Key Points
Introduction
Otalgia is a common reason for patients of all ages to be referred to the otolaryngology clinic. The etiology of otalgia can be derived from the history and physical exam; however, a subset of patients with otalgia experience non-otogenic pain referred from distant sites within the head and neck termed secondary otalgia. Secondary otalgia has been suggested to be responsible for up to half of all visits related to ear pain.1,2 Among other pathologies, secondary otalgia is frequently considered the result of eustachian tube dysfunction (ETD), particularly with accompanying sinonasal symptoms.3,4,5 ETD may be due to variety of etiologies that ultimately result in a diminished ability to equalize middle ear pressures through the eustachian tube; however, the exact pathophysiology of ETD is not fully understood nor is there a gold standard test for the diagnosis of ETD.6,7 Some small retrospective studies have suggested that nasal obstruction alone can influence eustachian tube function, and regardless, symptoms of ETD are well established aspects of diseases causing chronic nasal obstruction.8,9,10
Symptom assessment instruments such as the Sino-nasal Outcome Test (SNOT-22) for chronic rhinosinusitis (CRS) feature questions regarding ear pain and fullness. Otalgia and aural fullness are some of the common symptoms of ETD, along with tinnitus and temporary hearing loss.6,8 Due to this inclusion and the lack of objective diagnostic criteria in ETD, many otolaryngologists attribute aural symptoms in CRS to ETD. Currently, medical treatments for ETD aim to improve mucosal conditions of the nasal cavity and the eustachian tube with varying efficacy.6 More recently, procedural interventions such as eustachian tube balloon dilation have emerged as a treatment option for reducing symptoms; however, no study has prospectively examined the effect of septoplasty with inferior turbinate reduction (ITR) on symptoms related to ETD.6,10
Another lesser characterized etiology of secondary otalgia involves pain that originates from the nasal cavity. The concept of pain from the nasal cavity referring to other sites within the head was first described in 1942.11,12,13 Contact points between the nasal septum and the lateral nasal wall have been shown to cause referred ipsilateral pain in the distribution of trigeminal branches.13,14,15 Some retrospective literature suggests septoplasty as an effective treatment in reducing pain in these patients.16,17 Recent case reports have proposed a similar rhinogenic mechanism responsible for patients with unexplained otalgia; however, this association has not been examined prospectively.18,19 Specifically, there has been minimal investigation into the benefits of septoplasty as it relates to improvement of referred otalgia in which a contact point is not present.