From the Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.
From the Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
AJNR Am J Neuroradiol. 2020 Dec;41(12):2188-2198. doi: 10.3174/ajnr.A6808. Epub 2020 Oct 22.
Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for potential sources of referred ear pain (secondary otalgia). Innervation of the ear structures is complex, involving multiple upper cervical, lower cranial, and peripheral nerves, which transit and innervate a large anatomic territory involving the brain, spine, skull base, aerodigestive tract, salivary glands, paranasal sinuses, face, orbits, deep spaces of the neck, skin, and viscera. Interpreting radiologists must be familiar with these neural pathways and potential sources of secondary otalgia. The purposes of this review are to detail the currently proposed mechanisms of referred ear pain, review the salient neuroanatomy of the complex pathways responsible for secondary otalgia, highlight important benign and malignant etiologies of referred ear pain, and provide a structured search pattern for approaching these challenging cases on cross-sectional imaging.
耳痛非常常见，当耳镜检查和体格检查无法确定耳痛的原因时，通常会使用横断面成像来评估潜在的牵涉性耳痛（继发性耳痛）源。耳部结构的神经支配非常复杂，涉及多个颈上部、颅下部和周围神经，这些神经穿过并支配涉及大脑、脊柱、颅底、呼吸道、唾液腺、副鼻窦、面部、眼眶、颈部深部、皮肤和内脏的大片解剖区域。解读放射科医生必须熟悉这些神经通路和继发性耳痛的潜在来源。本文的目的是详细阐述牵涉性耳痛的目前提出的机制，回顾负责牵涉性耳痛的复杂通路的显著神经解剖结构，强调牵涉性耳痛的重要良性和恶性病因，并提供在横断面成像上处理这些具有挑战性病例的结构化搜索模式。
