Cryptogenic Vascular Dissection as a Potential Cause of Intractable Otalgia

Jun-Ting Li, Jing Pan* and Kai-Jun Zhao*

Department of Neurosurgery, Shanghai East Hospital, School of Medicine, Tongji University, China Department of Neurology and Institute of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China Department of Neurosurgery, Shanghai East Hospital, School of Medicine, Tongji University, China

^*Correspondance to: Jing Pan and Kai-Jun Zhao 

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Abstract:

Introduction: To highlight the diagnostic journey and management of otalgia linked to cryptogenic vascular dissection. Methods: A 68-year-old male experienced intractable right otalgia for 53 years, initially triggered by water ingress into his ear. This otalgia was a persistent pain that can worsen when exposed to cold, coughing, or exercise. It has been treated with multiple painkillers for a long time. and has been treated for presumed otitis and trigeminal neuralgia in multiple hospitals for 53 years, but the cause has not been identified. Dynamic contrast enhanced computed tomography (DCE-CT) revealed a long-segment cryptogenic vascular dissection with characteristic endometrial flaps in the intracranial vertebral artery, which was not detected by standard imaging. Results: Endovascular stent repair addressed the vascular dissection, resulting in the normalization of ischemic areas and the complete resolution of otalgia. Follow up for about almost 12 months after surgery showed good recovery for the patient, so there is no need to take painkillers anymore. Conclusions: This case illustrates the diagnostic complexity of secondary otalgia, highlights cryptogenic vascular dissection as a potential etiology, and illustrates the effectiveness of endovascular treatment for cryptogenic vascular dissection-associated otalgia, advocating for advanced imaging techniques in elusive cases.

Keywords:

Neurology

Cite the Article:

Li J-T, Pan J, Zhao K-J. Cryptogenic Vascular Dissection as a Potential Cause of Intractable Otalgia. Ann Clin Case Rep. 2025; 10: 2714..