Diagnostic Yield and Therapeutic Impact of Face and Neck Imaging in Patients Referred with Otalgia without Clinically Overt Disease

BACKGROUND AND PURPOSE: Otalgia may be secondary to serious pathology, such as upper aerodigestive tract malignancies, and CT or MR imaging of the skull base, face, and neck is often performed to detect clinically occult lesions. The diagnostic yield, management impact, and therapeutic impact of imaging in this clinical scenario, however, have yet to be elucidated.

MATERIALS AND METHODS: CT and MR imaging in patients who presented with otalgia without clinically overt disease was retrospectively analyzed from a single center over a 9-year period. The cohort was subdivided into groups, depending on the presence of additional symptoms and a history of head and neck cancer. Relevant diagnostic outcome findings were categorized, and the diagnostic yield and impact of imaging on management and therapy were calculated for each group.

RESULTS: In our study cohort of 235 patients, the diagnostic yield of imaging for otalgia, with or without other symptoms, in patients who lacked a history of head and neck cancer was negligible for upper aerodigestive tract malignancy (1%), abnormalities related to otalgia (2%), and other moderate or major findings (2%). Although equivocal or unimportant findings occasionally resulted in additional investigations, the therapeutic impact was also very low (2%). The diagnostic yield for upper aerodigestive tract malignancy (34%) and therapeutic impact increased (34%) when there was a history of head and neck cancer.

CONCLUSIONS: The diagnostic yield and therapeutic impact of imaging for otalgia without clinically overt disease are very low, unless there is a history of head and neck cancer.