European Radiology

, Volume 14, Issue 12, pp 2206–2211 | Cite as

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

  • Harriet C. ThoenyEmail author
  • Karl T. Beer
  • Peter Vock
  • Richard H. Greiner
Head and Neck


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 χ2-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.


Head and neck neoplasms Oropharynx Magnetic resonance imaging Earache 



We thank E. Stauffer, MD, for the histologic slides, S.C. Marré, MD, for the data acquisition, and H. Mattle, MD, for helpful comments.


  1. 1.
    Beer KT, von Briel C, Lampret T et al (1998) Predictive significance of reflex otalgia in local radical radiotherapy of oropharyngeal carcinomas. Strahlenther Onkol 174:306–310PubMedGoogle Scholar
  2. 2.
    Beer KT, Greiner RH, von Briel C, Thöni AF, Zbären P (1995) Reflex otalgia: prognostic relevance for radical radiotherapy of mesopharynx carcinomas. Eur J Cancer 31a [Suppl 5]:86CrossRefGoogle Scholar
  3. 3.
    Weissman JL (1997) A pain in the ear: the radiology of otalgia. Am J Neuroradiol 18:1641–1651PubMedGoogle Scholar
  4. 4.
    Wazen JJ (1989) Referred otalgia. Otolaryngol Clin North Am 22:1205–1215PubMedGoogle Scholar
  5. 5.
    Thaller SR, De Silva A (1987) Otalgia with a normal ear. Am Fam Physician 36:129–136Google Scholar
  6. 6.
    Olsen KD (1986) The many causes of otalgia. Infection, trauma, cancer. Postgrad Med 80:50–63PubMedGoogle Scholar
  7. 7.
    Harnsberger HR (1995) Handbook of head and neck imaging, 2nd edn. Mosby, St. LouisGoogle Scholar
  8. 8.
    Leblanc A (1995) The cranial nerves: anatomy, imaging, vascularisation, 2nd edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  9. 9.
    Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (1997) TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  10. 10.
    Smit M, Balm AJ, Hilgers FJ, Tan IB (2001) Pain as sign of recurrent disease in head and neck squamous cell carcinoma. Head Neck 23:372–375CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Harriet C. Thoeny
    • 1
    Email author
  • Karl T. Beer
    • 2
  • Peter Vock
    • 1
  • Richard H. Greiner
    • 2
  1. 1.Department of Diagnostic Radiology, InselspitalUniversity of BernBernSwitzerland
  2. 2.Department of Radiation Oncology, InselspitalUniversity of BernBernSwitzerland

Personalised recommendations