What causes swelling behind ear inspite of being on antibiotics for infection?

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Posted on Tue, 16 Jun 2015 in General Health
Question: Hi, I hope all is well. I received the Health Magic email inviting a question, and it's timely. Recall you helped with http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=186542

I have an MRI and updated X-ray and expert input now that indicate where I have some spinal issues, and that issue is progressing.

However, the original infection that sparked all this is back, and I would greatly appreciate your eyeballing some pics I took today and letting me know your thoughts. Sorry for quality, tried hard as I could. Will upload a PDF.

I have had a slow progression of symptoms ever since ending a second course of antibiotics, with slight visible swelling behind my right year for about a week. It is in the same line as the previous infection in the back of my ear fold, however a bit more towards the bottom.

Yesterday, there was a small black area visible in the center. Today, it became two areas, with one becoming red. A small amount of red stuff came out a few hours ago, three tiny flakes like dried blood, however there hasn't been any bleeding or fluid of any kind.

So slow progression for weeks, significant visual expansion in last 24 hours. Not sure what to do, or how fast to move. Don't want to try antibiotics randomly, having tried two rounds and did not have success. I had swabs taken by an ENT, however very puzzlingly I cannot get hold of him or find out the results - possibly on vacation.

Please let me know if the pics spark any thoughts from your neural net?

Most thankfully.
doctor
Answered by Dr. Dariush Saghafi 21 hours later
Brief Answer:
Appears to be possibly infected

Detailed Answer:
THANK YOU for returning a DIRECT QUERY to my attention. I am honored that you've chose to send a question my way based on information I've provided to you for other issues in the past. I'm also happy to hear that you feel that you're making some progress on other fronts that we've discussed.

As far as this particular one is considered. I am not an infectious disease specialist or wound specialist to feel 100% confident in what I'm going to tell you, however, I agree that from your pictures the area behind your ear certainly appears inflamed and swollen. If you've been through 2 rounds of antibiotics then, I think the next move should be to be seen precisely by an Infectious Disease specialist.

To my way of thinking, and again, please understand I am not a specialist in this area, but what needs to be done is to determine that there is actually an infection in this area to begin with....have CBC studies the presence of an elevated white cell count? Is the area warm to the touch? Is the swollen region painful to compression? Have you attempted to either use ice or heat to see if it either dis-inflames or perhaps develops a whitehead or situation whereby a physician may able to successfully XXXXXXX the lesion and collect some fluid for culture testing?

Of course, since you've just been on antibiotics any culture will probably be negative so you'll want to wait a little bit so that area becomes DE-sterilized before taking a culture.

I would also run an ESR or CRP test to check for the degree of inflammatory response there's been in your body. If those are elevated by your white blood cell count is normal then, it is less likely that there is an infection and more likely that there is an inflammatory process of some other type going on.....what? Well, again that would be the territory of another specialist to tackle but some guesses on my part could be something in the arena of rheumatology such as gouty arthritis, irritated plaque formation of some type from either eczema or psoriasis...again, my apologies but I am stepping out of my role as a neurologist to try and help with as much information as possible.

Of course, this COULD VERY WELL still be infectious in which case we return to the necessity of getting a sample of whatever is inside that area (be it blood or pus, or both) and send it to the lab for culture and sensitivity.

So, for the time being I would hydrate generously with fluids, keep the area clean and dry, avoid manipulating it a whole lot in case some of the redness and swelling could simply be due to a lot of handling, pulling, or what not....and see if your PMD or ENT will do anything to get that to swell up enough to give you a nice area to XXXXXXX and drain or something......

I hope this answer satisfactorily addresses your question despite my probably being somewhat inexpert in my responses. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and continue this discussion.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 16 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 2 days later
Thanks much. I will consolidate and reply as soon as I can.
doctor
Answered by Dr. Dariush Saghafi 9 hours later
Brief Answer:
Very well- I will be awaiting more information from you.

Detailed Answer:
Thank you for your response to my my suggestion and perspective on what appears to be an infection behind your ear.

In the mean time, may I ask that you close the query as soon as possible since we are currently awaiting more data or information from your end. You may certainly re-implement the question when more is available to share such as test results as well as condition of the wound.

However, I'd appreciate your evaluation to this point of the responses with your highest STAR RATING POSSIBLE and FEEDBACK as you generously did last time so that the question can be archived before month's end and credit received for this transaction.

When ready you may write back to:

bit.ly/drdariushsaghafi

The query has required a total of 23 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi 14 hours later
Ah, sorry, I am just kind of overwhelmed starting my cloud company. Even health, as long as I live ;-), must be priority 2 sometimes.

Would prefer to keep this open for just a bit. However, is time of a query staying open a metric for you? Please let me know and I will work as best possible to support you.

Thanks much.
doctor
Answered by Dr. Dariush Saghafi 15 hours later
Brief Answer:
Perfectly understandable

Detailed Answer:
Thanks for your response and having the insight and sensitivity to understand why the doctors on this network do try and encourage patients to close queries sooner rather than later.

To answer your question about this being a metric...it is and it isn't....however, toward the end of the month it becomes more a matter of queries that are closed being tallied as part of the month's earnings. Any query not closed within that time frame will not be distributed in the provider's earnings until at least following month.

And so, for the next couple of days there shouldn't be a problem keeping this question open...the danger simply becomes having people remember to close their questions out before month's end and then, to also remember to respond with feedback since that IS A METRIC that is useful to both us as well as those who administer this forum. Look at it as bigger bags of peanuts if you will! HAHA!

As one who is involved in their own business enterprise I know you understand the analogy! LOL....

Thanks for your support and understanding and by all means keep me informed as to what is happening with the ear "infection."



Cheers!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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