Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
191 Doctors Online

By proceeding, I accept the Terms and Conditions

Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

HCM Blog Instant Access to Doctors
HCM BlogQuestions Answered
HCM Blog Satisfaction

Suggest treatment for severe ear pain

Answered by
Dr.
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3632 Questions

default
Posted on Mon, 5 Oct 2015 in Ear, Nose and Throat Problems
Question: I have had severe (sharp, throbbing) ear pain in the area around the hole of the left ear for 14 months. No hearing loss, no discharge, no redness or swelling. No vertigo, no ringing of the ear. I passed a hearing test with 100% success. Neither Swimming nor Air Travel made it better or worse. It usually does not hurt for the 1st few hours of the day, them starts around 9-10 AM. It was assumed that my remaining top teeth (which did extend into my sinus) were causing the pain, but now all remaining teeth in the top left have been removed & the pain is returning. The pain did seem to abate while I was on antibiotics & pain meds following each extraction, but the latest extraction was 3 weeks ago now & I'm now well over a week off of the antibiotic (Sulfamethazone) & pain meds--& I can feel the pain rebuilding in intensity. The pain is not everyday at this point--there is a pattern to how I've felt following each tooth extraction (3 total) : the pain would diminish at first, then seem to move from the center of the ear to where the ear meets the face, & then settle back into its usual zone of the bone (cartilage?) surrounding the hole in the ear, returning back to its previous behavior of sharp throbbing. I also notice that when I sometimes turn my head sharply I feel a muscle pull sensation from the center of the ear that extends down the side of my neck almost to my shoulder. This will be followed by a sharper throbbing in the very center of the ear for a short while afterwards, which eventually recedes to the more familiar (duller) throbbing. I have been told that I should wait up to 8 weeks following the last extraction before moving on to a Neurologist --but I honestly don't think I can wait that long if the pain stays at this level for much longer. I get mild relief from OTC pain relievers such as Ibuprofen & Motrin--but it is short lived & does not work at all unless I take large amounts. Following the tooth extractions I was given Percocet along with the Antibiotic , which does give me almost total relief, but I don't want to make that my go-to treatment for obvious reasons, & I have not taken it in over a week.
doctor
Answered by Dr. Suresh Heijebu 16 hours later
Brief Answer:
Possible TGN? Need further evaluation.

Detailed Answer:
Hello, Sir.

I understand your concern.

I have gone through your query in detail.

The pain manifestation in your case is likely to represent a nerve pathology as CT PNS and MRI of TMJ has revealed negative results.

The possibility of Trigeminal Neuralgia/TGN is high as a diagnosis of exclusion, even though the typical presentation is absent in your case.

But the suspicion should be high considering the frequency and duration of pain attacks.

Hence, I advise you to get a Clinical Neurophysiology Testing as the initial test.

Clinical neurophysiology testing with a blink reflex study may be helpful to demonstrate a lesion of the trigeminus in which a bilateral delay occurs in response to the stimulation on the pathologic side.

The blink reflex can clearly help distinguish between the symptomatic form of trigeminal neuralgia and the idiopathic form of trigeminal neuralgia.

The sensitivity of this test across studies has been reported as 59-100%, and the specificity has been noted as 93-100%.

If this test is abnormal, you can go for MRI brain to assess any vascular compression of the trigeminal nerve.

Further management whether medical or surgical is based on the test results.

Post your further queries if any.
Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Drug/Medication
Lab Tests
Medical Topics ,  

Recent questions on  Hearing loss

doctor1 MD

sir, I am operated for epidermoid at left cerebello pontine angle .I suffered with post operative complications like hearing loss (up to 53...

doctor1 MD

Friend had severe sickness, diarrhea & stomach pain possible diagnosis of colitis. However, although slowly recovering he had hearing loss in left...

doctor1 MD

Our 17 year old daughter was diagnosed with Digeorge syndrom at 3 months of age. She has had major cardiac issues with 3 truncus artiriosis...

doctor1 MD

I m a lady of about 28 yrs old. i m suffering from headache since 9 years. but its frequqncy had increased in last 2 years. i m taking nimesulide...

doctor1 MD

What does a mastoidectomy involve? What type of care is required before and after such a procedure?

doctor1 MD

Dr. Eni My daughter is home now and is still nauseous, and dizzy with stomach pain, but is doing better since receiving CBD anally. No reason was...

doctor1 MD

I've seen 2 doctors. I've also emailed back and fourth with Dr. XXXXXXX XXXXXXX on this site. My symptoms are ringing in the left ear. Low grade...