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Dr. Andrew Rynne

Family Physician

Exp 50 years

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After a short flight for a new year holiday I

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Dr. Vaishalee Punj

General & Family Physician

Practicing since :2003

Answered : 2144 Questions

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Posted on Tue, 29 Jan 2019 in Internal Doctor Category
Question: After a short flight for a new year holiday I have developed a very painful one sided sore throat. I have now got piercing earache on the same side, and my head on that side feels tender and sensitive. I do not have signs of fever. I have been taking paracetamol for the last 24 hours but it does not make much difference and it hurts to swallow. I am 68 and have mild hypertension and paroyxysmal atrial fibrillation though this is largely asymptomatic. I am unlikely to be able to see a doctor as I am away from home and it is New Year’s Day. Can you advise me?
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Answered by Dr. Vaishalee Punj 1 hour later
Brief Answer:
Seems ear problem

Detailed Answer:
Hello and welcome to Ask A Doctor service.

I have reviewed your query and here is my advice.

During flight there is change in atmospheric pressure inside aeroplane and people with sore throat tend to experience exacerbation of ear pain during or after a flight.
I will suggest that you take an anti-allergic medicine like chlorpheniramine 2 times aday to lower the throat congestion, so that eustachian tube opens. Chlorpheniramine can cause sedation but is good at relieving throat congestion and mucous. This will relieve the ear pain. Also take an anti-inflammatory like Ibuprofen 200 mg 2-3 times a day.

It could also be ruptured tympanic membrane or acute otitis media. Though it doesnt seem like an emergency but examination of ear and throat and prescription of antibiotics maybe needed if it doesnt get better in 1-2 days.

There is also a possibility of carotid embolism from heart fibrillation. It can also cause jaw pain and severe headache are usual symptoms, which are not there in your case. This condition requires scan of the carotids in hospital.

Hope this helps. Let me know if I can assist you further.
Dr Vaishalee
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Vaishalee Punj 16 minutes later
Surely I should not be taking ibuprofen as I am, as stated, taking anticoagulants. And I did not develop the sore throat until the day after the flight - there was no ear problem at the time. The first sign of a problem was 24 hours after the flight when I became aware of pain in moving my jaw to eat breakfast. Could the problem be some sort of abcess? It seems very far back in the throat in the passage that connects to the ear - hence the earache. It is also intermittent and varies in severity. Swallowing solid food is particularly painful.
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Follow up: Dr. Vaishalee Punj 2 hours later
Could you answer my follow up question please.
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Answered by Dr. Vaishalee Punj 12 hours later
Brief Answer:
There is a risk of embolism

Detailed Answer:
Hi again

Sorry for delay in my response as I was busy with my other professional obligations.

Since there is a risk of embolism, I will suggest a carotid duplex at earliest. Its a possibility that emboli are getting fired from heart. Since there are no symptoms related to your brain, so possibly the emboli maybe affecting the external carotid artery. Its just a possibility, nothing to panic.

Otherwise other causes of TMJ problem will need to be explored. In this case, an ENT surgeon and dentist will be able to help with it.

Dr Vaishalee
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vaishalee Punj 6 hours later
First response helpful, though I was surprised that ibuprofen was recommended even though as had said I had atrial fibrillation.
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Answered by Dr. Vaishalee Punj 9 minutes later
Brief Answer:
Embolism and bleeds are opposite processes

Detailed Answer:
Hi again

To clarify,

NSAIDs like Aspirin are not advised during anticoagulant therapy due to risk of bleeding. Ibuprofen has lesser chances of bleeding than aspirin.

Embolism and bleeds are opposite processes, I was worried about in-sufficient anti-coagulant effect of medicine. If embolus is found, then you might need warfarin.

Dr Vaishalee
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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