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Can Mastoidits cause a 'referred' forehead pain ?
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Can Mastoidits cause a 'referred' forehead pain ?

Hi All,

My question to the group is:  Can Mastoiditis cause 'referred' symptoms like Eustachian Dysfunction, headache, dizziness, fatigue, and malaise?  The area behind my ear is NOT tender, although the cartilage part of the affected ear canal does very occasionally feel a slight sharp pain and/or burning sensation.

Here is some background:

I suffered Otitis Media in late September, which was temporarily controlled by Amoxicillin. The Otitis returned in September, and I had to undergo a second round of antibiotics (Ciprofloxacin) , before it was finally brought under control.  However, ever since then I have been left with persistent Eustachian Tube Dysfunction, daily headaches (pressure band across forehead and temples), dizziness, and general malaise and fatigue, with no sign of arriving at a definitive diagnosis.  

An ENT I visited initially suspected Sinusitis, and I accordingly had a CT scan done. This came back normal, except for 'very mild maxillary thickening' and 'mild deviated septum'.  Plus, I've never had any nasal symptoms like congestion, runny nose etc. The ENT prescribed me two rounds of Azythromycin (i.e.2 x 6-paks), which only helped for 2-3 days at the end of each round, and then my symptoms came right back..

Recently I visited an Oto-Neurologist, who said my initial Otitis Media could have left me with Mastoiditis, which is hard to cure using oral antibiotics. I am now scheduled for a brain MRI to see if my problem is Mastoiditis.

Again, my symptoms are a pressure-band like pain in forehead and temples for most of the day, dizziness most of the day, fatigue, and general feeling of sickness (malaise).

thanks!

Akshay
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Mastoiditis is very often a complication of acute otitis media. It occurs due to bacterial infection of honey comb like mastoid air cells. The most common symptoms are pain the ear, swelling and redness. Fever and headache can also occur.

There is a possibility that your symptoms are due to mastoiditis since you have a positive history of otitis media.
It is therefore worth to check out the possibility of mastoiditis. So please go ahead with the MRI scan and keep us posted.
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My MRI came back w/ the following result:

1. Mastoids are clear
2. Mild mucosal thickening of ethmoid and maxiallary sinus
3. small focal outpouching along superior margin of lateral ventricles.

According to the Otoneurologist, none of this would explain my ETD, pressure headache, dizziness or malaise/fatigue.  An audiology test I did was also clear. The only thing he could see was there was a slight nystagmus in left eye, under examination w/ Frenzel goggles.

He has suggested that I try 'Astelin' antihistamine nasal spray to help with the ETD, and has shown me 'Canalith Repositioning' exercise to help w/ the dizziness. He has no answer for headache and malaise, except to say that I should monitor the situation for 2 weeks, and if it doesn't get better, he will prescribe an anti-depressant called Venlafaxine (Effexor) to help with headache and malaise/fatigue.  

Does this seem like a logical course of action?  

thanks!

Akshay

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Dr. Noopur,

One more observation.. I have noticed that my headache is worst in the morning after waking up.   Could it be that the Otoneurologist is wrong to dismiss the report of 'mild' ethmoid/maxillary mucos thickening?   He reached this conclusion because 1) I have not nasal symptom like discharge, congestion etc., and 2) I've already been on several weeks of antibiotics in the recent past, which would have cured any possible sinus infection..  Also both the CT I had last month and my latest MRI show very slight mucosal thickening, which the doctor says is present in up to 30% of the population.

However, I'm still not convinced that my problem is DEFINITELY not sinus related, because my headaches seem very 'sinus-like' i.e. a dull pressure band across the forehead and between nose, which is worse in the morning.  Also, I've read that oral antibiotics are not always effective for sinusitis.

What is your opinion?    Also, what is your opinion on 'sinusitis vaporizer treatment' (see link below).  I'm wondering if it's worth trying this.

http://www.sinusdynamics.com/Sinusitis-Vaporizer-Treatment.html

thanks a lot!

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Hi Akshay,

Good to know that your scans are clear. The link that you have sent is just a novel way to aeroslize the medications like antibiotics etc for quicker action. Oral drugs take long to act as they have to be absorbed from the stomach into the blood stream.
I would also suggest you to discuss the possibility of TMJ or temporomandibular joing disorder, Meneire’s disease and allergies which can cause ETD along with dull pressure headaches.
ETD also occurs after a bout of otitis media and may persist for several months before getting better.

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