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Lai JT, Liu TC, Hwang JH. Hypothetical criteria and types for cochlear migraine. Medicine (Baltimore) 2025; 104:e41127. [PMID: 39792738 PMCID: PMC11729628 DOI: 10.1097/md.0000000000041127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 12/11/2024] [Indexed: 01/12/2025] Open
Abstract
Cochlear migraine (CM) and cochleovestibular migraine were first reported in 2018. However, the diagnostic criteria and types of CM were still undefined. We proposed a hypothetical criteria for CM as below: A. At least 2 episodes with cochlear symptoms with or without recovery. B. Current or previous history of migraine with or without aura according to the International Classification of Headache Disorders-3. C. One or more migraine features with at least 50% of the cochlear episodes. D. No current or previous history of vestibular symptoms. E. Not better accounted for by another cochlear or International Classification of Headache Disorders-3 diagnosis. Patients who were fitted with all 5 points could be diagnosed as CM. The clinical presentations of 62 adults with CM were included for descriptive and cluster analysis. There were 20 men and 42 women, with an age range of 27 to 72 years (mean, 50 years). 6 patients had migraine with aura, and the other 56 had migraine without aura. 4 types of CM could be categorized by cluster analysis. Type 1: unilateral fluctuating sensorineural hearing loss (SNHL) with or without tinnitus (35.5%). Type 2: repeated idiopathic sudden SNHL with or without tinnitus, with good recovery (22.6%). Type 3: idiopathic sudden SNHL with or without tinnitus, but deteriorated over time (21.0%). Type 4: unilateral fluctuating tinnitus with or without aural fullness, otalgia or mild SNHL (21.0%). We hope to raise more discussion about the criteria and clinical types of CM and/or cochleovestibular migraine.
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Affiliation(s)
- Jen-Tsung Lai
- Department of Otolaryngology, Kuang-Tien General Hospital, Taichung, Taiwan
| | - Tien-Chen Liu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Juen-Haur Hwang
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Pillsbury K, Helm B, Kuhn JJ. Recovery of hearing loss in atypical Meniere’s disease after treatment with orofacial and neck massage: A case report. World J Otorhinolaryngol 2024; 11:33-40. [DOI: 10.5319/wjo.v11.i3.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/30/2024] [Accepted: 10/30/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND A 48-year-old female presented with sudden-onset right-sided aural fullness, low-frequency hearing loss, and tinnitus. Medical history included right-sided temporomandibular joint disorder (TMJD) with crepitation, and retro-orbital headaches. The patient was diagnosed with atypical Meniere’s disease (MD) and received intratympanic steroids, prednisone, betahistine, and began a low-sodium diet; however, the patient’s symptoms worsened.
CASE SUMMARY The patient sought physical therapy for TMJD; testing revealed reduced motion and dysfunction with vertical opening, lateral excursion of the mandible to the right, and tenderness to palpation. Treatment included soft tissue mobilization of right facial structures and temporal fossa, intraoral massage of the right pterygoid musculature, and massage of right neck structures. After 4 weeks, the patient noticed subjective improvement in hearing and decreased headaches. After 11 weeks, an audiogram showed that the hearing loss had recovered. The patient has continued the daily at-home intraoral/neck massage therapy and maintained normal hearing over 4 years to date. The temporal relationship between physical therapy and recovery of hearing loss suggests muscular or inflammatory etiology as at least partially causative of this patient’s symptoms. The mechanism of healing may have been due to decreased inflammation, improved blood flow, restored function of cranial nerves, or some combination of these and other unknown factors.
CONCLUSION This report suggests that orofacial physical and massage therapy may be an effective treatment for the cochlear symptoms associated with MD.
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Affiliation(s)
- Kathleen Pillsbury
- Epidemiologist and Medical Writer, Self-employed, Ferrum, VA 24088, United States
| | - Beth Helm
- Bon Secours InMotion Physical Therapy, Virginia Beach, VA 23453, United States
| | - Jeffery J Kuhn
- Department of Neurotology, Advent Health, Celebration, FL 34747, United States
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Ceriani CEJ. Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine. Curr Pain Headache Rep 2024; 28:633-639. [PMID: 38780828 PMCID: PMC11271338 DOI: 10.1007/s11916-024-01245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.
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Affiliation(s)
- Claire E J Ceriani
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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Tawk K, Kim JK, Frank M, Goshtasbi K, Abouzari M, Djalilian HR. Correlation Between Laterality of Hearing Loss and Migraine Features in Menière's Disease. Otol Neurotol 2023; 44:651-655. [PMID: 37317519 PMCID: PMC10370460 DOI: 10.1097/mao.0000000000003925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The objective of this study is to understand whether the hearing loss laterality in Menière's disease (MD) correlates with migraine symptoms laterality such as headache, neck stiffness, and otalgia. METHODS We performed a retrospective review of prospectively obtained data on patients presenting between September 2015 and October 2021 with definite or probable MD. A custom-designed, comprehensive questionnaire was used to identify patients' migraine-related symptoms. The clinical and audiometric data were used to diagnose patients with definite or probable MD using criteria set by the American Academy of Otolaryngology-Head and Neck Surgery. RESULTS In total, 113 patients with definite or probable MD were included in the study. The mean age of the patients was 60 ± 15 years with no gender predominance (49.6% male and 50.4% female). A total of 57 (50%) patients were presented with headaches. Among the migraine headache cohort, headache and otalgia were on the same side as the MD ear affected by hearing loss. In addition, in patients who present with otalgia as the primary feature of headache, otalgia was more likely to be on the same side as the ear affected by the hearing loss. CONCLUSIONS The high prevalence of migraine symptoms on the same side of the ear affected by MD among this cohort could suggest a shared pathophysiology in both MD and migraine, possibly involving migraine-related changes in both the cochlea and vestibule.
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Affiliation(s)
- Karen Tawk
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Joshua K. Kim
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Madelyn Frank
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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Functional ear symptoms referred to an otology clinic: incidence, co-morbidity, aetiological factors and a new experience-driven clinical model. J Laryngol Otol 2023; 137:143-150. [PMID: 35801310 DOI: 10.1017/s0022215122001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to review the incidence and co-morbidity of functional ear symptoms in new referrals to an adult otology clinic and present a clinical model based on neuroscientific concepts. METHOD This was a retrospective review of 1000 consecutive new referrals to an adult otology clinic. RESULTS Functional disorder was the primary diagnosis in 346 patients (34.6 per cent). Functional ear symptoms included tinnitus (69.7 per cent), imbalance (23.7 per cent), otalgia (22.8 per cent) and aural fullness (19.1 per cent), with more than one symptom occurring in 25.1 per cent of patients. Co-morbidities included sensorineural hearing loss (39 per cent), emotional stress (30 per cent) and chronic illness (22 per cent). CONCLUSION Functional disorders commonly present to the otology clinic, often in the presence of emotional stress or chronic illness. They occur because of adaptation of brain circuitry to experience, including adverse events, chronic illness and fear learning. This study presented an experience-driven clinical model based on these concepts. An understanding of these principles will significantly aid otolaryngologists who encounter patients with functional ear symptoms.
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Aetiology and management options for secondary referred otalgia: a systematic review and meta-analyses. Eur Arch Otorhinolaryngol 2023; 280:47-59. [PMID: 36163556 DOI: 10.1007/s00405-022-07638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES OF REVIEW To review the literature for the evidence base for the aetiology and management of referred otalgia, looking particularly at non-malignant, neuralgic, structural and functional issues. TYPE OF REVIEW Systematic review. SEARCH STRATEGY A systematic literature search was undertaken from the databases of EMBASE, CINAHL, MEDLINE®, BNI, and Cochrane Library according to predefined inclusion and exclusion criteria. EVALUATION METHOD All relevant titles, abstracts and full text articles were reviewed by three authors who resolved any differences by discussion and consultation with senior author. RESULTS 44 articles were included in our review. The overall quality of evidence was low, with the vast majority of the studies being case-series with three cohort and four randomised-controlled trials included. The prime causes and management strategies were focussed on temporomandibular joint dysfunction (TMJD), Eagle syndrome and neuralgia. Our meta-analyses found no difference on the management strategies for the interventions found. CONCLUSIONS Referred otalgia is common and treatment should be aimed at the underlying pathology. Potential aetiologies are vast given the extensive sensory innervation of the ear. An understanding of this and a structured approach to patient assessment is important for optimal patient management.
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Sussman S, Zimmerman Z, Chishom T, Reid L, Seyyedi M. Migraine-Associated Otalgia: An Underappreciated Entity. J Audiol Otol 2022; 26:90-96. [PMID: 35196447 PMCID: PMC8996084 DOI: 10.7874/jao.2021.00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Otalgia can be primary/otogenic or secondary as a referred pain from another site, which can be difficult to establish owing to various causes and the complex innervation of the ear. In our center, we observed a large group of patients with unexplained otalgia that had a higher prevalence of migraine. We hypothesized that migraine may cause secondary otalgia. This study then aimed to determine the prevalence of migraine-associated otalgia and evaluate the efficacy of migraine treatment. Subjects and Methods This 2-year retrospective study was conducted at a busy otology clinic. Patients were identified using diagnostic codes corresponding to otalgia. The prevalence of migraine-associated otalgia was determined, and the efficacy of migraine treatment was evaluated in these patients. The interventions included prophylactic and abortive migraine treatments. Statistical analysis was conducted to compare between the pre- and post-treatment symptoms. Results A total of 208 patients with otalgia were identified. Sixty-four out of ninety patients with unexplained otalgia met the criteria for migraine; of them, 30 patients had an adequate follow-up and were thus included in the evaluation of treatment efficacy. Otalgia improved in 87% of the patients who received migraine treatment. After treatment, the mean pain score and headache frequency significantly decreased from 7 to 2 and from 27 to 9 days per month, respectively (p<0.001). Conclusions Migraine should be considered as a source of secondary otalgia, and patients should receive treatment as they often respond to migraine treatment.
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Affiliation(s)
- Sarah Sussman
- Department of Otolaryngology, Medical College of Georgia Augusta University, Augusta, GA, USA
| | - Zachary Zimmerman
- Department of Otolaryngology, Northwestern University, Chicago, IL, USA
| | - Taylor Chishom
- Department of Plastic Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Lauren Reid
- Department of Otolaryngology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mohammad Seyyedi
- Department of Otolaryngology, Medical College of Georgia Augusta University, Augusta, GA, USA
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Benjamin T, Gillard D, Abouzari M, Djalilian HR, Sharon JD. Vestibular and auditory manifestations of migraine. Curr Opin Neurol 2022; 35:84-89. [PMID: 34864754 PMCID: PMC8755616 DOI: 10.1097/wco.0000000000001024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to discuss current literature about vestibular migraine and other cochleovestibular symptoms related to migraine. RECENT FINDINGS Vestibular migraine affects 2.7% of the US population. Misdiagnosis is common. The pathophysiology is currently unknown but new research shows that calcitonin gene-related peptide, which is implicated in migraine headaches, is expressed in the audiovestibular periphery. A recent large-scale placebo-controlled trial looking at metoprolol for vestibular migraine was terminated early due to poor recruitment; however, at study completion, no differences were seen between treatment arms. Many other audiovestibular symptoms have been shown to be associated with migraine, including tinnitus, hearing loss, aural fullness, otalgia, and sinus symptoms. Migraine is also associated with risk for developing numerous otologic conditions, including Meniere's disease, vestibular loss, Benign Paroxysmal Positional Vertigo, and sudden sensorineural hearing loss. There is now some evidence that patients may experience fluctuating hearing loss and aural fullness without vertigo in association with migraine, which is called cochlear migraine. SUMMARY Migraine can cause a variety of audiologic and vestibular symptoms, and further research is required to understand how migraine affects the inner ear.
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Affiliation(s)
- Tania Benjamin
- University of California, San Francisco (UCSF) Department of Otolaryngology – Head and Neck Surgery, San Francisco, CA, USA
| | - Danielle Gillard
- University of California, San Francisco (UCSF) Department of Otolaryngology – Head and Neck Surgery, San Francisco, CA, USA
| | - Mehdi Abouzari
- University of California, Irvine (UCI) Department of Otolaryngology, Irvine, CA, USA
| | - Hamid R. Djalilian
- University of California, Irvine (UCI) Department of Otolaryngology, Irvine, CA, USA
- University of California, Irvine (UCI) Department of Biomedical Engineering, Irvine, CA, USA
| | - Jeffrey D. Sharon
- University of California, San Francisco (UCSF) Department of Otolaryngology – Head and Neck Surgery, San Francisco, CA, USA
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Risbud A, Muhonen EG, Tsutsumi K, Martin EC, Abouzari M, Djalilian HR. Migraine Features in Patients With Isolated Aural Fullness and Proposal for a New Diagnosis. Otol Neurotol 2021; 42:1580-1584. [PMID: 34420023 PMCID: PMC8595802 DOI: 10.1097/mao.0000000000003324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the presence of migraine features between patients with isolated aural fullness (AF) who meet the diagnostic criteria for migraine headache and those who do not, and to propose diagnostic criteria for migraine-related AF based on our results. METHODS We performed a retrospective study of patients presenting to a tertiary-care neurotology clinic between 2014 and 2020 with migraine-related AF. This was defined as isolated, prolonged aural fullness concurrent with migraine features once other etiologies were ruled out via examination, audiometry, and imaging. Migraine features were compared between patients meeting the diagnostic criteria for migraine headache and those not meeting the criteria. RESULTS Seventy-seven patients with migraine-related AF were included. The mean age was 56 ± 15 years and 55 (71%) patients were female. Eleven (14%) patients fulfilled the criteria for migraine headache (migraine group). Of the 66 patients who did not meet the criteria (nonmigraine group), 17 (26%) met 4/5 criteria, and 32 (48%) met 3/5 criteria, for a total of 49 (74%) patients. The migraine and nonmigraine groups were only different in 5 of 20 features, including family history of migraine (p = 0.007), sound sensitivity (p < 0.001), mental fogginess (p = 0.008), visual motion sensitivity (p = 0.008), and light sensitivity (p < 0.001). CONCLUSION There are minimal differences in the overall prevalence of migraine features between patients with migraine-related AF who meet and do not meet the diagnostic criteria for migraine. Our findings suggest that the criteria may be too stringent and exclude many patients from potentially benefitting from treatment with migraine prophylaxis.
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Affiliation(s)
- Adwight Risbud
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Ethan G. Muhonen
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Kotaro Tsutsumi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Elaine C. Martin
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
- Department of Biomedical Engineering, University of California, Irvine, California
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Hernández-Nuño de la Rosa MF, Keith DA, Siegel NS, Moreno-Hay I. Is there an association between otologic symptoms and temporomandibular disorders?: An evidence-based review. J Am Dent Assoc 2021; 153:1096-1103. [PMID: 34799013 DOI: 10.1016/j.adaj.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this article is to discuss the scientific evidence available on the the pathophysiology and management of otologic complaints in patients with temporomandibular disorders (TMDs). TYPES OF STUDIES REVIEWED The authors conducted an electronic search in MEDLINE, Web of Science and ScienceDirect and retrieved all the relevant peer-reviewed journal articles available in English on the topic. No time restriction was applied. RESULTS No consensus exists on the management of otologic symptoms in patients with concomitant TMD. The scientific evidence suggests that conservative or reversible TMD therapy might provide relief. However, this evidence is scarce and low, thus further studies with larger sample sizes and better designed methodological frameworks are needed. Until such evidence is available, dentists and orofacial pain specialists should treat TMD patients using current guidelines and refer those with otologic symptoms to an otolaryngologist. PRACTICAL IMPLICATIONS Given the wide range of potential pathophysiologies and treatments for each otologic symptom described in the TMD patient, close collaboration with otolaryngologists is essential to achieve the best patient care.
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Goshtasbi K, Abouzari M, Risbud A, Mostaghni N, Muhonen E, Martin E, Djalilian HR. Tinnitus and Subjective Hearing Loss are More Common in Migraine: A Cross-Sectional NHANES Analysis. Otol Neurotol 2021; 42:1329-1333. [PMID: 34238896 PMCID: PMC8590584 DOI: 10.1097/mao.0000000000003247] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate whether migraine is independently associated with tinnitus and subjective hearing loss (HL) in a large national database. METHODS The de-identified 1999 to 2004 National Health and Nutrition Examination Survey database was retrospectively queried for subjects aged 18 to 65. HL and tinnitus were subjectively reported by subjects. RESULTS A total of 12,962 subjects (52.9% female) with a mean age of 38.1 ± 14.6 years were included. This consisted of 2,657 (20.5%), 2,344 (18.1%), and 2,582 (19.9%) subjects who had migraine, subjective-HL, and tinnitus, respectively. In patients with tinnitus or subjective-HL, migraine was reported in 35.6% and 24.5%, respectively. Migraineurs were more likely to have subjective-HL (25.0% vs. 16.6%, p < 0.001) and tinnitus (34.6% vs. 16.9%, p < 0.001) compared to the nonmigraineurs. This corresponded to migraine having an odds ratio of 1.5 (95% confidence interval [CI] 1.3-1.7, p < 0.001) and 2.2 (95% CI 2.0-2.4, p < 0.001) for subjective-HL and tinnitus, respectively. After adjusting for confounders, subjective-HL (odds ratio [OR] = 1.2, 95% CI 1.1-1.4, p = 0.003), tinnitus (OR = 2.1, 95% CI 1.9-2.3, p < 0.001), and neck pain (OR = 4.0, 95% CI 3.6-4.5, p < 0.001) were more common in migraineurs. Among migraineurs, a higher proportion of those with tinnitus also had subjective-HL compared to those without tinnitus (40.0% vs. 15.3%, p < 0.001), and a higher proportion of those with subjective-HL also had tinnitus compared to those without HL (58.1% vs. 27.3%, p < 0.001). CONCLUSIONS This study suggests an independent association between migraine with subjective-HL and tinnitus. Otologic migraine, which is the effects of migraine on the ear, may be partly responsible for the link between HL, tinnitus, neck pain, and migraine.
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Affiliation(s)
- Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Adwight Risbud
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Navid Mostaghni
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Ethan Muhonen
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Elaine Martin
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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Abstract
Otalgia can be broadly categorized into primary otologic causes and secondary nonotologic causes. Isolated otalgia in the absence of hearing loss, otorrhea, or abnormal otoscopic findings is typically secondary to referred pain from nonotologic causes, as the sensory nerve supply to the ear arises from 4 cranial nerves and the cervical plexus. The most common causes of primary otalgia are acute otitis media and otitis externa, whereas the most common causes of secondary otalgia are temporomandibular joint disorders and dental pathology. Persistent unilateral ear pain and other alarm symptoms warrant further evaluation for possible neoplasm.
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Affiliation(s)
- Tiffany Peng Hwa
- Department of Otolaryngology/Head and Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Silverstein 5, Philadelphia, PA 19103, USA
| | - Jason A Brant
- Department of Otolaryngology/Head and Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Silverstein 5, Philadelphia, PA 19103, USA.
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谢 存, 牛 文, 丁 韶, 贾 晓, 丁 晓, 王 广, 宋 纪, 刘 宏. [Analysis of clinical characteristics of 87 patients with cochlear migraine]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:112-115. [PMID: 33540990 PMCID: PMC10127887 DOI: 10.13201/j.issn.2096-7993.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 06/12/2023]
Abstract
Objective:The aim of this study is to analyze the clinical features of cochlear migraine. Methods:The clinical data of cases of cochlear migraine were collected, and the clinical symptoms and hearing examination results were analyzed. Results:The ratio of male to female patients with cochlear migraine was 1∶3.1; the peak incidence was between 30 to 60 years old; the clinical symptoms were tinnitus in 61 people（70%）, mild hearing loss in 52 people（60%）, aural fullness in hyperacusis in 13 people（15%）, auditory allergy in 9 people（10%） and otalgia in 5 people（6%）; the audiology characteristic was that 61.5%（32/52） of patients with hearing loss showed mild high-frequency neurological hearing loss, 34.6%（18/52） of patients showed mild low-frequency neurological hearing loss, and 3.8%（2/52） of patients showed full-frequency mild neurological hearing loss; the effective rate of tinnitus treatment was 57.4%, the effective rate of hearing loss was 71.2%, and the effective rate of aural fullness was 69.2%, the effective rate of hyperacusis is 66.7% and the effective rate of otalgia is 60.0%. Conclusion:The clinical characteristics of cochlear migraine are summarized, which provides a basis for the intervention of anti-migraine treatment programs for inner ear diseases.
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Affiliation(s)
- 存存 谢
- 河南省人民医院 郑州大学人民医院 河南大学人民医院耳鼻咽喉头颈外科(郑州，450003)Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, China
| | - 文侠 牛
- 河南大学人民医院 河南省人民医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Henan University, Henan Provincial People's Hospital
| | - 韶洸 丁
- 河南省人民医院 郑州大学人民医院 河南大学人民医院耳鼻咽喉头颈外科(郑州，450003)Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, China
| | - 晓东 贾
- 河南省人民医院 郑州大学人民医院 河南大学人民医院耳鼻咽喉头颈外科(郑州，450003)Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, China
| | - 晓丽 丁
- 河南省人民医院 郑州大学人民医院 河南大学人民医院耳鼻咽喉头颈外科(郑州，450003)Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, China
| | - 广科 王
- 河南省人民医院 郑州大学人民医院 河南大学人民医院耳鼻咽喉头颈外科(郑州，450003)Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, China
| | - 纪军 宋
- 周口市中心医院耳鼻咽喉科Department of Otorhinolaryngology, Zhoukou Central Hospital
| | - 宏建 刘
- 河南省人民医院 郑州大学人民医院 河南大学人民医院耳鼻咽喉头颈外科(郑州，450003)Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, China
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Abouzari M, Sajjadi A, Djalilian HR. Regarding clinical implications of magnetic resonance imaging in temporomandibular disorder patients presenting ear fullness. Laryngoscope 2019; 129:E158. [PMID: 30768791 DOI: 10.1002/lary.27733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Autefeh Sajjadi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.,Department of Biomedical Engineering, University of California, Irvine, California, U.S.A
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15
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Contreras EFR, Fernandes G, Ongaro PCJ, Campi LB, Gonçalves DAG. Systemic diseases and other painful conditions in patients with temporomandibular disorders and migraine. Braz Oral Res 2018; 32:e77. [DOI: 10.1590/1807-3107bor-2018.vol32.0077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 02/21/2018] [Indexed: 02/17/2023] Open
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16
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Moshtaghi O, Ghavami Y, Mahboubi H, Sahyouni R, Haidar Y, Ziai K, Lin HW, Djalilian HR. Migraine-Related Aural Fullness: A Potential Clinical Entity. Otolaryngol Head Neck Surg 2017; 158:100-102. [PMID: 29205097 DOI: 10.1177/0194599817739255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this case series, we set out to describe the clinical entity of isolated, prolonged aural fullness (AF) and its relationship with migraine. Patients with isolated, persistent AF for 6 months or more were included with all possible etiologies ruled out. Migraine dietary and lifestyle changes and medical migraine prophylactic therapy were prescribed to all. Eleven patients were included (mean age, 52 years). Six (54%) patients fulfilled International Headache Society criteria for migraine with or without aura. Changes in perceived sensation of AF using the visual analog scale and quality of life questionnaires resulted in a statically significant improvement ( P < .001, 95% confidence interval [CI], 4.7 to 6.72, and P < .001, 95% CI, -5.3 to -2.7, respectively). As such, an improvement of isolated, prolonged AF with migraine lifestyle changes and prophylactic treatment may suggest an etiological association between migraine and prolonged aural fullness.
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Affiliation(s)
- Omid Moshtaghi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Yaser Ghavami
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Hossein Mahboubi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Ronald Sahyouni
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, Orange, California, USA
| | - Yarah Haidar
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Kasra Ziai
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Harrison W Lin
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Hamid R Djalilian
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, Orange, California, USA
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17
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Martiné G, Espagne-Dubreuilh G, Amilhaud-Bordier M, Magy L, Ranoux D. Signes otologiques dans la migraine. Et si c’était musculaire ? Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Vestibular migraine in an otolaryngology clinic: prevalence, associated symptoms, and prophylactic medication effectiveness. Otol Neurotol 2015; 36:133-8. [PMID: 25251304 DOI: 10.1097/mao.0000000000000596] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence of vestibular migraine (VM) in patients consulting to an otolaryngology clinic, the neuro-otological associated symptoms, and the effect of prophylactic antimigrainous medication on VM symptom improvement. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral otolaryngology clinic. SUBJECTS AND METHODS We used the diagnostic criteria from the Bárány Society and the International Headache Society to allocate patients to a subgroup: VM, possible VM, and atypical VM. MAIN OUTCOME MEASURE The prevalence of VM, percentages of associated neurotological symptoms, and percentages of effectiveness of prophylactic medication. RESULTS Sixty-five (16%) patients were selected from the total patient population (n = 407) from which 4.2% were assigned to the definite VM group, 5.7% to the probable VM group, and 6.1% to the atypical VM group. We found a significantly different distribution between the groups for photophobia (p = 0.035), ear pressure (p = 0.023), and scotoma (p = 0.015). Thirty patients were administered with flunarizine and 68% responded with an improvement in VM symptoms (p < 0.001). For propranolol, 31 patients were treated and there was an improvement of symptoms in 73% (p < 0.001). Remarkable was the fact that these percentages were not significantly different between the subgroups. CONCLUSION VM is a common disorder presenting in a dizziness clinic, and detailed history taking is important to assess VM-associated symptoms and thus to prevent underdiagnosis. The latter is very important because our study shows that the majority of patients, regardless of VM subtype, can benefit from a prophylactic treatment, but further prospective studies are necessary.
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Frequency of migraine as a chief complaint in otolaryngology outpatient practice. BIOMED RESEARCH INTERNATIONAL 2015; 2015:173165. [PMID: 25695049 PMCID: PMC4324102 DOI: 10.1155/2015/173165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/20/2014] [Accepted: 11/11/2014] [Indexed: 01/02/2023]
Abstract
Objective. To identify the frequency of typical (headache and dizziness) and common atypical (ear fullness, pressure, pain, tinnitus, facial fullness, and nasal congestion) migraine symptoms as chief complaints among patients presenting to otolaryngology clinic. Methods. This is a descriptive study of prospectively collected data from a general otolaryngology practice. Typical migraine presentations were diagnosed by applying international headache society (IHS) criteria for migraine headache and Neuhauser's criteria for migrainous vertigo. Atypical otologic and rhinologic migraine symptoms were diagnosed using individualized criteria. Charts were reviewed at 6-month interval from the first presentation. Results. Out of 1002 consecutive patients, 10.8% presented with “migrainous chief complaint.” All migrainous chief complaint patients had a history of headache but not all of them presented with headache. Corrected female to male ratio in the migraine group was 3 to 1; age distributions were significantly different between the migraine and nonmigraine groups by applying t-test. Out of the atypical complaints, 86% of the patients had a history of concomitant typical presentation. Conclusion. Actual diagnostic criteria for migraine do not satisfy the diversity of its presentation. Investigating the history of migraine is enough to diagnose most atypical presentations. Sound knowledge about migraine seems essential for any ENT practitioner.
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Shiue I. Chronic diseases and life events accounted for 2-18 % population attributable risks for adult hearing loss: UK Adult Psychiatric Morbidity Survey, 2007. Eur Arch Otorhinolaryngol 2015; 273:93-103. [PMID: 25575844 DOI: 10.1007/s00405-015-3504-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/06/2015] [Indexed: 11/29/2022]
Abstract
Links between chronic diseases and hearing loss in adults have emerged. However, previous investigations were not complete, and the role of life events was unclear. Therefore, it was aimed to examine the relationships of common chronic diseases and life events and adult hearing loss in a country-wide and population-based study. Data were retrieved from UK Adult Psychiatric Morbidity Survey, 2007, being cross-sectional, including demographics, self-reported prior health conditions and hearing loss (ever and in the last 12 months), and several major life events. Analyses included Chi square test, t test, logistic regression model, and population attributable risk estimation. People who had prior health conditions including cancer, migraine, dementia, depression, cataracts, chronic bronchitis, allergy, bowel problem, bladder problem, arthritis, muscle problem or skin problem tended to report hearing loss than their counterparts. People who have experienced major life events including post-traumatic stress disorder, serious illness of close relatives, death of family, serious problems with friends, major financial crisis, valuables stolen, being bullied, violence at home, sexual abuse or running away from home were also more likely to experience ever hearing loss problem or that in the last 12 months. 2.0-13.1 % adult hearing loss could be delayed or prevented by managing chronic diseases while 4.1-18.1 % might be delayed or prevented by minimizing the negative effects of life events. Chronic diseases and life events were associated with hearing loss in adults. Better managing lifestyle to minimize detrimental impacts in future health and nursing programs would be suggested.
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Affiliation(s)
- Ivy Shiue
- School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Riccarton, Edinburgh, EH14 4AS, Scotland, UK. .,Owens Institute for Behavioral Research, University of Georgia, Athens, USA.
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