FIG 11.

A 64-year-old woman with secondary otalgia caused by sinus mucosal disease. Axial bone algorithm CT shows a partially opacified right sphenoid sinus with marked hyperostosis and sclerosis of the sinus walls from long-standing mucoperiosteal reaction (white arrow) related to sinus mucosal disease. Note an air-fluid level (white arrowhead), which is a nonspecific finding that can be seen in the setting of acute inflammation related to the sinus mucosal disease. Sinus disease is a common source of secondary otalgia, thought to yield referred pain via CN VII parasympathetic branches or via CN V1 sensory branches.