Q: Since more than a year, I am having ear pain (right ear) with pain radiating till my forehead and a kind of cramping pain in the jaw muscles and tooth pain too. The consultations & diagnosis done so far are an ENT, neurological and dental check up. I had an audiometry, PNS X-ray, throat swab testing, blood test and elongation x-ray for the neck etc. All the above results were normal and no complaint found. The ENT surgeon concluded that I am having Neurositis for which I am under the prescription of Tegritol tabs - 200 mg twice a day with Renerve Plus per day for the past 6 months. I took Renerve plus only for a month then replaced with Neurobion Forte. But I am not feeling any improvement with this treatment. Please advise me what should I do? The pain is always there. Is it advisable to take tegritol for such a long time?

A:The causes for pain in this region are many and include: Diseases of external ear (infections, inflammations), middle ear (otitis media, mastoiditis, eustachian tube inflammations), Sinusitis, Nose (rhinitis), Throat (laryngitis, adenoiditis, tonsillar problems), parotitis, problems in the neck (deep neck infections, thyroid disease, parapharyngeal diseases), diseases involving base of skull or temporal bone, Bell’s palsy and diseases affecting the jaw (mandible & maxilla) etc. You may require a) Blood tests (CBC, ESR, thyroid function); b) Dental radiography; c) CT scans of the head or temporal bone, sinuses, and/or neck when no obvious source of the pain can be found (as it may provide information about the temporomandibular joint or intratemporal lesions); d) MRI: If indicated by clinical or audiometric suspicion (to define a cerebellopontine angle or other intracranial tumour); e) Panorex imagery is quite useful in diagnosing temporomandibular joint dysfunction, odontogenic pathology, and styloid abnormalities as there is a high prevalence of dental-related otalgia; f) Audiometry, nasal endoscopy, vestibulo-cochlear testing etc. As you can appreciate, the symptoms and clinical findings will guide the doctor. You may take another consultation from a dental surgeon/ENT specialist more experienced in these disorders.