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Mastoid Complication...ATFP or Petrous Apex?
I'm a 39 yr old female & 22 mo post-op a 2nd radical mastoidectomy (both rt ear). The first, 18 yrs ago, due to cholesteatoma w/extensive disease. All remnants removed & my hearing lost. The second, due to a benign fibrous connective mass, again w/extensive disease. Prior to 2nd surgery ct scan showed dehiscence of 3mm w/in anterior wall of eac & 2mm of tegmen tympani. Second also complicated by staph infection.

Additional post surgical problems: CHRONIC head, neck, jaw & ear pain, rt side. Also, all pre-surgical complaints. Dull, deep & constant. Also elevated wbc & bp since surgery. Have seen 12 medical/dental professionals...including IDS (6 wks IV antibiotics), Ortho (tmj eval, custom dental splint), Neuro (on 3 daily meds, 2-4 meds PRN & trigger point injections-now 2 mo intervals)-past 12 mo-current. Diagnosis:ATFP (Believes multiple superficial nerves damaged during surgery...only because somewhat responsive to meds. But, admits pain has been very difficult to manage.)

In my research of chronic mastoiditis I had read an article pertaining to the petrous apex. Is it plausible that the petrous apex may be involved in my case? That perhaps there is entrapment of infection or inflammation? Or would I be more symptomatic? It seems it can be defined with proper imaging. What particular imaging would be necessary? If not plausible is there another treatment course that may be explored? Chronic pain has dictated to me for over 2 years...I hope to find a solution sooner than later.  Any imput would be appreciated & I thank you for your time, in advance.








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