Self-Localization of Symptoms Useful When Evaluating Aural Discomfort

by Linda Kossoff •

What are the objective findings and clinical characteristics associated with differential self-localization of aural discomfort?

BOTTOM LINE

Self-localization of symptoms may provide useful information when evaluating patients who present with aural discomfort.

BACKGROUND: Patients presenting with aural discomfort are commonly encountered in otolaryngology. Part of the challenge in diagnosing these patients is the variability in their descriptions of the location, severity, and quality of aural discomfort. Localizing these patients’ perceived discomfort may be helpful in establishing a diagnosis.

STUDY DESIGN: Prospective cross-sectional study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Tulane University, New Orleans.

SYNOPSIS: Researchers enrolled 73 patients who were being treated in an outpatient otolaryngology practice for a primary complaint of aural discomfort. All patients in the study consented to receive diagnostic nasal endoscopy and tympanometry as part of their clinical evaluation. Aural symptoms were localized to the external auditory canal (EAC) in 38.4% of patients, the infratemporal fossa (ITF) below the lobule in 50.7%, and the preauricular region in 11.0%. Researchers found that the preauricular group was more likely to have temporomandibular joint or pterygoid muscle pain. Patients who localized to the EAC tended to have more negative tympanometric peak pressure (TPP) than the ITF and preauricular groups. The EAC and ITF groups had higher scores on the Endoscopic Evaluation of the Eustachian Tube (3ET) system. Authors concluded that patients with normal TPP and high 3ET scores localizing pain to the ITF suggests an association with nonobstructive Eustachian salpingitis diagnosis, and that patients with localizing symptoms deep in the EAC more closely suggests obstructive Eustachian tube dysfunction. The study limitations included the small sample sizes that were found within subgroups.

CITATION: Parsel SM, Moxley EM, Navarro AI, et al. Symptom localization may differentiate subtypes of Eustachian tube dysfunction. Laryngoscope. 2023;133:1818–1823.