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Treatment for CHRONIC EXCRUCIATING EAR PAIN more on night.

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I have chronic excruciating ear pain primarily in my left ear.

It often but not always accompanies a cold or flu, and can last more than two weeks at a time.

Unfortunately, the majority of times I have seen a physician, a basic ear exam rules out infection and I am told my ears look fine. The first ENT I met with believed it was a dental issue, however, a visit to my dentist ruled that out. The second ENT I saw believed it is due to slight friction problems in my jaw and prescribed hot compresses, soft foods, and robax platinum, an over the counter medicine containing a muscle relaxant and Ibuprofen. I recently visited my dentist, who showed me scans of my jaw and said they looked normal , and unfortunately, in the aftermath of a recent flu due to which I am still dry coughing like crazy, I am in excruciating pain and nothing the ENT recommended provides the relief I need. The pain is in both ears, but it is twice as bad in the left as in the right.

On a scale from 1 to 10, I put the pain at at least a 9.

I went to a clinic today in pain so severe I could barely speak, and once again, a general practitioner ruled out infection. I was prescribed 10 mg of Ketorolac and instructed to take 2 per day with meals, and, if the pain was severe enough, 1000 mg of Acetaminophen 4 times daily. Unfortunately, neither medication is providing any significant relief, and I have had to add 2.5 mgs of Supeudol which I have from a shoulder injury to the mix in order to be able to think beyond the pain. However, even this only takes the edge off. The emergency room is not an option, as the hospitals in Montreal do not have the resources necessary to fully explore and determine the source of a patient's problem and pain in order to determine the best possible treatment.

I am 32 years old, female, relatively healthy aside from occasional migraines, and of Southeast Asian and Eastern European descent.

I am on the following medications:

Modafinil - 200 mgs in the morning

Dienogest - 2 mgs - for endometriosis

Valtrex - 500 mg daily for prevention

Cellcept - This was prescribed to treat my severe hand eczema, but at the first sign of a cold or flu, I stop it for 2 weeks

Hydroxyzine - 25 mg tabs - 2 to 4 as needed - These were prescribed for severe eczema itch, but I also use them as an occasional sleep aid

Nasal Spray for Seasonal Allergies

I also take calcium, magnesium, omega3s, B12 and a multivitamin

My questions is as follows: What is it the doctors I have seen are missing that could cause ear pain this severe?

Category: ENT Specialist

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Category: ENT Specialist
 29 Doctors Online

Hello,

Thanks for your query at DoctorSpring.com

I can understand your problem.

You are suffering from recurrent ear pain, now severe.

You are also suffering from eczema and nasal allergy.

You pain can be due to Eustachian tube dysfunction ( tube connecting ear and nose) due to nasal allergy. But this is usually not severe.

Another possibility it can be eczema of external ear skin and self-cleaning or scratching of ear can cause severe pain

It can be a referred pain from throat or teeth.

So to know the correct diagnosis you need examination by an Ent specialist, who can do endoscopic examination if required. As you taking analgesia already, I believe that you need an ENT opinion

Hope this helps

Beat regard



Patient replied :

Dear Dr. Jalan,
Thank you very much for your reply.
Dental exams ruled out teeth issues.
Wouldn't eczema of external ear skin show up on a basic ear exam?
The pain I experience is sharp, sometimes burning, and feels like it's deep in the ear. It also sometimes accompanies a feeling of heat around the ear, jaw, and throat, and loud noises often aggravate the pain to the point that I can't use the phone for days.
Let me know.
Sincerely,
Samantha


Hello,
Yes, eczema does show up on routine ear exam, sometimes it can be missed in the earlier stages.
It could be due to Eustachian Tube Dysfunction, as I said earlier.
Please get the endoscopic evaluation done, and get back to me.
Regards.


Patient replied :

Dear Dr. Jalan,
I met with an ENT who said that the problem is being caused by a combination of Eustachian Tube Dysfunction, jaw trouble, teeth grinding, and nasal sensitivity and allergies, all aggravated by stress and anxiety. He said that individually, they wouldn't cause pain this severe, but together they form "a perfect storm".
He recommended an antihistamine nasal spray, and a moisturizing one, and that I should get fitted with a mouth guard to minimize tooth grinding. He also said to do what is necessary to minimize the anxiety, and ordered a CT scan of the area just to make sure. Regarding pain medicine, he said I should confer with my GP and other specialists in order to figure out what is best given the other medications I am taking.
Thank you for all your help,
-Samantha


Hello,

Still eustachen tube and some nerve related pain in likely possibility

So nasal spray will help and CT sacn will also help in diagnosis.

So I ll also suggest for same.

Hope this helps

Best regards


Dr. Sunil Jalan
Category: ENT Specialist
Experience: 
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
Dr. Sunil Jalan and 4 other Medical Specialists are ready to help you

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