Review article: Otalgia as presenting symptom of myocardial infarction

There are many etiologies for otalgia, most of which are benign conditions. However, it can also be the initial symptom for life threatening emergencies such as a myocardial infarction (MI). This case report and review of literature describes diagnosis of MI with the initial primary complaint of unilateral otalgia. A 77-year-old female with intermittent left-sided otalgia with exertion for many years that recently worsened. In the clinic, she had a normal otologic exam and denied any other associated symptoms. The following day, her symptoms progressed to otalgia radiating down her arm and dyspnea on exertion. After progression of symptoms, a nuclear stress test was performed revealing a large and severe apical infarct. Diagnosis of referred otalgia from a cardiac source. She had subsequent medical management of cardiac risk factors and treatment of angina. Resolution of otalgia with medical management for coronary artery disease (CAD) after treatment of unstable angina. Otologists should be aware of the atypical presentations of angina because a missed diagnosis is potentially fatal. Otalgia, either unilateral or bilateral, may be the only presenting symptom of underlying cardiac ischemia and a high index of suspicion is needed for early diagnosis. Patients with otalgia related to exertion, no abnormal findings on otoscopic examinations, and significant risk factors for cardiac disease should undergo systematic evaluation including a cardiac rule out. •Secondary otalgia is caused by a wide-range of pathologies involving CN V, VII, IX, X, and cervical nerves C2-C3.•Otalgia may be the only presenting symptom of underlying cardiac ischemia.•Cardiac related otalgia may be explained by the involvement of CN X, specifically the auricular branch of the vagus nerve.•Patients with cardiovascular risk factors and unexplained otalgia should undergo systemic evaluation.