The Infratemporal Fossa Sign: Pilot Study of a Potential Clue to Eustachian Salpingitis

Abstract

Aural discomfort may be the result of obstructive eustachian tube (ET) dysfunction, temporomandibular joint dysfunction, or other causes. The infratemporal fossa (ITF) sign, in which a patient points to a characteristic location below the auricle, is proposed as an indicator of nonobstructive eustachian salpingitis. A preliminary study included patients with a complaint of aural discomfort who were prompted to localize symptoms using a single finger. Group 1 localized by using the ITF sign; group 2 localized deep within the external ear canal (suggesting ET dysfunction); and group 3 localized to the preauricular region (suggesting temporomandibular joint dysfunction). Findings of ET inflammation recorded during nasal endoscopy were greater in groups 1 and 2. Tympanometry and otoscopy were uniformly abnormal for group 2 and uniformly normal for groups 1 and 3. The ITF sign may help to identify eustachian salpingitis as a phenotype of ET disease characterized by symptomatic inflammation without abnormal middle ear pressure.

Association of a standardized measure of nasopharyngeal inflammation with Eustachian tube dysfunction questionnaire score

“…It is important to note that an elevated ETDQ-7 score is not necessarily indicative of obstructive ETD, and may instead reflect patulous ETD or the presence of non-obstructive ET inflammation, consistent with a diagnosis of Eustachian salpingitis. 4,23 The 3ET score demonstrated high specificity for predicting an ETDQ-7 score ≥2.1 and may play a confirmatory role in establishing a diagnosis of ETD. The wide availability of nasal endoscopy in otolaryngologic practice coupled with favorable diagnostic performance make the 3ET score a potentially valuable component of the clinical assessment F I G U R E 6 (A) Scatter plot showing correlation between 3ET score and tympanometric peak pressure (ρ = −0.17).…”

“…The mechanism of this relationship is unclear, but a higher degree of inflammation may cause dysfunctional mucociliary clearance and luminal obstruction that give rise to ETD symptoms. It is important to note that an elevated ETDQ‐7 score is not necessarily indicative of obstructive ETD, and may instead reflect patulous ETD or the presence of non‐obstructive ET inflammation, consistent with a diagnosis of Eustachian salpingitis 4,23 …”

Symptom Localization May Differentiate Subtypes of Eustachian Tube Dysfunction

“…This study builds upon the findings of recent pilot data 2 to assess patient self‐localization of symptoms in patients with suspected diagnoses of nonobstructive eustachian tube inflammation or OETD, which can both be difficult to distinguish and diagnose. In addition to often vague symptoms, there is significant overlap with other sinonasal and otologic pathologies, notably CRS, AR, and intrinsic middle ear disease, which can sometimes mask the symptoms or diagnosis 4,5 .…”

“…1 Recently, the infratemporal fossa (ITF) sign has been described which may be useful in differentiating patients with the presence of nonobstructive eustachian salpingitis (ES) compared to other etiologies with similar symptoms of aural fullness. 2 Elicitation of this clinical sign may be useful in characterizing the site of eustachian tube pathology; however, the clinical utility has not been validated. Given the ease of assessing for this sign, the primary aim of this study was to establish the objective findings and clinical characteristics associated with differential self-localization of aural discomfort.…”

“…Obstructive eustachian tube dysfunction (OETD) is a common condition that is associated with aural discomfort, fullness, occasional pain, and abnormal tympanometry and otoscopic findings 1 . Recently, the infratemporal fossa (ITF) sign has been described which may be useful in differentiating patients with the presence of nonobstructive eustachian salpingitis (ES) compared to other etiologies with similar symptoms of aural fullness 2 . Elicitation of this clinical sign may be useful in characterizing the site of eustachian tube pathology; however, the clinical utility has not been validated.…”