ear pain/pressure

[medic6613]

I am a 53 y/o male with left ear pain/pressure x 2 1/2 months.  Been on several antibiotice, a steroid pack, a muscle relaxer and antihistinmines.  Seen a chiropractor, had a root canal.  Had a CT of the head and sodft tissue of the neck.  Results showed  a slight venticular dilitation and mild corical atrophy.  I also have neurfibromatosis which is not a problem for me.  No head aches, blurred vision, or tinitis.  Pain is sometime not but but does get worse at times.  I have an appt with another ENT 12/21.  Its about to drive me nuts.  Also I have at times a scratchy throat.

[mgfriesen]

I have the exact same symtoms as you and am waiting to schedule my MRI appt.  I doubt anything will show up either but want to do it for peace of mind.  I also went to a TMJ specialist and have mouth pieces for day and night but my symptoms got worse after several months of wearing the mouth pieces for grinding.  I am frustrated as well as my ears hurt, light ringing, lots of pressure (hurt when listening on speaker phone, when only one window is open, etc), and some dizziness when doing yoga when head not upright.  I have been to my ENT 3 times and tests show nothing wrong but at least he treats the symptoms and what patient says not the results of the tests thank goodness.  I totally understand where you are coming from.  

[medic6613]

I swa the TMJ specialist yesterday.  His xray revealed the i have a problem with a ligament on the left side that might be inflamed.  All these months and test and that all it is.  At least its not worse. Wants tio make me a bite guard.  Would one from a drug store do the same thing?

Thanks

[medic6613]

ENT office called today.  Stated there was nothong on my test that would indicate ear pain.  Also no reason for my follow up vistit 1/15.  They did however say i should see the TMJ specialist i was refered to.  I'm about tired of seeing different Docs.  I'm also tired of ear pain.  At least I guess I can put CA on the back burner.  But even though a dedicated MRI was not done in the TMJ area, what I did have showed nothing.  Think I still need to see the TMJ guy?

Thanks

[medic6613]

T SOFT TISSUE NECK W CON,CT HEAD W/WO CONTRAST

10/30/2007
History: Ear pain, sore throat.

CT HEAD

CT head before and after contrast infusion of 100 ml of Omnipaque-300.

There is some artifact secondary to metallic dental fillings near the
base of skull.

The brain midline is normal without shift or mass effect. There is
slight ventricular dilatation. Mild cortical atrophy changes are seen.
No focal brain lesion is observed or mass or hemorrhage. No unusual
enhancement pattern is seen postcontrast.

Impression: Mild ventricular prominence. Otherwise the exam is
negative.

CT SOFT TISSUES NECK

CT neck soft tissues: Imaging is from the base of the skull through the
thoracic inlet with contrast infusion.

Evaluation at this time shows no evidence of definitive mass or
adenopathy. No unusual enhancement pattern is seen with contrast
infusion. The airway appears normal. There is suggestion of a small
cyst or nodule in the right lobe of the thyroid. It is not
sufficiently characterized by this exam.

Impression: CT of the neck soft tissues is unremarkable.

Incidental note is made of what appears to be a small nodule in the
right lobe of the thyroid that could either be a small cyst or a small
solid nodule. It is insufficiently characterized because of its small
size by this exam.

[medic6613]

The head is on the films.  I did have a CT of the brain last month.

[Nancy T]

You didn't have a brain MRI? Did they look at your ears?

[medic6613]

Results.  What the heck.  Now what?  At least now I know whats it not, which I think is good.

History: Otalgia, possible nerve compression due to neurofibromatosis
versus TMJ problem.

Multiecho/multiplanar images of the neck were obtained prior to and
following the intravenous administration of contrast. It does not look
like there is a definite enhancing mass suggestive of a neurofibroma on
this study. No significant abnormality is seen around the TMJ area on
the left although a dedicated TMJ sequence was not carried out. The
patient was going to have a more focal TMJ study on the current exam on
the day performed, however, declined to have this study at this time.
There is no laryngeal abnormality. There is no pathologic-appearing
lymphadenopathy. The salivary glands look relatively normal. It is
noted within the subcutaneous soft tissues of the neck posteriorly that
there are some enhancing nodular areas. These could relate to
underlying neurofibromas.

IMPRESSION:
1. There are enhancing nodular areas within the subcutaneous soft
tissues of the posterior neck that could relate to underlying
neurofibromas.
2. There is no definite abnormality readily apparent around the area of
the TMJ joint on the left.

[Nancy T]

You can get the CD, but if you're not a radiologist trained to read MRIs, all you can do is marvel at those crazy-looking eyeballs. :) You could get the report, but it's really better to see your doctor first, to put in proper perspective whatever the report says.

[medic6613]

Its hard to say.  I'm goign to try to get the CD today, but it might not be ready until tomorrow.  I guess if nothing is there, i'll see a TMJ specialist.

Thanks

[Nancy T]

Prolly depends on HOW he said "you'll have some answers to your ear pain." Was it in a tone of "someday we'll have answers to everything, like why did the chicken cross the road?" Or was it a hard-boiled, no-two-ways-about-it tone?

If he saw an acoustic neuroma, that wouldn't explain ear pain. But maybe he did see something else.

[medic6613]

Had an MRI today.  Haven't been informed of the results.  For the heack of it  I asked the tech if he saw anything on it.  I knew he couldn't say anything, but he did say the doc would read it today, but I would have some answers to my ear pain.  Is that a red flag or what?  Makes me wonder.

[medic6613]

I'm on the fence about the MRI. Especially after having a CT.   I just made an appt with a dentist that specializes in TMJ.  This was actually mt ENT's first suggestion.  Still might get a MRI if I don't need to sell a kidney to do it

Thanks

[Nancy T]

I wasn't actually thinking that medic6613 had the symptoms of an acoustic neuroma, only that an ENT was likely to want an MRI just to be sure. I.e., maybe that's the reason the ENT ordered it. Because neurofibromatosis CAN cause bilateral acoustic neuromas. At least one type of it.

Hope all goes well for you,
Nancy T.

[medic6613]

Thank You.  The first ENT I went to did a hearing test which showed what I had had for a long time.  High frequency hearing loss.  He also did another test, not sure what.  Put some devices in my earsthat seemed to have some sort of suction to it.  Then th CT.  I'm still on the fence with the MRI.  I have insurance, but it won't pay all of it, and if its done after the first of the year i'll need to meet my deductable again.  It does seem to be a little better, and no as often.  Still bothers me though. As far as the sx of acoustic neurom you lised, I have none of those.  Just pain and pressure.

Thanks

[Wear/a/Jimmy]

An acoustic neuroma would not manifest like this. An acoustic neuroma would not cause an eustachean tube disfunction.....  or at least I don't see how it could. Seems to me you have yet to have thorough auditory evaluation, including tympanometry, which checks for middle ear pathologies. The GSI TympStar has special testing capabilities for testing eustachean tube disfunction. I would think a college university would have one. They are pretty advanced, most ENT offices would not have such a machine. They would have a lower end tymp machine that does basic tympanometry.

If you would like and do a quick self check ans se if you have a conductive hearing loss, you can make a humming noise down in your throat. If you hear the humming sound more so in the left ear. you have a conductive hearing loss, which in your case would be caused by a middle ear pathology. Which is not indicative to an acoustic neuroma.

I think an MRI in your case is over kill, if other basic testing has not been done yet. BUT, if you have good insurance....  Hey, I like MRI's just to have a base line. You never know when something may come up, and having a comaparitve MRI is nice.

My advices, for your future auditory needs, see an ENT.

Acoustice Neuromas are ususally unilateral, as Nancy suspected. Here are some of the symtoms of an Acoustic neuroma.

1) Asymetrical Sensory Neural Hearing loss
2) Dizzy
3) Tinnitus
4) Facial Paralyssis
5) Loss of taste
6) Vission change
7) Head aches

So don't lose a lot of sleep over the Acoustic Neuroma possibility.

[medic6613]

Thanks.  The NF has never really been a problem for me, but it would still be good to know whats going on.  I believe i do grind my teeth at night  I also notice at time I "work" my jaw muscles.  All this leads me to. believe TMJ, but my dentists says no.  All i know is its driving me nuts

[Nancy T]

If you have neurofibromatosis, they will probably want to rule out an acoustic neuroma with an MRI (WITH contrast). I believe these are common with that disease (although I'm sure you know more about it than I do--I do know there are two types of it and I don't know if acoustic neuroma happens in both or just one of them). Hope it's not that! Acoustic neuromas don't cause pain, as far as I know, but maybe the ENT feels it should be ruled out anyway. I would certainly get the MRI. Good luck and let us know.

[medic6613]

OK  I had my appt 12/21 with a different ENT.  He's also not sure.  Exam showed nothing.  He want me to have an MRI.  He also as the other ENT suggested TMJ, but my dentist said thats not it.  I even had a root canal done hoping that would help.  Pain doesnt seem to be as bad or frequent as before, but it is still there and not constant.  Any ideas what he looking for with the MRI and is it worth it? He did mention something might be pressing againt it.  Should i start worrying?

Thanks

[Enoch Choi, MD]

if you can "at times hold {your} nose and blow to try to clear it, and can feel it trying to clear" then that makes me think of post-nasal drip causing eustachian tube dysfunction.  nasal saline rinses and steroids sprays can help

[medic6613]

Dentist said  no to TMJ.  When I first started having a problem I could hear the fluid in my ear.  I'm a Paramedic, so one night when I took a pt to the ER I hade one of the docs look at it.  He said it was full of fluid, and he gave me antibiotics and a decongestant.  Shortly after that is when the pain and pressure started.  I wnt to my regular doc, and the ear was clear.  Got another antibiotic amd a steroid pack.  Ear canal still remains clear, but I still have the pain and pressure.  I can at times hold my nose and blow to try to clear it, and I cann feel it trying to clear.

Thanks

[Enoch Choi, MD]

Glad to hear you have a second opinion on the 21st.  let us know how it goes.

Ear pain and pressure for months can be from many of the places you've been evaluated for already: ear, brain, teeth, jaw, neck.

Did your dentist evaluate for TMJ?  temporalmandibular joint pain?

A scratchy throat would make me wonder about post nasal drip and allergic rhinitis that can lead to a blocked eustachian tube.  Did your doctor see fluid behind the eardrum without infection?  that's called serous otitis media (otitis media with effusion) which could contribute to pain & pressure.  Nasal steroids can help.