4 year old with ear pain

I have a 4yr old that has had daily ear pain for 14weeks now. The pain is always in his right ear and he has always said that it is his ear that hurts. In the beginning, the pain only lasted about 15min. and then would subside. This would occur 2 or three times a day. It would be a gradual pain that would peak and then subside. The severity of the pain and the length of the episodes gradually increased over time. In May. He is now in pain all the time and is on a temporary drug...Toradol...that gives him about 5 hours of pain relief and then we have to alternate with Tylenol. There is no sign of ear infection. He has been to an ENT, an otologist, a visit to the ER and a neurologist. He has had a full head CT, an EEG, a MRI with and without contrast and a CT of the temporal bone.  The CT and the EEG were completely normal. The MRI showed something in the right mastoid process. The impression is that it could be related to a type 1 branchial cleft sinus remnant or a cholesteatoma. However the follow up CT on the temporal bone showed absolutely nothing. I see another ENT tomorrow. (Referred by my current ENT) My fear as that I will be right back where I started...undiagnosed ear pain of a poor 4 year old. I need help and feel that I need at least one doctor dedicated to helping my son. It seems like we are just being passed on from one doctor after another. Daily medication can't be healthy for him and he only has one kidney that functions at 100% (due to kidney reflux) Any suggestions?

[Eric Genden, MD]

I would recommend that you consider a pediatric otolaryngologist at the nearest major academic medical center. This problem sounds a little more perplexing than the typical otlagia- Has anyone checked his throat to make sure that this pain is not referred from the throat? Again, a major medical center is your best best.