• Third level ~ Fourth level • Fifth level Imaging of Otalgia at 12 am Karen Tong, MD. Associate Professor No disclosures Click to edit Master title style » Click to edit Master text styles ~ Second level • Third level ~ Fourth level • Fifth level Karen Tong, M.D. Imaging of Otalgia at 12 am https://apkgk.com/com.OneLife2Care.BabiesEarInfectionHelp Click to edit Master title style » Click to edit Master text styles ~ Second level • Third level ~ Fourth level • Fifth level Karen Tong, M.D. Objectives • Review neurosensory pathways of ear pain • Review causes of otalgia (especially urgent/important ones) • Case presentations Click to edit Master title style » Click to edit Master text styles ~ Second level • Third level ~ Fourth level • Fifth level Karen Tong, M.D. Recommended references: • Weissman JL. “A pain in the ear: the radiology of otalgia.” AJNR 1997 Oct;18(9):1641-51. • Scarbrough TJ, et al. “Referred otalgia in head and neck cancer: a unifying schema.” Am J Clin Oncol. 2003 Oct;26(5):e157-62. • Chen RC, Khorsandi AS, Shatzkes DR, Holliday RA. “The radiology of referred otalgia.” AJNR 2009 Nov;30(10):1817-23. • Dr. Lindell Gentry’s lecture, “Imaging of Otalgia”, ASHNR 2013 • Cranial nerve lectures from: Drs.Lindell Gentry, John Go, Wendy Smoker Click to edit Master title style » Click to edit Master text styles ~ Second level • Third level ~ Fourth level • Fifth level Karen Tong, M.D. Classification of otalgia • Primary : ear pain resulting from pathologic conditions of the ear itself • Secondary : pain referred to the ear from nonotologic sites, usually in the distributions of cranial nerves V, VII, IX, or X; or the cervical plexus Click to edit Master title style » Click to edit Master text styles ~ Second level • Third level ~ Fourth level • Fifth level Karen Tong, M.D. Primary otalgia • In children, most cases of otalgia are primary. • In adults, less than half of the cases of otalgia are primary. • Usually have clinical findings on exam • Simple otitis does not require imaging • If needed, temporal bone CT usually imaging of choice
8
Embed
Imaging of Otalgia at 12 am Click to edit Master title style Imaging … · abscess, perimandibular abscess Click to edit Master title style » Click to edit Master text styles ~
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Imaging of Otalgia at 12 amKaren Tong, MD. Associate Professor
Dx: Malignant/Necrotizing Otitis Externa Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Malignant/Necrotizing Otitis Externa• Rare complication of otitis externa that spreads to skull base and causes osteomyelitis
• Usually due to pseudomonas aeruginosa but can be fungal (aspergillus, mucor)
• Sx: severe otalgia, facial nerve palsy, also CN IX to XII • Usually elderly diabetics, but increasingly seen with immunocompromise (HIV)
• Can be life-threatening if there are intracranial complications
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Case: 12 mo old w bilateral otalgia, ear drainage Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Dx: T-bone Langerhan Cell Histiocytosis
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
T-bone Langerhans Cell Histiocytosis
• Usually in children < 10 yo • Histiocytic tumor-like proliferation • Otologic symptoms in 25% cases: conductive hearing loss, otorrhea, otalgia, periauricular soft tissue swelling, CN VII palsy
• Soft tissue mass w osseous destruction, may have fluid-fluid levels
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Case: 62 yo male w otalgia, plugged ear
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Case: 10 yo w severe ear/facial pain, sound sensitivity Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Nasopharyngeal tumors
• Can obstruct eustachian tube and cause otitis and ear pain
• In adults: NPC most common • In children: rhabdomyosarcoma most common
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Case: 30 yo w facial, jaw and ear pain Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Dental infection
• Dental infections are a frequent cause of referred otalgia
• Pain from molars, especially mandibular molars, radiates to the ear
• Severe ear pain is one hallmark of peritonsillar abscess
• Diseases of retropharyngeal nodes (of Rouviere) can present with otalgia
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Case: 14 yo w ear/facial pain, swelling Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Case: 3 yo w periauricular swelling and ear pain
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Parotid infection
• Acute parotiditis presents w marked periauricular tenderness and fever; can be associated with cellulitis, abscess is rare
• Recurrent parotid abscess in child should suggest underlying 1st branchial cleft cyst
Click to edit Master title style
» Click to edit Master text styles ~ Second level
• Third level ~ Fourth level
• Fifth level
Karen Tong, M.D.
Summary
• Most ear pain in children arises from primary otologic source • Otalgia can be a pain to diagnose, especially if secondarily referred from a non-otologic source
• Referred pain can travel along shared neural pathways involving CNs V, VII, IX, X; cervical nerves C2, C3, and possibly cervical sympathetic fibers
• Source of pain can range from sinonasal to lung • Diagnostic steps may include: clinical → CT → MRI