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Have ear infection. Feeling pain in head. Can there be nerve pain without infection?

Sep 2012
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General & Family Physician
Practicing since : 2008
Answered : 1416 Questions

I had a bad ear infection which has resolved as my ENT says looking at my ear drum. However, I still feel some pain in the ear radiating to my head. My ENT says it might be some nerve pain. I also had mastoidectomy 2 months back. I have the following questions:
1. Can there be nerve pain without infection? If yes then how long does it usually last?
2. My mastoid cavity was found to contain glue. However, culture of that did not grow anything. What is this glue in the mastoid cavity and if this does not culture anything then how can doctors be able to know what organism is responsible (is there any other way)?
3. They found some granulation tissue. They sent it for HPE. HPE report says - mildly inflammed fibrocollagenous tissue. What does that mean? How is HPE different from culture? Was it better had they send that granulation tissue for culture instead of HPE?

Posted Tue, 6 Nov 2012 in Ear, Nose and Throat Problems
Answered by Dr. Das Arindam 2 hours later
I am giving answers of your question one by one.

1. Nerve pain can be present without infection, if there is some neurological problem. But, in your case, as there is infection which is causing inflammation and edema in that area, the nerve fibres either get inflamed or compressed which leads to pain sensation.
The pain will persist as long as the infection and inflammation is there.

2. The glue which you are talking is nothing but the proteinaceous material formed due to edema and inflammation. It is sterile in usual cases. It may also become sterile after taking antibiotics. Thus it did not yield any bacteria in culture.
In these cases we usually do not wait for the culture report but start antibiotic empirically. So, after taking antibiotic, a culture may not yield anything.

3. Now, the histopathology report indicates fibrocollagenous tissue. It means that body's repairing mechanism has started functioning and is working against the inflammation. It also indicates a chronic infection.
HPE is the microscopical examination of the tissue for its morphological changes like benign or malignant changes / inflammatory changes or others.
HPE is done on tissue. Culture is done on the pus / blood / urine / other body fluids.
So, granulation tissue cannot be sent for culture.
So, sending granulation tissue for culture, instead of HPE was not better.

Let me know if you have any more questions.

Above answer was peer-reviewed by
Follow-up: Have ear infection. Feeling pain in head. Can there be nerve pain without infection? 1 hour later

Few more queries:
As per your answer to my 1st question, I still have infection even after mastoidectomy and antibiotics. Please suggest what option I have after this. Please suggest any proper antibiotic that I can take for this.

Can this nerve pain be due to surgery?

Answered by Dr. Das Arindam 20 minutes later
Thank you for asking question.

As you still have infection, it is evident that the previous antibiotic therapy has failed.
In case of these type of infections, multiple parameters should be checked like oral hygiene, presence of any teeth infection, etc. You should be physically examined thoroughly. If any discharge comes out, then it should be sent for culture.
Treatment of these type of infection include -
1. Ear toileting for keeping the ear dry.
2. Ear drop containing good antibiotic like fluoroquinolones ( eg:ciprofloxacin).
3. If local application of the drops fails to cure , systemic therapy should be started.
4. If necessary, then intravenous antibiotics like penicillin group of drugs. Since these are prescription drugs, I would suggest you see your physician for the same.

Most probably, the nerve pain is not due to surgery. Because in that case there should be some neurological problem (like increased/ decreased salivation / lacrimation etc) in your facial area.
So, it is not possible.

Above answer was peer-reviewed by
Follow-up: Have ear infection. Feeling pain in head. Can there be nerve pain without infection? 14 hours later

I don't have any discharge out of my ear and my ear drum is fine.

I have pain in my temple and jaws.

I have taken the following antibiotics :
Augmentin - 1 month
Pippercillin/tazobactum - 3 weeks
Ofloxcin - 2 weeks
Gentamicin - 5 days
Ciftriaxone - 2 weeks
Amikacin - 5 days
Ciprofloaxcin tablets (750 mg BD) - 3 weeks

Never had any ear discharge.

Please suggest what next can be done.

Answered by Dr. Das Arindam 1 hour later
Thank you for asking question.

Firstly, you have taken many antibiotics. I think no more antibiotics are appropriate for you. Please wait for few days.

Use good mouthwash, for maintaining good oral hygiene.

Use non-steroidal anti-inflammatory drugs for reducing pain.

Take proton pump inhibitors daily.

Take balanced nutritional diet.

If then also, the pain and infection persist then do a blood sugar level for diabetes, anti HIV Test for detection of any immunocompromised state and then you have to be treated accordingly.

Above answer was peer-reviewed by
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