July 1, 2017 to December 31, 2017.*Non probability convenience sampling technique was used to include patients in the study. Patients with true ‘otogenic pain’ as determined on clinical examination or imaging studies were excluded from analysis. Only those who presented with referred ear ache were included in the study to determine the frequency of involvement of distant head & neck sites in ‘referred otalgia’. Otalgia was designated as “Unknown Origin” when the ear and distant sites too were found normal. RESULTS: Out of a total of 150 patients, there were 81(54%) males and 69(46%) females. The ages ranged from 5 to 66 years with a mean age of 29.15 years. The commonest age groups involved were 21-35 years and 36-55 years. Referred otalgia of tonsillar origin was found in 47(31.3%) of patients followed by that of dental origin in 35(23.3%). Otalgia due to pharyngitis, rhinosinusitis and cervical origin was 24(16%), 8(5.3%) and 6(4%) respectively. Otalgia due to temporomandibular joint was noted in 12(8%) of females and 3(2%) of males & that of “unknown origin” affected 5(3.33%) of females and 2(1.3%) of males. CONCLUSIONS: The ear should be examined in detail in patients presenting with earache to look for indigenous pathology. In the presence of a ‘Normal Ear’, it is important to examine the tonsils, teeth, pharynx and the nose & paranasal sinuses as the possible sites of origin of earache.