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Otology/Neurotology

(302) Mastoid T2 Hyperintensity in Patients with Migraine-Related Aural Fullness

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • KT

    Karen Tawk, MD

    Postdoctoral Fellow
    University of California, Irvine
    Orange, California, United States

    • Co-Author(s)

  • AA

    Abdula Al-Seraji, BS

    University of California, Irvine, USA

  • JK

    Joshua K. Kim, BS

    Medical Student
    Duke University School of Medicine
    Fullerton, California, United States

  • KG

    Khodayar Goshtasbi, MD, MS

    University of California, Irvine, USA

    • Senior Author(s)

  • Mehdi Abouzari, MD, PhD

    Assistant Professor
    University of California, Irvine
    Orange, California, United States

  • Hamid R. Djalilian, MD

    Professor of Otolaryngology, Neurosurgery, and Biomedical Engineering, Director of Division of Neurotology and Skull Base Surgery
    University of California, Irvine
    Irvine, CA, United States

Disclosure(s):
Karen Tawk, MD: No relevant relationships to disclose.
Joshua K. Kim, BS: No relevant relationships to disclose.
Mehdi Abouzari, MD, PhD: No relevant relationships to disclose.


Introduction: To investigate whether aural fullness in patients with migraine headache correlates to mastoid T2 hyperintensity on magnetic resonance imaging (MRI).

Methods: We performed a retrospective chart review of patients presenting to a tertiary-care neurotology clinic between 2014 and 2020 with migraine-related aural fullness according to recently outlined diagnostic criteria. Patients’ T2-weighted MRI sequences were reviewed independently by two neurotologists blinded to their migraine-related aural fullness status and graded as positive or negative for the presence of T2 hyperintensity. The results were then compared between patients meeting the ICHD-3 criteria for migraine headache and those who did not fulfill the criteria.

Results: Seventy-seven patients with aural fullness were included. The mean age was 58 ± 15 and 71% were female. Seventeen patients (22%) fulfilled the ICHD-3 criteria for migraine headache, 31 (41%) did not meet the criteria, and 29 (37%) had no headaches. Fluid signal in the mastoid was found in 14 patients (18%). Of those with migraine headache, 7 out of 17 (41%) had T2 hyperintensity in the mastoid compared to those without migraine headaches where only 1 out of 31 (3%) (p= 0.002).

Conclusions: Patients with aural fullness that fulfilled the ICHD-3 migraine headache criteria have a higher likelihood of having mastoid fluid compared to patients who did not fulfill these criteria and non-headache patients. These findings may indicate that mastoid T2 hyperintensity in patients with migraine headaches and aural fullness may be related to the migraine-related neurovascular (possibly increased vascular permeability or neurogenic inflammation) phenomenon rather than Eustachian tube dysfunction.