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Intermittent chest pain and ear pain. US showed no heart blockage. Have TKR and knee OA. What to check?

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Intermittent upper right chest pain with associated left ear pain. Sometimes both ears are involved. Lasts for 5-7 minutes and always when I am sedentary or walking slowly. Not after eating. Over last 6 years about 2-4 episodes per year. Ultrasound with XXXXXXX shows 0 blockages in heart vessels. 57 year old female with TKR and acute on chonic OA in other knee. No gall bladder. Kidney stone removed 2 years ago. My dr doesn't know what to check.
Posted Sat, 8 Sep 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 5 hours later
Hi,

Thank you for your query.

1. If cardiac, respiratory and musculo-skeletal causes have been ruled out, a source of intermittent chest pain and ear pain may be acid reflux.

2. Get an ear drum examination, a PTA (Pure Tone Audiogram) and a Tympanogram (Impedance Audiometry) done. If all these are normal, then your ear pain is due to a referred pain due to the varied nerve supply of the ear. If your tests are abnormal then allergy or sinusitis.

3. Acid reflux may present as GERD (Gastro Esopageal Reflux Disease) or LPR (Laryngo Pharyngeal Reflux). Have you ever experienced the chest pain without ear pain or vice versa?

4. Esophageal Manometry and FEES (Fiberoptic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing) may be done.

5. You may follow up with the examination findings and the results of these investigations here.

6. I must emphasize that since you have only 2-4 episodes a year, it will be better to do these tests during such an episode. It may be interesting to note that a few episodes of acid reflux may also occur in normal individuals in a day.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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