Suggest treatment for ear pain

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Posted on Tue, 7 Oct 2014 in Bones, Muscles and Joints
Question:
I've been suffering from severe referred otalgia after sustaining a mild concussion almost 3 years ago along with a whiplash injury, which was never completely addressed. The ear pain is at a constant dull ache 24/7 with multiple "attacks" of electrical, sharp, shooting pain throughout the day to the deep inner ear in conjunction with a horrificly tight and painful neck, all left sided. I can't seem to pinpoint any aggravating factors. I have exhausted all specialities from Neurology, ENTs, Ortho, PT, vestibular rehab, PM&Rs, Neurosurgeons and finally pain management to help with my symptoms.
Literature shows that sources for my referred ear pain can be from my unaddressed whiplash injury, nerve involvement at C2-C3 or CN5,7,9 and 10.
I've been diagnosed with ATN-V3, Geniculate Neuralgua, Occipital Neuralgia, Cervical strain/sprain, cervical Radicuolpathy just to name a few. I'm just tired of being passed on from one specialty to another with no one giving be a clear or concise link to my "mystery" ear pain!
To date, my last treatment for the above is an SNRB at C3, which yield complete resolution of my ear pain. My question to you is, where do you think is the culprit of this mystery ear pain and what should I consider as the best next step. Do I proceed with a cervical facet block at C2-C3, PT for my upper cervical spine and SMC, rhizotomy, cervical fusion/foraminotomy?
I sincerely thank you for your time and advice.

Sincerely,

Mystery ear pain
doctor
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
Cervical facet block at C2-C3 will help.

Detailed Answer:
Hello,
Thanks for posting your query.
The sudden sharp shooting pain that you have is characteristic of a nerve injury or compression. Since a selective nerve root block has given a complete relief from your symptoms it is diagnostic of C2-C3 level nerve as the culprit. You can proceed with cervical facet block at C2-C3. Cervical fusion and foraminotomy depends on the position of your cervical vertebrae. Your surgeon can best decide regarding this.
Regular physiotherapy is a must to regain the proper tone and flexibility of the neck muscles.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 1 hour later
Could I also have this referred ear pain from the SCM muscle injury/ myofascial pain syndrome?? Pain pattern is deep in the ear, behind the ear/mastoid region and along the lower jaw line as well. I've had a history of a whiplash injury with multiple cervical strains/sprains which have not been thoroughly addressed.
Could the cervical facet ligaments and/or the facets themselves along C2-C3 be injured with my whiplash injury causing referred pain to my ear/neck and face??

Thank you Dr. Tayal for your advice! I look forward to hearing from you.
doctor
Answered by Dr. Praveen Tayal 20 minutes later
Brief Answer:
Details below.

Detailed Answer:
Hello.
Thanks for writing again.
SCM muscle injury is less likely to get a relief from SNRB. Myofascial pain syndrome can be a contributing factor and cause a dull constant ache in the region. The injury to the facet ligaments and facet joints are a more likely cause. The ligaments are slow to heal and can cause a nerve root compression or irritation ion the area. The pain in the ear and neck that you have is a referred pain. Facet block will help in symptomatic relief as well as confirmation of the diagnosis.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal 13 hours later
Dr. Tayal,

If the facet block does provide me with both a diagnostic and therapeutic effect, do I proceed with a series of this type of injection along with PT or should I meet with my surgeon to discuss about a more "definitive" solution??
What do you recommend as the next best step after a successful facet block since I have been dealing with this for nearly 3 years??
Also, I've failed to mentioned that my cervical MRI demonstrates no spinal cord or forminal stenosis along the vertebral segments. I understand that these are static images and can be difficult to evaluate for facet injuries/irritation. I would like to avoid a protracted surgical road unless it is absolutely necessary.
Thank you for your time!
doctor
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
Injections are better.

Detailed Answer:
Hello.
In my opinion it is best to go for a series of injections and physiotherapy sessions since you have got a complete relief earlier. Surgery cannot assure you a 100% result since there is no demonstrable nerve root compression in MRI scan.
Symptomatic relief is a better option right now instead of suffering and searching for a definitive solution which is difficult to achieve in such nerve related problems.
I hope you understand.
Take care.
Regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12052 Questions

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