A Pain in the Ear: The Radiology of Otalgia

referred to the ear from distant structures that receive sensory innervation from the same four cranial nerves as the ear itself: the upper and lower aerodigestive tracts, TMJs, teeth, salivary (middle ear) surface of the TM (7), the middle ear mucosa, and the upper eustachian tube (4). Jacobson’s nerve anastomoses in the tympanic Address reprint requests to Jane L. Weissman, MD, Department of Radiology, Room D-132 PUH, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213. Index terms:

Ear, diseases; Special reports AJNR 18:1641–1651, Oct 1997 0195-6108/97/1808–1641 © American Society of Neuroradiology 1641 Jane L. Weissman, Departments of Radiology and Otolaryngology, Otalgia is ear pain. Ear disease causes pri- mary otalgia. Secondary (referred) otalgia is referred to the ear from disease in structures remote from the ear. Otalgia, especially referred otalgia, can be a diagnostic challenge. The radiologic approach to a patient with otalgia relies on the physical examination. If the otoscopic findings are abnormal, the computed tomographic (CT) or magnetic resonance (MR) study focuses on the temporal bone. (The ap- propriate radiologic study depends on the dis- ease.) The physical examination for ear pain includes the ear (auricle and temporal bone) and structures that are potential sources of re- ferred pain. Imaging studies can show clinically occult temporal bone disease as well as sources of referred pain in the nasopharynx, retrophar- ynx, paranasal sinuses and nasal cavity, tem- poromandibular joint (TMJ), parotid gland, oro- pharynx and oral cavity (including teeth), hypopharynx and larynx, thyroid gland, esoph- agus, and trachea. Tailoring a CT or MR study to evaluate primary or referred otalgia requires an understanding of the (admittedly complex) anatomy of ear pain. Sensory Innervation Briefly, sensation from...

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