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Risbud A, Muhonen EG, Tsutsumi K, Martin EC, Abouzari M, Djalilian HR. Migraine Features in Patients With Isolated Aural Fullness and Proposal for a New Diagnosis. Otol Neurotol 2021; 42:1580-1584. [PMID: 34420023 PMCID: PMC8595802 DOI: 10.1097/mao.0000000000003324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the presence of migraine features between patients with isolated aural fullness (AF) who meet the diagnostic criteria for migraine headache and those who do not, and to propose diagnostic criteria for migraine-related AF based on our results. METHODS We performed a retrospective study of patients presenting to a tertiary-care neurotology clinic between 2014 and 2020 with migraine-related AF. This was defined as isolated, prolonged aural fullness concurrent with migraine features once other etiologies were ruled out via examination, audiometry, and imaging. Migraine features were compared between patients meeting the diagnostic criteria for migraine headache and those not meeting the criteria. RESULTS Seventy-seven patients with migraine-related AF were included. The mean age was 56 ± 15 years and 55 (71%) patients were female. Eleven (14%) patients fulfilled the criteria for migraine headache (migraine group). Of the 66 patients who did not meet the criteria (nonmigraine group), 17 (26%) met 4/5 criteria, and 32 (48%) met 3/5 criteria, for a total of 49 (74%) patients. The migraine and nonmigraine groups were only different in 5 of 20 features, including family history of migraine (p = 0.007), sound sensitivity (p < 0.001), mental fogginess (p = 0.008), visual motion sensitivity (p = 0.008), and light sensitivity (p < 0.001). CONCLUSION There are minimal differences in the overall prevalence of migraine features between patients with migraine-related AF who meet and do not meet the diagnostic criteria for migraine. Our findings suggest that the criteria may be too stringent and exclude many patients from potentially benefitting from treatment with migraine prophylaxis.
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Affiliation(s)
- Adwight Risbud
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Ethan G. Muhonen
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Kotaro Tsutsumi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Elaine C. Martin
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, California
- Department of Biomedical Engineering, University of California, Irvine, California
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Wu AW, Ow RA, Tang DM, Mirocha J, Walgama ES, Illing EA, Hopp ML, Ting JY, Higgins TS. Effect of nasal fluticasone exhalation delivery system on Eustachian tube dysfunction. Int Forum Allergy Rhinol 2020; 11:204-206. [PMID: 33135869 DOI: 10.1002/alr.22728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Dennis M Tang
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - James Mirocha
- Cedars-Sinai Biostatistics and Bioinformatics Research Center, Los Angeles, CA
| | - Evan S Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elisa A Illing
- Department of Otolaryngology, Indiana University, Indianapolis, IN
| | - Martin L Hopp
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, IN
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville, Louisville, KY.,Kentuckiana ENT, Louisville, KY
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Wu AW, Walgama ES, Higgins TS, Borrelli M, Vardanyan N, Hopp S, Shamsian A, Hopp ML. Eustachian Tube Quality of Life and Severity of Disease in Patients With Chronic Rhinosinusitis. Am J Rhinol Allergy 2020; 34:532-536. [PMID: 32188265 DOI: 10.1177/1945892420912366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) has long been a suspected risk factor for Eustachian tube dysfunction (ETD). However, there have been few studies quantifying the presence of ETD in CRS patients. We sought to determine the prevalence of ETD symptoms in patients undergoing functional endoscopic sinus surgery (FESS) for CRS using the validated 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate the ETDQ-7 scores with scores of CRS symptom severity based on the 22-item Sino-Nasal Outcome Test (SNOT-22). METHODS Patients for FESS were preoperatively administered both the ETDQ-7 and the SNOT-22 validated quality of life instruments. Pearson and Spearman correlation coefficients were calculated. Changes in ETDQ-7 were measured at 3 months and differences were compared via paired t test. RESULTS A total of 82 patients completed the surveys. Thirty-nine (47.6%) patients had ETDQ-7 score ≥14.5, signifying clinically significant ETD symptoms. The mean ETDQ-7 score of the study population was 15.8 ± 8.8, and the mean SNOT-22 score was 37.5 ± 19.7. The Pearson and Spearman correlation coefficients between ETDQ-7 and the total SNOT-22 score were 0.52 (P > .0001) and 0.51 (P < .0001), respectively. There was significant improvement in ETDQ-7 scores postoperatively. CONCLUSION While the association between ETD and CRS has long been known, this is one of the few prospective patient studies evaluating otologic symptoms in a CRS population. We found that a significant percentage of CRS patients suffer from ETD symptoms based on patient-reported subjective outcome measures. This study demonstrates that otologic symptoms increase with CRS severity and improve after FESS.
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Affiliation(s)
- Arthur W Wu
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Evan S Walgama
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Thomas S Higgins
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, & Throat, Department of Otolaryngology-Head & Neck Surgery, University of Louisville, Louisville, Kentucky
| | - Michela Borrelli
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Narine Vardanyan
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Stephanie Hopp
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Arash Shamsian
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
| | - Martin L Hopp
- Division of Otolaryngology-Head & Neck Surgery, Cedars-Sinai Sinus Center, Los Angeles, California
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4
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Newman AC, Omrani K, Higgins TS, Ting JY, Walgama ES, Wu AW. The prevalence of eustachian tube dysfunction symptoms in temporomandibular joint disorder patients. Laryngoscope 2019; 130:E233-E236. [PMID: 31265138 DOI: 10.1002/lary.28162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS Ear fullness and pressure is a common complaint seen in otolaryngology clinics and frequently is attributed to eustachian tube dysfunction (ETD). In addition to traditional tympanometry and physical examination, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) has recently been used to aid in the diagnosis of ETD and to assess its severity. Temporomandibular joint disorder (TMJD) is a common condition that causes similar symptoms to ETD and has been recognized as a potential confounding condition in patients presenting with ETD symptoms. We sought to determine the cross-sectional prevalence of ETD symptoms in patients with TMJD using the ETDQ-7. STUDY DESIGN Prospective cross-sectional analysis. METHODS An analysis was performed of ETDQ-7 scores in patients diagnosed with TMJD. RESULTS A total of 21 patients with confirmed TMJD completed the ETDQ-7 at routine consult or follow-up for their TMJD. The mean ± standard deviation ETDQ-7 score for the cohort was 24.5 ± 12.5. Two-thirds of patients had an ETDQ-7 score of >14.5, which has been used in the literature to denote clinically significant ETD. No single question was scored significantly higher than the others. CONCLUSIONS Symptoms of ETD are highly prevalent among patients with TMJD determined by patient-reported outcome measures. It is not clear if these symptoms reflect true derangement of eustachian tube function in these patients or whether there is only clinical similarity between ETD and TMJD. However, future research efforts may resolve this dilemma. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E233-E236, 2020.
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Affiliation(s)
- Alan C Newman
- Cedars-Sinai Program for Headache, Orofacial Pain, and Sleep Apnea, Cedars-Sinai Pain Center, Los Angeles, California
| | - Katayoun Omrani
- Cedars-Sinai Program for Headache, Orofacial Pain, and Sleep Apnea, Cedars-Sinai Pain Center, Los Angeles, California
| | - Thomas S Higgins
- Rhinology, Sinus and Skull Base, University of Louisville, Louisville, Kentucky.,Kentuckiana Ear, Nose, and Throat, University of Louisville, Louisville, Kentucky.,and Department of Otolaryngology-Head and Neck Surgery, University of Louisville, Louisville, Kentucky
| | - Jonathan Y Ting
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Evan S Walgama
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Arthur W Wu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
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Tangbumrungtham N, Patel VS, Thamboo A, Patel ZM, Nayak JV, Ma Y, Choby G, Hwang PH. The prevalence of Eustachian tube dysfunction symptoms in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 8:620-623. [PMID: 29227048 DOI: 10.1002/alr.22056] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/13/2017] [Accepted: 11/12/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND While Eustachian tube dysfunction (ETD) is a known comorbidity of chronic rhinosinusitis (CRS), the prevalence of ETD symptoms in the CRS population is poorly understood. We sought to determine the cross-sectional prevalence of ETD in patients with CRS using the validated Eustachian Tube Dysfunction Questionnaire (ETDQ-7) and to correlate ETDQ-7 scores with 22-item Sino-Nasal Outcome Test (SNOT-22) scores, endoscopy scores, and computed tomography (CT) scores. METHODS A total of 101 patients with confirmed CRS completed the ETDQ-7 and SNOT-22 at their initial visit to our rhinology clinic. Lund-Mackay CT and Lund-Kennedy endoscopy scores were also obtained. Spearman's correlation coefficient (ρ) was calculated. RESULTS Among the 101 patients, 49 patients (48.5%) had an ETDQ-7 score of ≥14.5, signifying clinically significant ETD. The mean ± standard deviation (SD) ETDQ-7 score of the entire cohort was 17.8 ± 10.1. There was a moderately strong correlation between ETDQ-7 and the SNOT-22 ear subdomain (ρ = 0.691, p < 0.001). The correlation coefficient between ETDQ-7 and total SNOT-22 scores was ρ = 0.491 (p < 0.001), indicating moderate correlation. ETDQ-7 scores were poorly correlated to objective measures of sinonasal disease, including Lund-Mackay CT score (ρ = -0.055, p = 0.594) and Lund-Kennedy endoscopy score (ρ = -0.099, p = 0.334). CONCLUSION Symptoms of ETD are highly prevalent among patients with CRS as documented by patient-reported outcome measures. The correlation between ETDQ-7 scores and SNOT-22 ear subdomain scores is moderately strong, while the correlation between ETDQ-7 scores and SNOT-22 scores is moderate. ETD severity does not correlate with CT score or nasal endoscopy score.
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Affiliation(s)
- Navarat Tangbumrungtham
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA.,Department of Otorhinolaryngology, Ramathibodi Hospital, Bangkok, Thailand
| | - Vishal S Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Andrew Thamboo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA.,Department of Otorhinolaryngology, University of British Columbia, Vancouver, Canada
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA
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Moshtaghi O, Ghavami Y, Mahboubi H, Sahyouni R, Haidar Y, Ziai K, Lin HW, Djalilian HR. Migraine-Related Aural Fullness: A Potential Clinical Entity. Otolaryngol Head Neck Surg 2017; 158:100-102. [PMID: 29205097 DOI: 10.1177/0194599817739255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this case series, we set out to describe the clinical entity of isolated, prolonged aural fullness (AF) and its relationship with migraine. Patients with isolated, persistent AF for 6 months or more were included with all possible etiologies ruled out. Migraine dietary and lifestyle changes and medical migraine prophylactic therapy were prescribed to all. Eleven patients were included (mean age, 52 years). Six (54%) patients fulfilled International Headache Society criteria for migraine with or without aura. Changes in perceived sensation of AF using the visual analog scale and quality of life questionnaires resulted in a statically significant improvement ( P < .001, 95% confidence interval [CI], 4.7 to 6.72, and P < .001, 95% CI, -5.3 to -2.7, respectively). As such, an improvement of isolated, prolonged AF with migraine lifestyle changes and prophylactic treatment may suggest an etiological association between migraine and prolonged aural fullness.
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Affiliation(s)
- Omid Moshtaghi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Yaser Ghavami
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Hossein Mahboubi
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Ronald Sahyouni
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, Orange, California, USA
| | - Yarah Haidar
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Kasra Ziai
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Harrison W Lin
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Hamid R Djalilian
- 1 Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.,2 Department of Biomedical Engineering, University of California, Irvine, Orange, California, USA
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