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Suggest treatment for severe jaw and inner ear pain?

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ENT Specialist
Practicing since : 1991
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Hi, I was wondering if you could help me with a question. I have been suffering with severe jaw and inner ear pain that is getting progressively worse. It started as an earache so I went to my MD and he looked inside and said my ear was just fine. Slowly it progressed to jaw pain and now I can't even chew the softest food. The worst part is is that my dentist sent me to an oral surgeon who said it was probably TMJ and sent me back to the dentist to have her ajust my bite plate. That did nothing and she said did I tell him that I've been on Boniva for five years which I forgot to mention to him, so back I'm going again tomorrow. All this without dental insurance. The worse part is the pain is so intensified when I lay down at night to sleep and there is absolutely no way I can put any pressure on my left side to sleep. Niether the dentist or the oral surgeon seemed conserned about the fact that laying flat intensifes my pain. I have had mixed collagen vascular disease since I was 19yrs. old and Hashimotos Thyroiditis about the same time. Now to add insult to injury I was diognosed with small fiber neuropathy in May of this year. I am already in so much pain with the neuropathy, this jaw thing is just making a bad situation worse. Please if you have any suggestions I'm desperate, both for sleep, and I don't relish the idea of eating my Thanksgiving dinner liquified and drinking it with a straw. Sincerely, XXXXXXX
Posted Sun, 22 Dec 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later
Brief Answer: As below: Detailed Answer: Hi, Thank you for your query. 1. The pain and sensitivity in the jaw may be due to the following reasons: a. Pain due to Bisphosphonate (Boniva/ Inbandronic acid) deposition in bone. b. Osteonecrosis of the mandible (jaw bone) due to bisphosphonates (rare). c. Vasculitis due to mixed collagen vascular disease. d. Neuropathy due to small fiber neuropathy. 2. Discontinuation of the bisphosphonate is recommended. It may take many months for the pain to disappear. 3. Get an MRI and a Bone Scan done to rule out Osteonecrosis. 4. Hypothyroidism following Hashimoto's may worsen small fiber neuropathy. Get your thyroid Function Tests done. A skin biopsy may help. 5. The vision problems may be due to the mixed collagen vascular disease and the small fiber neuropathy. 6. Get your EMG (electromyogram) and NCS (Nerve Conduction Studies) done. These tests should be done in an Institute specializing in Neurological testing. 7. Neuralgic pain requires painkillers which are different from routine painkillers. request your physician to give a trial with pregabalin, gabapentin, carbamazepine or amitriptyline. I hope I have answered your query. If you have any further questions I will be available to answer them. Regards.
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