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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33544
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have mild left ear pain for 2 month, No, I have mild

Customer Question

Hello
JA: Hi. What is your issue regarding?
Customer: I have mild left ear pain for 2 month
JA: Are you experiencing any dizziness? Do you have a fever?
Customer: No
JA: Anything else in your medical history you think the doctor should know?
Customer: I have mild tonsill swollen with white in color for about 3 weeks now
Submitted: 3 months ago.
Category: Health
Customer: replied 3 months ago.
Hi
Expert:  Dr. Muneeb Ali replied 3 months ago.

Hello im just now writing down your answer, just a couple of minutes thanks!

Customer: replied 3 months ago.
sure
Expert:  Dr. Muneeb Ali replied 3 months ago.

Hi,

Welcome to JA and thanks for this question. Im sorry to hear about your symptoms. From what you are describing it sounds like that you may have developed an infection of the middle ear cavity, the reason im saying this is because you have an infection of one of the tonsils in the throat. And the middle ear cavities are connected to the throat via the eustachian tube, any infections which are likely to be chronic in nature in your case, can travel via this tube into the middle ear cavity. The pain that you are experiencing can be due to chronic otitis media albeit a mild form of the disease. This can also cause discharge in more severe cases but mild cases usually only cause pain. The diagnosis is on a medical examination and then treated with antibiotics.

Another cause of this can be associated with ear wax, one of the commonest causes of minor ear pain is ear wax which bcan be slight deep inside the ear canal which is why you could miss it on simple examination. This is a common cause of pain as i said and in most cases cleaning out the canal results in improvement of the pain. This can be done at home in some cases.

Now in your case i would advise that you have your doctor examine the ears just to be on the safe side, so that an infection is ruled out and then have him clear out the ear of wax. In the meantime start using OTC tylenol for the pain if it worsens.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Customer: replied 3 months ago.
i have already contacted ENT doctor, they mentioned, there is no wax or infection in the ear
Expert:  Dr. Muneeb Ali replied 3 months ago.

They examined the ear internally? Also is the pain more stabbing or a dull ache?

Customer: replied 3 months ago.
ENT Doctor also mentioned to check with Dentist, then I went to Dentist and removed my both left side wisdom tooth extrated, now its been 3 weeks now, I extracted, still the pain I could feel in the ear
Expert:  Dr. Muneeb Ali replied 3 months ago.

Any facial pain? pain over the eye region etc? ANy numbness?

Customer: replied 3 months ago.
No numbness, but the pain on temple area sometime, and once a sharp pain in left side of skull in the night for 2-3 seconds and after it did not repeated till now.
Expert:  Dr. Arun Phophalia replied 3 months ago.

What is your age and gender?

What did your ENT say about the mild tonsil swelling and white color?

Are you diabetic?

Are you on any medications?

Any significant past medical illness?

Customer: replied 3 months ago.
I am 41, male.
ENT doctor mention, could be issue with dental/tooth
I am not diabetic
Yes. I am on medications. (After wisdom tooth extraction, for a week i used pain killers and anti..) and some ear pain killers
NO medical illness to my knoweldge in the past
Expert:  Dr. Arun Phophalia replied 3 months ago.

Was something mentioned about your tonsil by your ENT specialist? Some chronic infection?

Do you have heartburn, acid reflux?

Expert:  Dr. Arun Phophalia replied 3 months ago.

Your symptoms point to Otalgia. It means ear pain. This can have two origin (You mentioned that first one has been ruled out by the ENT specialist);

1) pain due to ear conditions.

2) referred pain due to other conditions which have diverse cause.

The ear conditions can be;

1) external otitis,

2) otitis media,

3) mastoiditis, and

4) auricular infections.

The conditions which can cause referred pain can be (these are main conditions);

1) Ramsay Hunt syndrome
2) Temporomandibular Disorders
3) Trigeminal Neuralgia
4) Dental infection or abscess
5) Labyrinthitis; internal ear infection

6) Sinusitis; sinus infection

7) Pharyngitis; throat infection

Referred otalgia (ear pain), which means pain in ear may not be related to ear diseases but remote or distant anatomical sites which share dual and common nerve supply (innervation) with the ear, and noxious stimuli to these areas may be perceived as ear (otogenic) pain. By definition, referred otalgia is the sensation of ear pain originating from a source outside the ear. Following are the causes which may be considered;

1) Chronic sinusitis; an MRI or the CT scan of sinuses would be suggested. Allergic fungal sinusitis, Barosinusitis should be looked for the cause.

2) Neck problems can also refer pain to the ears. These disorders include cervical osteoarthritis, cervical myofascial pain syndrome, and traumatic injuries. MRI of the neck spine would be advised.

3) Eagle syndrome, in which the elongated styloid process irritates branches of cranial nerves can cause ear pain. MRI of styloid process is needed, but this is not a common cause.

4) Laryngitis, esophagitis and gastroesophageal reflux disease (GERD) can be responsible for the bilateral ear pain which increases during migraine. Direct laryngoscopy, upper gastrointestinal endoscopy, 24 hours pH estimation of the esophagus would diagnose these issues. A therapeutic trial of antacids and acid blockers may also help in determining the cause and may give the clue for the further investigative work up.

5) Various neuralgias; Apart from trigeminal neuralgia; various other neuralgias can cause the ear pain. Sphenopalatine and vidian neuralgias cause ear. Glossopharyngeal neuralgia, which causes a phantom tonsillar pain, may also cause otalgia.

6) Meniere disease.

7) Tympanic tube dysfunctions.

8) Dental disorders of malocclusion.

9) TMJ joint issue.

Following investigations, if not done would be advised with the above recommended investigations and medical imaging;

1) Thyroid function and erythrocyte sedimentation rate (ESR).

2) Antibodies for thyroiditis.

3) Vestibulocochlear testing.

4) Audiography

5) Nasal endoscopy.

6) Upper aerodigestive tract endoscopy,

7) Laryngoscopy.

Consulting an ENT specialist or a neurologist working in a hospital attached to a medical school would be ideal. These doctors / specialists work in tandem and as a team to ascertain the cause. Various numbing medications can be locally applied or injected (like sinus, larynx, pharynx etc) and that way specific cause of ear pain can be diagnosed or ruled out in these medical research institutions.

Please read this reference resource:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667230/

This mentions: an unusual case of large tonsillolith presented with acute otalgia. Since the tonsils and tonsillar fossa are supplied by the glossopharyngeal nerve, any irritation or pain can be referred to the ear along the tympanic branch of the glossopharyngeal (Jacobson's) nerve.

The ear receives an extensive sensory innervation via four cranial nerves (V, VII, IX, and X) and two spinal segments (C2 and C3). The most common causes are temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 3 months ago.

It is privilege assisting you.

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Thank you.

Wishing you all the very best in life.