{"content":[{"text":"Taziki Mh, et al","bbox":{"left":0.77602,"top":0.040274,"width":0.10717199999999993,"height":0.015779}},{"text":"Introduction \n Otalgia can originate from pathologies \n inside the ear (primary otalgia) or can be a \n referred pain originating from outside the \n ear (referred otalgia) (1). \n If the ear is found normal in the \n examination, Otalgia will be considered \n referred pain. In many patients who have \n normal ears, the origin of the pain should \n be sought much further away (2). The ear \n receives its sensory nerves from six \n sources, and several other head and neck \n structures share a common nerve supply \n (3). Thus, pathologies occurring in the \n neural network of cranial nerves V, VII, \n IX, and X and cervical spinal nerves C2 \n and C3 can be considered as possible \n etiologies of referred otalgia (4). Children \n tend to suffer from primary otalgia, while \n adults tend to suffer from referred \n otalgia (5). \n In one study, the most common etiology of \n referred otalgia was found to be dental \n pathologies, accounting for 50% of the \n cases (6). \n In another study, the incidence of otalgia \n was found to be 33% in patients suffering \n from the carcinoma of the base of the \n tongue (7). \n The pathologies of cervical vertebrae have \n also been identified as causing referred \n otalgia (8). Bell's palsy can lead to otalgia, \n which is considered referred otalgia as the \n ear examination is normal (9). An enlarged \n styloid process (11) and metastases to the \n pharynx (12) have been identified as \n possible causes of referred otalgia. In \n another study, a patient complaining from \n otalgia was later found to suffer from \n nasopharyngeal carcinoma (12). \n As the muscles of the middle ear have the \n same embryological origins as those of the \n face, pains originating from those areas \n can be felt in the throat. These and the \n malfunction of temporomandibular joint \n can also cause referred otalgia (13). If \n physical examinations and case histories \n do not lead to conclusive diagnoses, it is \n recommended that a course of \n symptomatic treatment be administered,","bbox":{"left":0.120984,"top":0.087616,"width":0.34905500000000006,"height":0.820593}},{"text":"and upon failure of this, further systematic \n examinations be conducted (13). \n As there is no simple, single algorithm for \n identifying referred otalgia, and as the \n areas supplied by the above-mentioned \n nerves are extensive and as late diagnoses \n can lead to irreparable consequences (5), \n the present study was conducted to \n identify the etiologies of referred otalgia \n and to underline the need for increased \n attention to the dangerous etiologies.","bbox":{"left":0.530219,"top":0.086176,"width":0.34886400000000006,"height":0.18277999999999997}},{"text":"Materials and Methods \n This study was conducted in 2009 and \n 2010 on patients visiting the ENT clinic. The \n patients underwent thorough examinations, \n and those who had a normal ear examination \n were selected for the study. The \n examinations covered the teeth, the \n temporomandibular joint, the nose, the \n sinuses, and head and neck areas, and when \n necessary, examinations included direct and \n indirect laryngoscopy and biopsy. \n Those who had previously undergone \n tonsillectomy or other head and neck \n surgeries and had later developed otalgia \n were excluded from the study. Patients’ \n data including age, sex, season of the \n disease development, the afflicted side and \n the cause of the otalgia were recorded. In \n view of the wide spectrum of the etiologies \n of referred otalgia, when necessary, \n consultations were made with other \n specialists such as dentists. The collected \n data were then statistically analyzed with \n the SPSS software.","bbox":{"left":0.530219,"top":0.284162,"width":0.34910299999999994,"height":0.39457299999999995}},{"text":"Results \n Out of 770 patients complaining from \n earaches, 94 (12.2%) suffered from \n referred otalgia, in eight of whom \n pathologies were simultaneously found \n both in the ear and in the adjacent \n structures. In the referred otalgia patients, \n 72.3% were women and 27.7% were men. \n In this study the etiologies of referred \n otalgia were investigated, the most \n frequent of which was toothache (62.8%). \n Other etiologies included pharyngitis \n (24.5%), inflammation of the","bbox":{"left":0.530219,"top":0.696649,"width":0.3487,"height":0.21426699999999999}},{"text":"172, Iranian Journal of Otorhinolaryngology No.4, Vol.24, Serial No.69, Autumn 2012","bbox":{"left":0.117154,"top":0.942511,"width":0.585745,"height":0.015778999999999987}}],"images_bbox":[],"images_bbox_not_text_overlap":[]}