Abstract
Recently, the author experienced a case of intractable right-sided otalgia in a 17-year-old male patient. The pain was intermittent and frequently radiated to the right forehead and periorbital region. He had received unsuccessful medical treatments for migraine headache. The otoendoscopic examination revealed a normal tympanic membrane. Nasal endoscopy showed only an intranasal mucosal contact point between the septal crest and the right inferior turbinate, without other signs of sinus inflammation. Topical application of an anesthetic and vasoconstrictive solution-soaked cotton pledget at the intranasal contact area made the patient experience a significant improvement of symptoms. After surgical removal of the mucosal contact point by conventional septoplasty and turbinoplasty, he experienced significant relief of symptoms and complete recovery. Here, the author report a case of intractable otalgia induced by nasal septal deviation with review of literatures, and suggestion for new disease entity of rhinogenic contact point otalgia induced by nasal septal deviation is carefully made.
1
Introduction
The cases of rhinogenic contact point headache (RCPH) have been previously described in the literature. RCPH is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Facial pain and headache can be caused by nasal mucosal contact points such as nasal septal deviation, septal spur, concha bullosa of middle turbinate, and so on. If neither the findings of inflammation in the nose and sinuses nor other causes of headache are present, it should be included to evaluate intranasal contact points.
In recent experience, the author encountered a 17-year-old patient who presented with intermittent and intractable otalgia which was supposed to be induced by nasal septal deviation. After surgical correction of nasal mucosal contact point, the problem of this patient has been alleviated. This highlights the need to consider a rhinogenic contact point otalgia (RCPO) in cases such as this.
2
Case report
A 17-year-old male patient presented with a several-year history of intractable right-sided otalgia. He described the pain as within the canal and deep and penetrating in character. The pain was intermittent and sometimes lasted for several hours, extending either anteriorly or posteriorly to the pinna and frequently radiating to the right forehead and periorbital region. He had received unsuccessful medical treatments for migraine headache. He had no history of nasal trauma or dental treatment. The otoendoscopic examination revealed a normal tympanic membrane ( Fig. 1 ). Nasal endoscopy showed only an intranasal mucosal contact point between the septal crest and the right inferior turbinate, without other signs of sinus inflammation ( Fig. 2 ). Computed tomography (CT) confirmed a distinct point of contact between the deviated septum and the right inferior turbinate ( Fig. 3 ). After topical application of an anesthetic and vasoconstrictive solution (10% lidocaine and epinephrine)-soaked cotton pledget at the intranasal contact area (shrinkage test; Fig. 4 ), the patient experienced a significant improvement of right otalgia and radiating orbital pain by 5 min after cotton pledget removal. On the basis of these findings, the patient agreed for surgical removal of the mucosal contact point by conventional septoplasty and inferior turbinate coblation-channeling, after which he experienced significant relief of symptoms and complete recovery by four weeks after surgery ( Fig. 5 ). At post-operative follow up after 12 months, significant relief was maintained. We considered this an important indicator that the presence of the intranasal mucosal contact point had been the main cause of the otalgia.
2
Case report
A 17-year-old male patient presented with a several-year history of intractable right-sided otalgia. He described the pain as within the canal and deep and penetrating in character. The pain was intermittent and sometimes lasted for several hours, extending either anteriorly or posteriorly to the pinna and frequently radiating to the right forehead and periorbital region. He had received unsuccessful medical treatments for migraine headache. He had no history of nasal trauma or dental treatment. The otoendoscopic examination revealed a normal tympanic membrane ( Fig. 1 ). Nasal endoscopy showed only an intranasal mucosal contact point between the septal crest and the right inferior turbinate, without other signs of sinus inflammation ( Fig. 2 ). Computed tomography (CT) confirmed a distinct point of contact between the deviated septum and the right inferior turbinate ( Fig. 3 ). After topical application of an anesthetic and vasoconstrictive solution (10% lidocaine and epinephrine)-soaked cotton pledget at the intranasal contact area (shrinkage test; Fig. 4 ), the patient experienced a significant improvement of right otalgia and radiating orbital pain by 5 min after cotton pledget removal. On the basis of these findings, the patient agreed for surgical removal of the mucosal contact point by conventional septoplasty and inferior turbinate coblation-channeling, after which he experienced significant relief of symptoms and complete recovery by four weeks after surgery ( Fig. 5 ). At post-operative follow up after 12 months, significant relief was maintained. We considered this an important indicator that the presence of the intranasal mucosal contact point had been the main cause of the otalgia.
