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Triggerless neuralgic otalgia: A case series and systematic literature review.
MedLine Citation:
PMID:  23444079     Owner:  NLM     Status:  Publisher    
BackgroundIsolated neuralgic pain in the deep ear may arise from either nervus intermedius (NIN) or glossopharyngeal (GPN) neuralgias. Current International Headache Society (IHS) International Classification of Headache Disorders, second edition (ICHD-2) criteria for these cranial neuralgias require the presence of a characteristic trigger.AimThe aim of this article is to report cases of triggerless neuralgic otalgia to better understand a subset of patients for whom there may be diagnostic uncertainty.MethodsMethods included an observational cohort series and systematic literature review.ResultsWe identified five female patients with a median age at symptom onset of 58 (range: 47 to 73). Our patients generally experienced an excellent clinical response to carbamazepine. Patients were contacted by telephone at a median follow-up duration of seven years (range: four to 32) from symptom onset, at which time carbamazepine-free remissions were reported by five of five (100%) of the patients. A systematic review of the literature on neuralgic otalgia led us to conclude that NIN was most common among young women (age < 50), and GPN across a wider range of ages of either gender. Among surgically validated cases reported in the literature, triggers were frequently absent in NIN, and variably noted in GPN.ConclusionsWe conclude that the presence of a trigger is not fundamental, and may be impractical, to the diagnosis of neuralgic otalgia, but remains important for specificity between NIN and GPN.
Jonathan H Smith; Carrie E Robertson; Ivan Garza; F Michael Cutrer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-26
Journal Detail:
Title:  Cephalalgia : an international journal of headache     Volume:  -     ISSN:  1468-2982     ISO Abbreviation:  Cephalalgia     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200710     Medline TA:  Cephalalgia     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Mayo Clinic, Department of Neurology, MN, USA.
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