Unexplained Discomfort Behind the Ear and Neck: A Neurology Perspective

Discomfort behind the ear and in the neck of unknown origin?

Hello Doctor: About a month ago, I started experiencing a noticeable feeling of pressure in my left ear, similar to the sensation of having water trapped in the ear while showering.
In quieter surroundings, I can hear a ringing in my ear.
Resting has not improved the condition; instead, I feel similar pressure in my left neck, head, and lower jaw, and sometimes the entire left side of my head feels numb and tingly.
After visiting an otolaryngologist, I underwent hearing and tympanometry tests, and the doctor indicated that everything with my ear was normal.
They suggested I get a blood test to check for high cholesterol levels, as elevated cholesterol can sometimes cause stiffness in the shoulders and neck.
The blood test results showed slightly elevated triglycerides (195 mg/dL), but nothing else was abnormal, so the doctor recommended that I see a neurologist.
The neurologist conducted several tests (including walking in a straight line, holding both arms up, and an EEG), all of which were normal.
However, over the past month, in addition to my original symptoms, I have developed occasional nasal congestion and mild pressure in the right side of my lower jaw.
I also consulted a traditional Chinese medicine practitioner, who suggested that my body was not detoxifying well and that there was some lymphatic congestion in the lower jaw.
They prescribed herbal medicine, but after two weeks, there was no improvement.
Recently, in addition to my original symptoms, I have started to feel noticeable weakness in my left hand, and sometimes it feels tingly (though I am unsure if this is related to my original condition, as I have experienced occasional tingling in my hands and feet in the past).
I am unsure which specialty I should consult next.
Thank you, Doctor, for your guidance.

Miss Yang, 30~39 year old female. Ask Date: 2016/10/06

Dr. Gao Chunde reply Neurology

Left hand weakness is a new symptom; it is advisable to see a neurologist as soon as possible to arrange for further evaluation.

Reply Date: 2016/10/06

More Info

Based on your description, it seems you are experiencing a complex set of symptoms that may involve both neurological and otological (ear-related) issues. The pressure sensation in your left ear, along with the associated discomfort in your neck, head, and jaw, could be indicative of several underlying conditions.
Firstly, the sensation of pressure in the ear, often described as feeling like water is trapped, can be related to Eustachian tube dysfunction. This occurs when the tube that connects the middle ear to the back of the throat becomes blocked or fails to open properly, leading to a feeling of fullness or pressure. This dysfunction can also cause tinnitus (ringing in the ears), which you mentioned experiencing. However, since your ear examinations have returned normal results, this may not be the primary issue.

The additional symptoms you've described, such as the pressure in your neck and jaw, along with the numbness and weakness in your left hand, raise concerns that may require further investigation. The numbness and weakness could suggest a neurological issue, potentially involving nerve compression or irritation. Conditions such as cervical radiculopathy, where a nerve in the neck is compressed, could lead to symptoms radiating down the arm and into the hand. This could explain the left-sided symptoms you are experiencing, especially if there is any associated neck stiffness or pain.

Given that your symptoms have persisted and even worsened over the past month, it is essential to pursue further evaluation. While your initial assessments by both ENT and neurology have not revealed any significant abnormalities, the addition of new symptoms, particularly the left hand weakness and numbness, warrants a more thorough investigation. You may want to consider scheduling an appointment with a neurologist who specializes in peripheral nerve disorders or a neurosurgeon if your symptoms continue to escalate.
In addition, it may be beneficial to undergo imaging studies, such as an MRI of the cervical spine, to rule out any structural issues that could be causing nerve compression. Blood tests to check for inflammatory markers or other systemic issues may also be warranted, especially given your history of elevated triglycerides.

Lastly, it's important to consider the possibility of a multifactorial issue, where both neurological and otological factors may be contributing to your symptoms. Stress and anxiety can also exacerbate physical symptoms, so addressing any psychological factors may be beneficial as well.

In summary, while your symptoms may initially appear to be isolated to the ear, the progression and addition of new symptoms suggest a more complex underlying issue. A thorough evaluation by a specialist, possibly including imaging and further neurological assessments, will be crucial in determining the appropriate diagnosis and treatment plan. Please ensure to communicate all your symptoms clearly to your healthcare provider, as this will aid in their assessment and management of your condition.

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