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Suggest Treatment For Severe Ear Pain
Question: I have had severe (sharp, throbbing) ear pain in the area around the hole of the left ear for 14 months. No hearing loss, no discharge, no redness or swelling. No vertigo, no ringing of the ear. I passed a hearing test with 100% success. Neither Swimming nor Air Travel made it better or worse. It usually does not hurt for the 1st few hours of the day, them starts around 9-10 AM. It was assumed that my remaining top teeth (which did extend into my sinus) were causing the pain, but now all remaining teeth in the top left have been removed & the pain is returning. The pain did seem to abate while I was on antibiotics & pain meds following each extraction, but the latest extraction was 3 weeks ago now & I'm now well over a week off of the antibiotic (Sulfamethazone) & pain meds--& I can feel the pain rebuilding in intensity. The pain is not everyday at this point--there is a pattern to how I've felt following each tooth extraction (3 total) : the pain would diminish at first, then seem to move from the center of the ear to where the ear meets the face, & then settle back into its usual zone of the bone (cartilage?) surrounding the hole in the ear, returning back to its previous behavior of sharp throbbing. I also notice that when I sometimes turn my head sharply I feel a muscle pull sensation from the center of the ear that extends down the side of my neck almost to my shoulder. This will be followed by a sharper throbbing in the very center of the ear for a short while afterwards, which eventually recedes to the more familiar (duller) throbbing. I have been told that I should wait up to 8 weeks following the last extraction before moving on to a Neurologist --but I honestly don't think I can wait that long if the pain stays at this level for much longer. I get mild relief from OTC pain relievers such as Ibuprofen & Motrin--but it is short lived & does not work at all unless I take large amounts. Following the tooth extractions I was given Percocet along with the Antibiotic , which does give me almost total relief, but I don't want to make that my go-to treatment for obvious reasons, & I have not taken it in over a week.
Brief Answer:
Possible TGN? Need further evaluation.
Detailed Answer:
Hello, Sir.
I understand your concern.
I have gone through your query in detail.
The pain manifestation in your case is likely to represent a nerve pathology as CT PNS and MRI of TMJ has revealed negative results.
The possibility of Trigeminal Neuralgia/TGN is high as a diagnosis of exclusion, even though the typical presentation is absent in your case.
But the suspicion should be high considering the frequency and duration of pain attacks.
Hence, I advise you to get a Clinical Neurophysiology Testing as the initial test.
Clinical neurophysiology testing with a blink reflex study may be helpful to demonstrate a lesion of the trigeminus in which a bilateral delay occurs in response to the stimulation on the pathologic side.
The blink reflex can clearly help distinguish between the symptomatic form of trigeminal neuralgia and the idiopathic form of trigeminal neuralgia.
The sensitivity of this test across studies has been reported as 59-100%, and the specificity has been noted as 93-100%.
If this test is abnormal, you can go for MRI brain to assess any vascular compression of the trigeminal nerve.
Further management whether medical or surgical is based on the test results.
Post your further queries if any.
Thank you.
Possible TGN? Need further evaluation.
Detailed Answer:
Hello, Sir.
I understand your concern.
I have gone through your query in detail.
The pain manifestation in your case is likely to represent a nerve pathology as CT PNS and MRI of TMJ has revealed negative results.
The possibility of Trigeminal Neuralgia/TGN is high as a diagnosis of exclusion, even though the typical presentation is absent in your case.
But the suspicion should be high considering the frequency and duration of pain attacks.
Hence, I advise you to get a Clinical Neurophysiology Testing as the initial test.
Clinical neurophysiology testing with a blink reflex study may be helpful to demonstrate a lesion of the trigeminus in which a bilateral delay occurs in response to the stimulation on the pathologic side.
The blink reflex can clearly help distinguish between the symptomatic form of trigeminal neuralgia and the idiopathic form of trigeminal neuralgia.
The sensitivity of this test across studies has been reported as 59-100%, and the specificity has been noted as 93-100%.
If this test is abnormal, you can go for MRI brain to assess any vascular compression of the trigeminal nerve.
Further management whether medical or surgical is based on the test results.
Post your further queries if any.
Thank you.
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. Chakravarthy Mazumdar
Answered by
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