1/3. Chronic paroxysmal hemicrania presenting as otalgia with a sensation of external acoustic meatus obstruction: two cases and a pathophysiologic hypothesis.OBJECTIVE: To describe two cases of chronic paroxysmal hemicrania manifested by otalgia with a sensation of external acoustic meatus obstruction and to suggest that the trigeminal-autonomic reflex is a mechanism for the sensation of ear blockage. BACKGROUND: Maximum pain in chronic paroxysmal hemicrania is most often in the ocular, temporal, maxillary, and frontal regions. It is less often located in the nuchal, occipital, and retro-orbital areas. review of the literature on chronic paroxysmal hemicrania found no reports of pain primarily localized to the ear and associated with a sensation of external acoustic meatus obstruction. methods: The history, physical examination, imaging studies, and successful treatment plan in two patients with otalgia and ear fullness and a subsequent diagnosis of chronic paroxysmal hemicrania are summarized. RESULTS: The first patient was a 42-year-old woman with a 10-year history of unilateral, severe, paroxysmal otalgia occurring five times a day with a duration of 2 to 60 minutes. During an attack, the ear became erythematous and the external acoustic meatus felt obstructed. There were no other associated autonomic signs. The second patient was a 49-year-old woman with a 3-year history of unilateral, severe, paroxysmal otalgia occurring 4 to 15 times a day with a duration of 3 to 10 minutes. During an attack, her ear felt obstructed, and she noted ipsilateral eyelid edema and ptosis. Both patients quickly became pain-free after taking indomethacin and required its continued use to prevent headache recurrence. CONCLUSIONS: Chronic paroxysmal hemicrania may be manifested by otalgia with a sensation of external ear obstruction. When the otalgia is paroxysmal, unilateral, severe, frequent, and associated with autonomic signs, one should consider the diagnosis of chronic paroxysmal hemicrania, especially because of the prompt response to indomethacin. The most important feature to consider when making the diagnosis of chronic paroxysmal hemicrania is the frequent periodicity of discrete, brief attacks of unilateral cephalgia separated by pain-free intervals. It is hypothesized that the sensation of ear obstruction in these patients is due to swelling of the external acoustic meatus mediated through increased blood flow by the trigeminal-autonomic reflex.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/3. Heterogeneity in the clinical presentation of Eagle's syndrome.OBJECTIVE: Eagle's syndrome (ES) or symptomatic elongated styloid process is an uncommon but important cause of chronic head and neck pain. This study reports our experience in the diagnosis and treatment of a series of patients with ES. STUDY DESIGN: Patient histories, radiographic tests, and operative reports of 3 patients over a 3-month period were prospectively collected. SETTING: Tertiary referral otolaryngology service. RESULTS: All patients had resolution of symptoms relating to their elongated styloid processes after surgical resection. CONCLUSION: Although sometimes clouded by coexisting symptoms, ES can be easily diagnosed based on good history taking and physical examination. If diagnosed appropriately, surgical treatment can be administered promptly. SIGNIFICANCE: patients with ES commonly have a long history of chronic pain treated by multiple physicians. Appropriate diagnosis can lead to prompt treatment of this condition. EBM rating: C-4.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/3. Aural pain resulting from acoustic reflex.We present an unusual case of physical discomfort, as opposed to objective or subjective tinnitus, caused by a unilateral acoustic reflex. The cause of the discomfort was identified audiologically by the use of acoustic impedance audiometry. The dull pain that was elicited upon contraction and relaxation of the stapedius muscle was eliminated with sectioning of the stapedial tendon. No explanation of the mechanism for the pain is suggested at present.- - - - - - - - - - ranking = 0.046205548469953keywords = physical (Clic here for more details about this article) |