Referred otalgia: Etiology and incidence among 136 patients in Hillah City, Iraq

Abstract

Abstract Background: Prompt history and clinical examination are mandatory to fix the proper diagnosis of refereed ear pain which sometimes needs the aid of laboratory, radiological assessments, and even examination under general anesthesia. Objectives: To diagnose cases of referred otalgia with the estimation of the incidence according to different age groups and sex. Materials and Methods: A prospective study was done in the ENT clinic in Hillah City, to evaluate 600 patients who presented with ear pain, 136 patients out of them were labeled as referred otalgia cases when the ear showed normal examination. The study started from January 2019 to February 2021. Physical examination with required investigations according to etiologies suspected for referred otalgia was done accordingly. Results: Out of 600 patients who presented with otalgia, 136 patients had referred otalgia (22.6%). The right ear was more affected than the left one (54%), whereas four cases had bilaterally referred ear pain. Of them, 57 patients had temporomandibular (TM) dysfunction (42%), 34 patients had pharyngeal pathologies including tumors (25%), 20 patients had cervical causes (14.7%), 11 patients had dental problems (8%), 8 patients had miscellaneous cases including salivary glands, oral cavity, lymph nodes, and long styloid process (5.8%), and 6 patinets had nasal and sinus problems (4.5%). Conclusion: Ear pain could be due to remote etiologies rather than the ear especially when it is normal by examination. The pain is mainly from adjacent head and neck structures. Physical examination of those structures especially TM joints, teeth, pharynx, nose, and sinuses is important to identify the causes of ear pain. Malignancy may be one of the causes and should not be missed.