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Ear pain, jaw pain, headache, trouble swallowing. CT scan showed fluid in air cells. How can it be treated?

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Internal Medicine Specialist
Practicing since : 1996
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Hi Doctor.....So 3 months ago I started getting bad headaches..everyday. I went to Dr. and was treated with antibiotics for sinus infection. Did not work. Was treated again with different antibiotics and predisone. Still no relief. So to sum it up....after 3 months I now have severe ear pain, jaw pain, headaches in front and sides of head everyday as well as now I feel trouble swallowing. So I was sent for a MRI and the results are....Brightening signal on T2 weighing right petrous apex likely secondary to pneumatized air cells with inflammatory change (petrous apicitis) I talked to my Dr. who said to go hospital you need an IV antibiotic. The hospital said that is not a possible reading I could not have that condition??? So they gave me a Ct Scan and it showed that the air cells all have fluid in them??? I hope I am explaining that correctly. (That is pretty much what they said) and this is the problem but they said I need a specialist and they sent me home with no answer and no medication. I feel worse everyday and it is affecting my life with pain. I also feel chest pressure my heart skipping and a cough starting. I know this sounds crazy but could this be going into my chest also? Please help what could this be and how can it be treated???
Posted Thu, 20 Sep 2012 in Ear, Nose and Throat Problems
Answered by Dr. Prasad Akole 3 hours later
Dear friend,

From your information, it appears to be a right side petrositis (an inflammation / possible infection).
The petrous bone of the skull where the inner ear is housed and the mastoid tip behind your earlobe.
It is often secondary to respiratory/ inner ear infections as the ear tube and throat are connected. The air cells in the bone are usually filled air. The scan shows a fluid, which is infective/ like sinusitis.

Treatment is antibiotics. They may fail due to:

Wrong antibiotics
Wrong route-oral Vs I.V.
Inadequate dosing
Inadequate duration of antibiotic treatment
Undrained abscess (pus)—your scans do not say this.(but I would like a detailed report of the scans posted here).
Resistant/ atypical microbes causing it
Untreated, it has the potential to spread to the bone and rarely brain inside with serious sequelae.

Has an ENT doctor seen and investigated you?
Could you mention all the antibiotic regimens given to you? In addition, upload all reports using the site’s uploader. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

Do you have fever, vomiting, neck pain?
Do you have hearing defects, ringing in the ear, visual disturbances?
Cough, expectoration, breathlessness? Throat pain, choked nose?

I would like to have all this info and would also suggest an ENT opinion (2nd, if needed), X-ray chest, an EKG, complete blood panel (routine), sputum exam (if produced).
Throat swabs and cultures
IV antibiotics –appropriate, adequate dose and duration, accordingly.
We should look for any simultaneous lung infection and treat appropriately, as cause is usually common.

Please be guided by your ENT specialist at a good centre.

Take care and please keep me informed of your progress.
Good Luck !

I hope to have answered your query satisfactorily.

May I request for your rating and review of this answer as you press the “Accept the answer” button and close the query (if there are no more follow up questions or after I answer them)?

Thank you !
Above answer was peer-reviewed by
Follow-up: Ear pain, jaw pain, headache, trouble swallowing. CT scan showed fluid in air cells. How can it be treated? 22 hours later
Thank you Dr. for your response- I am having some other symptoms like visual and hearing loss. I was already on first the zpack antibiotics then they put me on Augmentin then predisone all with no help. I do not have a fever. The pressure and pain I am having by my neck and ears is causing me serious discomfort. I feel so fatigued and short of breath- i feel very sick! I am waiting to get into a specialist because the Dr's here say only one type of Dr can treat this- is this not a common problem?? Do u think that the antibiotics will work and which one would you recommend?? I hope I can start feeling like myself again- :(thank you for your help!!
Answered by Dr. Prasad Akole 3 hours later

Thanks for reverting.

Oh, no fever!
Infections usually have fever, but sometimes without. Augmentin is a good respiratory antibiotic to start with. But if it had not worked; you may have to give others which also tackle resistance. Betalactam, beta-lactamase and a fluoroquinolone or combinations like these depending on culture reports. If MRSA is suspected, different gram positive cover is needed.

Have they obtained any pus, secretions for culturing the microbes?
Ideally it is necessary to treat the troubling infections. In addition there is a need to rule out osteomyelitis, (bone infection) - in that case prolonged IV antibiotics will be needed.

Inner ear should be fully evaluated as well as CT scan brain to look for spread, especially if you have visual and hearing loss - something like a cholesteatoma may pose trouble.

Your pain in the neck and ear is probably due to petrous affection.
Take powerful anti-inflammatory NSAIDs till then under guidance, to help with the pain.

Uncommonly, a badly infected bone may have to be surgically debrided.
Continue the antibiotics under supervision until the expert's evaluation.

Hope this information serves as a guide way towards your recovery. Revert if I can be of any more help. Post all reports as I advised.
Take care and keep me informed.

Please accept the answer and close the query with a review, if you have no more doubts.
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