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Suggest Treatment For Persistent Pain In Ear And Fever
Question: Last Thursday I had some odd sharp, stabbing sensations under my left jaw (not in the jaw but behind it in my neck). By Friday the pain was no longer there, but my left jaw/cheek was swollen. I went to urgent care and they told me it was a dental abscess and prescribed Clindamycin. By Sunday the pain and pressure in my neck and behind my ear was ridiculous! I also felt like I had a really bad flu and had trouble swallowing and opening my mouth wide. Simply breathing caused the stabbing pain in my neck. I ended up going to the ER and the doctor said I had a viral throat infection. I saw my pcp and an oral surgeon on Tuesday. The dentist said there was most likely an infection in my gums or jaw and it had most likely spread into my lymph nodes and throat. The pcp seemed clueless and said to gargle salt water. They both said I could take a ZPack (I have GI issues that keep me from being able to tolerate antibiotics such as doxycycline, which works great for me, and I am allergic to penicillin) one a day without the loader dose. I have been taken the zithromax all week. Last night I had a fever, chills, splotchy red rash all over my face, pain in and behind my ear, dizziness, and pain and pressure in my head (mostly behind my eyes) and went back to the ER. They did a CT scan and diagnosed me with cellulitis in my neck, gave me a form of ibuprofen in my iv, and sent me home. Today, I have the same symptoms (only my ear is much worse with stabbing pain inside and slight hearing loss at times) and it is hard to talk and turn my head. My temperature has been as high as 101.8. I called my pcp and he said that the final result of my CT scan didn't show any signs of cellulitis and only some sort of calcifications? How can one radiologist find cellulitis (I saw the report in the ER) and then the next sees nothing of the sort? What do my symptoms sound like so that I know whether to start shelling out money for dental work that I may or may not need done? I am miserable and my doctor seems to be washing his hands of the whole thing because he isn't sure what is happening. Thank you!
Brief Answer:
complications of viral illness.
Detailed Answer:
Hi,
I had gone through your question and understand your concerns that you are having ear pain with fever.
1.. Based on your clinical details (Ear symptoms, pain behind the eyes and fever), it appears to be acute sinusitis with ear drum infection secondary to complications of viral illness. This seem more likely than cellulitis or dental abscess.
2. Further as per my knowledge, CT scan neck provide more details of bony shadows rather than soft tissues (it's difficult to diagnose cellulitis). Therefore I feel the second opinion was right.
3. In your case, since the symptoms suggest active infection (fever with pain in ear), you need one more course of antibiotic and ear medications and antipyretics (depending on the examination findings). It would be better that you visit an ent surgeon rather than dentist / oral surgeon. He/she can review my opinion.
4. In the mean time, take pain killer (tylenol 500mg twice daily-best works for both fever and pain), along with tab. zyrtec (citrizine) once daily and steam inhalation twice daily.
Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.
Wishing you good health.
complications of viral illness.
Detailed Answer:
Hi,
I had gone through your question and understand your concerns that you are having ear pain with fever.
1.. Based on your clinical details (Ear symptoms, pain behind the eyes and fever), it appears to be acute sinusitis with ear drum infection secondary to complications of viral illness. This seem more likely than cellulitis or dental abscess.
2. Further as per my knowledge, CT scan neck provide more details of bony shadows rather than soft tissues (it's difficult to diagnose cellulitis). Therefore I feel the second opinion was right.
3. In your case, since the symptoms suggest active infection (fever with pain in ear), you need one more course of antibiotic and ear medications and antipyretics (depending on the examination findings). It would be better that you visit an ent surgeon rather than dentist / oral surgeon. He/she can review my opinion.
4. In the mean time, take pain killer (tylenol 500mg twice daily-best works for both fever and pain), along with tab. zyrtec (citrizine) once daily and steam inhalation twice daily.
Hope this answers your question, if you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you so much for your help! I saw my pcp today and he did say that my sinuses looked pretty miserable. He said that my ears both look good, though. He said something along the lines of a salivary gland problem. However, he doesn't recommend any more antibiotics. This kind of concerns me because of the fever and chills and the worsening headaches/dizziness. He is scheduling a CT of my sinuses. I had a CT of my sinuses back in April. I had mild sinusitis at the time. Do you think that an infection in my tooth/gum could be spreading to my sinuses? Or my sinus congestion is aggravating my tooth/gums/jaw? Also, do infections, specifically oral or bone infections (thinking of my jaw), always show up on x-rays? I have had 1 panoramic x-ray, 3 regular dental x-rays, and at least 1 CT scan of my head/neck/jaw area and nobody has seen any indication of an oral infection or abscess. I am so confused over all of this!
Thank you!
Thank you!
Brief Answer:
CT scan
Detailed Answer:
Hello again,
Thanks for considering my answer and for your follow up.
I am glad that the doctors found atleast some clues to manage your problem. And yes the CT scan will be worthwhile. Now to answer your questions:
1. Yes, it's possible - this type of infections are always two way ( tooth to sinus, sinus to tooth). Source of infection can be ruled out only with detailed history and local examination. I recommend looking into the sinus area first before going to check teeth again as you already have had couple of dentist evaluation.
2. Yes. Modality of x-ray can dectect bony artefacts and infections, but, degree, magnitude and extent of the infection can be seen through CT scan (ct images are generated in the axial or transverse plane, which will give deatiled study). therefore. kindly go ahead for the same.
3. Do not worry, it's a simple chronic infection (having since april), can be managed.
All the best. Take care.
CT scan
Detailed Answer:
Hello again,
Thanks for considering my answer and for your follow up.
I am glad that the doctors found atleast some clues to manage your problem. And yes the CT scan will be worthwhile. Now to answer your questions:
1. Yes, it's possible - this type of infections are always two way ( tooth to sinus, sinus to tooth). Source of infection can be ruled out only with detailed history and local examination. I recommend looking into the sinus area first before going to check teeth again as you already have had couple of dentist evaluation.
2. Yes. Modality of x-ray can dectect bony artefacts and infections, but, degree, magnitude and extent of the infection can be seen through CT scan (ct images are generated in the axial or transverse plane, which will give deatiled study). therefore. kindly go ahead for the same.
3. Do not worry, it's a simple chronic infection (having since april), can be managed.
All the best. Take care.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Prasad
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