Ear pain in patients with oropharynx carcinoma: how MRI contributes to the explanation of a prognostic and predictive symptom

Abstract

Reflex otalgia is a predictive and prognostic parameter for local control in patients with oropharynx carcinoma. Can a morphologic correlate of this important symptom be detected by MRI? Thirty-six patients were prospectively evaluated by MRI before radical radiotherapy. Sixteen patients had reflex otalgia; 20 did not. The oropharynx and adjacent regions were analyzed. Alteration was defined as effacement of anatomical structures, signal alteration or enhancement after contrast medium administration. The χ 2 -test was used to compare categorical parameters. In patients with reflex otalgia, alteration of the following structures innervated by the glossopharyngeal nerve were found significantly more often: nasopharynx, hard palate, superior constrictor pharyngis muscle, palatine tonsil, palatopharyngeus muscle, palatoglossus muscle, stylopharyngeus muscle, hyoglossus muscle and preepiglottic space. No difference was found for the muscles of mastication, levator and tensor veli palatini muscles, styloglossus muscle, genioglossus muscle, intrinsic muscles of the tongue, digastric muscles, mucosal surface of the lateral and posterior pharyngeal wall, uvula, valleculae, parapharyngeal space and larynx. An alteration of structures innervated by the glossopharyngeal nerve was visualized on MRI significantly more often when reflex otalgia was present. Involvement of structures innervated by other cranial nerves did not show the same association with ear pain.

Cricopharyngeal myotomy under regional anaesthesia

“…Ear pain may be caused by deep somatic pain occurring elsewhere, including the pharyngeal mucosa [6]. In oropharyngeal cancer, referred ear pain is associated with involvement of structures innervated by the glossopharyngeal nerve [7]. The external branch of the superior laryngeal nerve also provides sensory innervation of the pharynx.…”

Dor como queixa inicial do câncer de boca e orofaringe: caracterização de amostra

“…O presente estudo mostra que dor tipo "dor de dente" (p=0,044) afetaram mais os pacientes com CaB, enquanto que dificuldade de engolir (p=0,009), dor de garganta (p=0,007) e otalgia bilateral (p=0,004) ocorreram mais nos pacientes com CaO. A literatura científica já aponta para essas distinções e queixas (Thoeny et al, 2004;Gorski et al, 2004;Cuffari et al, 2006;Pinto;Brescia, 2013), mas isso ficou bem evidente no presente estudo.…”

“…A dor referida é um fenômeno comum na face (Schoenen, 2001;Sessle, 2011), como pode ser observado no presente estudo em que a localização da queixa principal é variável, a exemplo da otalgia reflexa que é um tipo de dor referida amplamente reconhecida e que também deve ser considerada nos pacientes com câncer de boca ou orofaringe (Durazzo, 2001(Durazzo, , 2005Scarbrough et al, 2003;Thoeny et al, 2004., Cuffari et al, 2006Brescia, 2013;.…”

“…não incluírem todos os nervos cranianos e cervicais envolvidos na sensibilidade da face e pescoço, particularmente os nervos glossofaríngeo (IX) e vago (X).Propuseram um modelo unificado que ajudasse a compreender melhor o fenômeno e que também auxiliasse o profissional que atende pacientes com otalgia em ouvidos normais, ou seja, pacientes com dor referida ou reflexa Thoeny et al (2004),. em estudo realizado em pacientes recém diagnosticados com câncer de orofaringe, mostram que houve predomínio dos pacientes das categorias mais altas do TNM dos pacientes que relatavam de 12,9% no T1 a 40,5% no T2 e a 65,5% de invasão perineural nos estádios T3 e T4.…”