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Pain in preauricular region radiating to temple, CT scan shows soft tissue opacification. Had viral ear infection. Healing?

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Internal Medicine Specialist
Practicing since : 2001
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Hi

6 months back I had a viral ear infection . I had blood filled blisters on my ear drum. Fluid (lot of blood + pus ) got accumulated in my middle ear after those bursted and for that a grommet was inserted after 20 days of the infection. My hearing returned to normal but since then I am having pain in my TMJ region. My grommet was taken out after 2 months of its insertion since my doctor found it unnecessary. My MRI /CT shows minimal fluid in my mastoid. I also had a bone scan and the last phase of it (SPECT) came to be positive. I have been put on IV antibiotics (Piptaz + Oflox) for 3 weeks and then had 3 weeks of oral ciprofloxcin. My MRI after antibiotic shows no fluid in mastoid. Only the last phase of bone scan is still positive. When I asked the nuclear medicine doctor about the report, he told me its just a osteoblastic response and no active infection. He explained that had it been active bone infection (osteomyelitis) it should have come in all the three phases of the scan. He told it takes time for the bone scan to be normal. I have a dull pain around my ear and sometimes this goes to my temple region. My preauricular jaw region is stiff and pains when pressed hard. However I XXXXXXX t have any pus coming out of my ear and my TM is fine according to my ENT. I had a CT scan yesterday which shows subtle soft tissue opacification in posterio-inferior mastoid air cells suggesting chronic mastoiditis. Now I XXXXXXX t have any pain on back of my ear, never had any discharge from ear, no swelling at the back of ear. Only I have some dull pain in preauricular region radiating to temple region.
Now I have the following questions:

1. I wanted to know if I am healing or is there still infection.
2. Also please advice is it time for me to go for mastoidectomy?
3. Also let me know how long such infections usually take to heal.
4. Can this be a neuralgia due to infection? If so how long it usually takes to heal?

Please let me know if you require any more

information.

Thanks,
XXXXXX
Posted Wed, 5 Sep 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Ram Choudhary 2 hours later
Hi XXXXXXX
Welcome to healthcare magic!
With the decreasing intensity of shadows it is likely that you are in a process of healing.
You can wait for mastoidectomy, it is to be decided when it is for sure that the congestion and pain would not subside anymore.
These infections usually heal without consequences but because you are having the complicated course, this depends on your immunity and the virulence of the bacteria, there are no scientific tests to gauze this.
Neuralgia does not develop like that, it is the pain due to local congestion.
I would advise you to have a CBC, CRP & Pro-Calcitonin levels done, just to have an idea about nature of inflammation whether just nonspecific or still remnant infection there.
You had aggressive treatment with antibiotics and had initial response as well, I would advise at present to give time to further reparatory processes of nature, may be the condition will resolve. You can undergo Mastoidectomy later on safely.
Take tablet Lyser-D for 15 days twice a day after meals to suppress inflammation.
Get imaging about a month later only if you have symptoms otherwise omit it.
I hope this advise would be helpful for you.
Above answer was peer-reviewed by
 
Follow-up: Pain in preauricular region radiating to temple, CT scan shows soft tissue opacification. Had viral ear infection. Healing? 43 hours later
Hi,

According to your suggestion I have done the CBC and CRP tests.
Here are the results:
CRP - 15.89
Total WBC count - 8300

I have burning pain in my preauricular region and around the ear where the pinna joins the skull which radiates to my temples. There is always a dull pain which sometimes becomes severe.

Please suggest what to do next.

Thanks,
XXXXXX
 
 
Answered by Dr. Ram Choudhary 35 minutes later

Hi XXXXXXX

Welcome back to healthcare magic Physician's desk!
At present you should take the painkiller I have advised in the earlier answer for coming few days for comfort.
Our middle ear is connected to our throat by a thin tube which opens intermittently to drain and equalise pressure in the middle ear.
You should keep the affected ear up when you are sleeping and should make chewing movements to open the tube to drain and decongest the ear.
You can in fact chew a chewing gum to help you make chewing movements better.

I think the advise would be helpful for you.

Wish you a great XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Pain in preauricular region radiating to temple, CT scan shows soft tissue opacification. Had viral ear infection. Healing? 2 minutes later
Sir,

Kindly let me know how severe are the CRP and CBC reports. Any active infection still there?

Thanks,
XXXXXX
 
 
Answered by Dr. Ram Choudhary 14 minutes later

Hi XXXXXXX

Welcome back to healthcare magic Physician's desk!
The results of these reports are suggestive of nothing alarming about the infection
The CRP is indicative of inflammation/infection but TLC/WBC reading is ruling it out although both the tests are have very poor specificity.
I think you should get the pro-Calcitonin levels to be more sure against infection and get a repeat CBC with it to compare with the current value.
It appears as if a residual inflammation which would ultimately subside with healing but it is a slow process having many variation.
I think the advise would be helpful for you.

Wish you a great XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Pain in preauricular region radiating to temple, CT scan shows soft tissue opacification. Had viral ear infection. Healing? 15 minutes later
Sir,

I have given 6 month's time for this infection to come down by medical management. Still everytime either in the CT or MRI or blood test I get this minimal infection. How long is it worth to wait for mastoidectomy? Is 6 months not long enough wait.

I forgot to mention that I have a high triglyceride value of 273. Can this hamper the healing?

This pre-auricular pain in the TMJ region started only after a grommet was inserted into my ear some 4 months back. This has come out but the pain persist. Can this be a TMJ pain - CRP high marking inflammation but WBC normal marking no infection?

Regards,
XXXXXX
 
 
Answered by Dr. Ram Choudhary 3 hours later
Hi XXXXXXX

Welcome back to healthcare magic Physician's desk!
TMJ may be involved, disease can be persistent but they are lessened than you had them in earlier time.
Human body is too complex to carve out future course of a thing that is there, we can guess in tandem- a thing improving would heal some day and a thing worsening needs intervention.
So be watchful.
TLC/CRP are weak tests to give you the yes/no type possibility rule out.
Watchfulness for improvement/deterioration would be the best strategy.

I think the advise would be helpful for you.

If you still have queries if any, please feel free to communicate back.

And if satisfied with my solution then please accept the answer and take a moment to express your feelings in the Review Section about my Clinical skills!

Above answer was peer-reviewed by
 
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