Key Points
- Our study suggests otalgia or ear fullness could be associated with a
DNS.
- Patients may have a significant reduction in aural pain post
septoplasty.
- Post septoplasty, ETDQ-7 showed a significant reduction in aural
symptoms of patients.
- Patients who have aural symptoms concomitate with nasal obstruction
may be attributable more due to the inability to equalize middle ear
pressures.
- Septum deviation should also be evaluated in the diagnosis and
management of ETD, and a treatment algorithm is proposed.
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.