Ear Pain and Discomfort: When to Seek Further Evaluation

Ear problems

Hello doctor, my husband mentioned that when he sleeps on his right side, it feels like there is water coming out of his ear, which feels warm, but nothing actually comes out.
He also experiences a tingling pain that extends from his ear to the middle side of his throat.
We have already seen an otolaryngologist, but the doctor said there was nothing wrong.
I would like to know if he should undergo more detailed examinations or if we should consult a neurologist or something similar.
Thank you.

Miss Lin, 20~29 year old female. Ask Date: 2017/02/03

Dr. Ji Zhaoyun reply Otolaryngology

Hello, Ms.
Lin.
Based on your description, the issues you mentioned could potentially be attributed to the following three possibilities:
1) Otitis Media:
a) Acute Otitis Media: This often occurs alongside upper respiratory infections (such as colds) and sinusitis.
In severe cases, there may be ear discharge or pus.
b) Chronic Otitis Media with acute exacerbation: This typically occurs when there is a pre-existing perforation in the eardrum, which can be aggravated by unclean water or improper ear cleaning, leading to inflammation.
Treatment for mild cases may involve ear drops combined with oral medications (such as antibiotics and anti-inflammatory pain relievers).
Severe cases may require hospitalization.
If hearing is affected, it is advisable to seek medical attention promptly.
2) Temporomandibular Joint Disorder (TMJ): This condition affects the joint located in front of the ear and can often be confused with ear pain.
It is usually caused by poor bite habits and can be managed with medication and adjustments to biting habits.
3) Neuralgia: If you have already been examined by an otolaryngologist (ENT), and conditions 1 and 2 have been ruled out (possibly requiring endoscopy or X-rays), you may consult a neurologist regarding the potential for this type of condition.
Wishing you peace and health.
Sincerely,
Dr.
Chi Chao-Yun
Director, Department of Otolaryngology
Taichung Hospital, Ministry of Health and Welfare

Reply Date: 2017/02/03

More Info

When it comes to ear pain and discomfort, especially when accompanied by sensations such as warmth, a feeling of fluid, and radiating pain to the throat, it is essential to consider various potential underlying causes. Your husband's symptoms, particularly the warmth and the sensation of fluid without any visible discharge, could indicate several conditions that warrant further evaluation.

Firstly, the sensation of warmth and pain in the ear may suggest an inflammatory process. Conditions such as otitis externa (outer ear infection) or otitis media (middle ear infection) could be responsible, even if initial examinations did not reveal any obvious issues. In some cases, inflammation can be subtle and not easily detected during a routine examination. The fact that the pain radiates to the throat could also suggest a connection to the Eustachian tube, which connects the middle ear to the back of the throat. Dysfunction of this tube can lead to pressure changes and discomfort in the ear, often exacerbated by changes in position, such as lying on one side.

Additionally, the symptoms could be related to temporomandibular joint (TMJ) disorders. The TMJ is located near the ear, and issues with this joint can lead to referred pain in the ear and throat. Symptoms of TMJ disorders can include pain when chewing, clicking sounds when moving the jaw, and discomfort in the ear area.
Given that your husband has already seen an ENT specialist without a definitive diagnosis, it may be beneficial to seek a second opinion or further evaluation. A more comprehensive assessment could include imaging studies such as a CT scan or MRI to rule out any structural abnormalities or other underlying conditions. If TMJ dysfunction is suspected, a consultation with a dentist specializing in this area may also be warranted.

In terms of next steps, here are some recommendations:
1. Seek a Second Opinion: If the symptoms persist or worsen, consider visiting another ENT specialist for a thorough evaluation. Sometimes, different doctors may have varying perspectives on the same symptoms.

2. Consider Imaging Studies: If the ENT specialist feels it is necessary, they may recommend imaging studies to get a clearer picture of what might be happening in the ear and surrounding structures.

3. Evaluate for TMJ Disorders: If TMJ issues are suspected, a consultation with a dentist or oral surgeon who specializes in TMJ disorders could provide insights and potential treatment options.

4. Monitor Symptoms: Keep a detailed record of the symptoms, including when they occur, their intensity, and any associated factors (like changes in position or activities). This information can be valuable for healthcare providers in diagnosing the issue.

5. Pain Management: In the meantime, over-the-counter pain relievers may help manage discomfort. However, it is crucial to consult with a healthcare provider before starting any new medication.

In conclusion, while initial evaluations may not have revealed significant issues, persistent symptoms warrant further investigation. It is essential to advocate for your husband's health by seeking additional opinions and exploring all potential avenues for diagnosis and treatment.

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