title: The Otalgia Point: A Novel Clinical Gesture in Otolaryngology.
abstract: BACKGROUND
  In cases of otalgia without any accompanying findings, some patients locate their otalgia below the attachment of the lobule, at the apex of the jugulodigastric region.
  
  
  OBJECTIVE
  To present a series of these patients for whom nasal steroids or myringotomy usually ameliorated their pain.
  
  
  METHODS
  Thirty-two patients with normal physical examinations, tympanograms, and age-appropriate audiograms spontaneously indicated otalgia at "the otalgia point." Inspection of the oropharynx and nasal airway, palpation of the neck and temporal mandibular joints, and nasopharyngoscopy/laryngoscopy ruled out referred causes of otalgia. Patients were offered either nasal steroid spray or trial myringotomy followed by tympanostomy tube.
  
  
  RESULTS
  Otalgia improved in all 10 (100%) patients who selected nasal steroids. Otalgia resolved in 17 of 20 (85%) myringotomy participants. Three patients declined intervention. In all, symptoms improved in 27/29 treated patients (93%).
  
  
  CONCLUSIONS
  This description of "the otalgia point" introduces a new otolaryngologic gesture in physical examination that can aid in the therapeutic management of some patients with otalgia and normal examinations. This is an uncontrolled case series that serves as a pilot study for further exploration of this gesture.
authors.affiliation: Department of Otolaryngology-Head Neck Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Lieberman
authors.affiliation: Department of Otolaryngology-Head Neck Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA mredleaf@uic.edu.
authors.forename: Miriam I
authors.initials: MI
authors.lastname: Redleaf
mesh_terms: D000328:Adult; D000368:Aged; D004433:Earache / Q000175:diagnosis* / Q000628:therapy*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D059085:Nasal Sprays; D010808:Physical Examination / Q000379:methods*; D014432:Tympanic Membrane / Q000601:surgery
chemical_list: D005938:Glucocorticoids; D059085:Nasal Sprays
keywords: differential diagnosis; ear; eustachian tube; pain; quality of life