From: anonymous@execpc.com
Subject: ear pain
Posted-By: xx108 (Moderator ofcn.clinic.ent)
Organization: Organization For Community Networks
Date: Thu, 9 May 1996 12:56:49 GMT
Newsgroups: ofcn.clinic.ent

For the last 2-1/2 years, I've been experiencing intermittant shooting/stabbing pain in my left ear. I've been to my GP on numerous occasions, and she has put me on antibiotics several times because I had otitis media. The pains are still here! I went to an ENT in 1994 and he said my hearing is normal and said there was a little positive pressure in my left ear. Most recently, I told my doctor that I'm still suffering, she told me to take Advil Cold & Sinus, which I did regularly for a month, with minimal results. She sent me to the ENT (I saw a different one than before) and he told me that my ears looked fine except that I have dry ear canals. So, he prescribed drops (Fluocinolone Acet 0.01% Soln) and using earplugs when showering (why, then, is my left ear the only one that bothers me if they're both dry?). No results. Now, for the past couple months, I've been having pain in various molars on the left side - traveling toothaches, if you will. Is it possible that some sort of cyst or blockage not in my ear canal, could be causing my troubles? I can't seem to find any other explanation. Can you help? I'm at wits end. I'm tempted to just live with it, but I don't want it to affect my hearing.

Answer -----------------

You describe the symptom of chronic ear pain occuring in the absence of significant findings on examination of the ear. The ear pain is further described as shooting or stabbing.

First of all it is important for you to know that pain felt in the ear does not always originate in the ear. Such pain is known as "referred otalgia" and occurs because of the existence of shared nerve pathways. For example, a very common form of referred otalgia occurs with common strep throat in which the tonsils are infected. Many patients will feel most of the pain in their ears, yet the ears are not infected. The main point here is that when the cause of chronic ear pain is not easily identified by examination of the ears, it is necessary to carefully examine the entire upper aerodigestive tract including the sinuses, the muscles surrounding the ears,the teeth, the jaw joint, the tonsils, the throat, and the voice box. Chronic unexplained ear pain requires a thorough ear, nose and throat examination and may require a thorough dental examination including an evaluation of the temporo-mandibular joint. Ultimately, if unexplained ear pain is severe and fails to resolve, a CT scan or MRI scan may be warranted.

The description of the pain as intermittent and shooting or stabbing tends to rule out infection since that would typically cause a more steady form of pain. Air pressure imbalance caused by eustachian tube dysfunction could cause intermittent symptoms of this nature and would be associated with normal looking ear drums, however a tympanogram should be abnormal. Inflammation of a muscle or ligament near the ear or eustachian tube might account for the symptoms you describe. Temporo-mandibular joint syndrome (TMJ) is a commonly seen example of a musculo-skeletal disorder frequently associated with ear symptoms including ear pain. Neuralgias are inflammations of individual nerves. A neuralgia might account for the symptoms you describe and would most likely be associated with a normal examination of the ear. Mucosal inflammations of the throat or larynx might cause ear pain, but such pain would most likely be of a more steady nature rather than intermittent or shooting, unless the pain was consistently related to the use of the voice or swallowing. Occasionally outer ear conditions such as dry ear canal skin or frank eczematous conditions causing itching or scaling might be associated with intermittent pain or discomfort. Such conditions usually respond to topical steroid drops or creams such as the ones you describe. Certainly, dental conditions such as caries, gingivitis, dental abscesses, etc all can be associated with ear pain. These are just a few of the many conditions that can cause ear pain with minimal or no findings on ear examination and are presented to illustrate the need for a thorough examination of entire ears, nose, throat, teeth, and jaw bones.

--

Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis

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