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Suggest Treatment For Cervical Spondylitis, Obstructive Sleep Apnoea Syndrome And Anxiety.

Posted on Tue, 2 Sep 2014

Question: 8 weeks- R side ear pain now radiates from temple to collarbone, base of skull. No med has helped. PT helps neck not ear. Vertigo each time i tilt head back to drink, move or laydown. and base or skull on right side is always sore. PT is worried about problem with artery, ER Dr. considered temporal arteritis, despite my young age (32). My primary care Dr. thinks its nothing more than muslce spasms, but the pain is awful. No scans of any kind have been taken and I am terrified that I have some kind of arterial dissection. The pain in my ear is significant and i also have pain in my jaw and temple, constant headache. I have sleep apnea and use a cpap. I am significantly overweight, BP runs about 130 over 90 steady or less. Can this simply be muscular or is it something more serious? Meds prescribed over the last 8 weeks: tylenol 3 (occaisonal relief, not complete, lasts about 2.5 hours), XXXXXXX (relaxes neck enough that I can sleep), percocet (knocks me out, wears off quickly), IB 800 (hit or miss, often works well when swapping with tylenol 3 every 4 hours), currently taking 60 mg prednisone a day ( taken 3 doses so far - prescribed at ER.

My quality of life is now zero as I am afraid to go snywhere alone because of pain, dizzyness. I've heard horror stories about ear pain connections to anyuersm / atery dissecition. Where do I go now, what can i do?

I just dont know where else to turn, I am truly suffering.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (4 hours later)

Brief Answer:
Please see the answer below...

Detailed Answer:
Hi

Thanks for posting the query. I have gone through the history thoroughly and understood your problem. I will try my best to help you out with this problem.

You seem to be suffering from multiple problems; Temporo-mandibular joint (TMJ) dysfunction on the right, cervical spondylitis, obstructive sleep apnea syndrome (OSAS) and anxiety.

1. The symptom of right sided pain from the temple to the collar bone is secondary to the TMJ dysfunction. Avoiding the usage of the joint on the right side can reduce most of your symptoms. Also, you need to chew the food on the opposite side and preferably soft food. Once the pain subsides, you can chew equally on both the sides. Apply pain reliever gel around the affected joint.

2. As you have mentioned that you are slightly overweight; this can affect the joints of the cervical vertebra causing pain in the neck and dizziness on making neck movements. Weight reduction and neck strengthening exercises with application of the pain relieving gel over the neck can control most of your problems. MRI of the neck and TMJ can confirm the diagnosis.

3. Similarly, over weight can also cause OSAS because of the short and stout neck. Accumulation of the fat around the neck loosens the neck muscles, thus aiding in falling back of the tongue and obstructive symptoms.

4. All these above problems have made you anxious and that in turn worsened your present symptoms. I doubt any vascular related issues.

5. Thus, the best treatment for you is weight reduction. Once this is done, all your problems will subside.

Hope this clarifies your doubts. I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (16 hours later)

Thank you for your thorough answer. Today, the neck pain has spread some to the left side and hurts under my ear at base of skull and in shoulder. Am I correct in assuming that this is normal? I am also taking 50,000 IU of D every 3 days and iron supplemetns 3x daily for extreme deficiencies.

Youre absolutely right that I've developed anxiety from this, 8 weeks with no relief and no one taking me seriously is devastating and I worry constantly about this being something serious. I am meeting with my Dr. Wednesday, but I do no know what to say to her to get her to understand that I have no life because of this pain and that I need to understand what has happened to me. I dont know how to get her to order an MRI, because thus far she keeps blowing me off and giving me pain relievers and physical therapy. I just feel hopeless, but am working steadily on reducing my weight, i know i need to lose 100 lbs.

Can vascular problems present with pain, stiffness and vertigo?

Thank you Dr.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (6 hours later)

Brief Answer:
I doubt vascular issues in your case.

Detailed Answer:
Hi

Thanks for writing back

Do not worry! With appropriate intervention everything will settle. Do not be desperate in your life. Anxiety will take you nowhere. You now know the root cause of all your problems, that is, over weight. Continue the measures you have taken to reduce the weight. I doubt any vascular issues in your case.

Secondly, discuss with your doctor about the problems which is bothering you more, rather than telling her everything. If your neck pain is more bothersome, request her to refer you to an orthopedician or a neurologist. Once you meet the specialist, discuss with him regarding all your issues. Be firm with your doctor and politely request her whether she can advise MRI for you.

Continue with neck physiotherapy and rest of the measures as I mentioned in the previous response.

I wish you good luck and good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (40 hours later)

Thank you Dr. I will try to be specific, firm and confident when I speak to her. So often I get overwhelmed and end up in tears before any progress can be made because I just want to feel better.

I feel as though the steroids I've been taking are helping and that physicsl therapy has been beneficial, but I still have significant pain in my right ear and from under my chin down the front of my neck on the right side.

I will update you when i see the Dr. tomorrow. Thanks.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (5 hours later)

Brief Answer:
I appreciate your decision...

Detailed Answer:
Hi

Welcome back

I appreciate the stance taken by you. Please talk to your doctor politely and try to get the most out of her. I wish you good luck and speedy recovery.

God bless you.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (17 hours later)

Thanks Dr. Wanted to update you with my visit today. My Dr. believes that it is muscular, perhaps with some nerve involvement. She wants me to try 30 days of 10mg amitriptyline to see if we have improvement before we go with scans or specialists. The physical therapist is now working with the theory that it may be my SMC muscle rhat is causing all of the pain.

I am doing my best to stay calm and not worry. My neck, particularly at base of skull on right side feels like it cracks alot and it almost feels like there is fluid trapped there. My ear has been popping alot too. Is the fluidy feeling in my head anything to worry about? Its only in one spot, feels sorta ceunchy or crackly I guess and sometimes increases ear pain.

She, like you, believes that there is no chance this is artery related and expects to see alot of relief over the next four weeks.

Any advice? Do you think I am on the right track with my Dr or should I get a 2nd opinion?

Thank you!

Answered by Dr. Dr. Naveen Kumar Nanjasetty (8 hours later)

Brief Answer:
You need to consult another doctor...

Detailed Answer:
Hi

Thanks for writing back and updating regarding your visit.

1. I do not understand why your doctor is so reluctant in sending you for further investigations. You are already suffering from all these problems since past 8 weeks. Amitriptyline is an antidepressant medicine, to relieve your anxiety and neuralgic pain.

2. Crackling sound in the ear could be either related to the TMJ or water inside the middle ear secondary to the blockage of the Eustachian tube. In your case, there is no history of cold or nasal block, hence the fluid in the middle ear is ruled out. So the next common cause is TMJ dysfunction. As I mentioned in my previous response, avoid using the affected joint and try to chew on the other side. Eat soft food, so as to give rest for the affected joint. After a week, chew equally on both the sides.

3. My sincere suggestion to you is to take a second opinion.

4. Continue with the neck physiotherapy and the traditional pain killers.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad