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Sinus/Ear Issues?....TMJ?
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Frustrated84 posted:
Since May I have been on antibiotics 4-5 times for sinus infections, ear infections and fluid behind my eardrum -- not all at the same time but sometimes coupled together. Also, I've been prescribed nasal sprays and steroids. Nothing seems to make my issues go away. It will get better for a bit then go right back to how it was previously. Even when I went to the doctor and they found nothing wrong, I still had some right ear achiness and pain behind my eyes.

A couple months ago I went for a sinus x-ray which came back clear. My ENT referred me to another ENT who handles allergies. When I went to that appointment I had a sinus infection and right ear infection. I've been taking antibiotics for 3 weeks, yet when I went to the doctor a couple days ago he said that I still have a bit of a sinus infection so he prescribed more Penicillin. Also, my ear canal was a little red so he gave me ear drops.

He suspects that I have some underlying allergy that has is causing my immune system to be weakend and susceptible to the sinus infections. He recommended allergy testing but I'm hesitant to do so. The only continuous symptoms I have are sinus congestion and right ear achiness. Actually, I don't know if it's ear of jaw pain as it seems to be in front of my ear at the jaw joint. After eating a bagel yesterday, it has been aching right in that spot.

I have no idea whether to pursue allergy testing as I'm worried about the cost even with health insurance. Would I need to see a dentist to rule out or diagnose TMJ? I don't have dental insurance either. Would you think this is more likely to be sinus/ear issues given I've clearly had issues with both the last several months? Honestly, I don't know what to do and this is all stressing me out.

Also, I have anxiety issues and am on medication for that currently. Any advice/suggestions would be greatly appreciated. Thanks!
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Frustrated84 responded:
I forgot to mention that my left jaw makes a popping/clicking noise when I open my mouth wide or chew. That is why I mentioned TMJ.
 
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Rod Moser, PA, PhD responded:
You may be correct. TMJ disorders can definitely cause ear PAIN, but would not cause "fluid behind your ears" or sinus problems -- assuming you were correctly diagnosed. When you are also under stress, TMJ can worsen since you may be grinding your teeth at night (bruxism) or clenching your jaw. Obviously, I can't render an opinion since I cannot examine you.

ENTs can diagnose TMJs, but most of the time it is a dentist -- a dentist who specializes in TMJ if you can find one. Since you do not have dental insurance, this may be up to you to pay. Many health insurances will not pay for "dental issues", even TMJ.

To complicate matters, a person can have more than one medical issue at the same time....in other words, you could have sinusitis, middle ear flud, allergies, AND TMJ. Wouldn't that be pleasant?

I wish you the best, but you will need to be properly diagnosed - insurance or not.
 
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Frustrated84 replied to Rod Moser, PA, PhD's response:
Thank you, Dr. Moser. While not what I wanted to hear, I do appreciate you taking time to respond. Gosh, I wish it could just be something simple. All this comes for me after not having been to a doctor for 6 years prior. Now, I've had to have my gallbladder removed, had irritation in my esophagus from acid reflux, and now all the ear/sinus stuff -- within the past year. I'm getting extremely frustrated and don't know what to do. I'm falling apart at the age of 26!

What can be done if the ear pain is TMJ? How is it treated? Would you recommend that I have allergy testing? Shouldn't 3 weeks worth of Penicillin cure a sinus infection? He wrote my current prescription for a month if need be -- is it safe to keep taking antibiotics that long?
 
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Rod Moser, PA, PhD replied to Frustrated84's response:
Are you taking plain penicillin or amoxicillin? Amoxicillin would most likely help the sinusitis; penicillin would not likely be strong enough. Yes, it is okay to take it for three weeks....I once stayed on antibiotics for 12 weeks to get a handle on my own sinusitis (under the care of an ENT, I might add...so I didn't treat myself).

Allergy testing? I don't know enough about you or your case to render a comment. Sorry.

TMJ can be treated like arthritis...with anti-inflammatory meds, with mouth braces (expensive), or with surgery (very expensive), all depending on the severity of your problem.
 
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Frustrated84 replied to Rod Moser, PA, PhD's response:
I'm taking penicillin 3 times per day -- can't remember the dosage. It's frustrating because I don't necessarily do a good job of communicating my problems to the doctor. That or they are always just in a hurry and don't take the time to listen. Going to the doctor causes me quite a bit of anxiety. Even though I'm obviously having a problem I'm always paranoid about being a hypochondriac. Anyway, this is all worrying me and I'm not sure what to do next. The ENT I saw wrote me a penicillin prescription for another month worth, but didn't schedule an appointment to come back. He recommended allergy testing.

I just keep hoping that magically all these issues will disappear -- it's not happening. My ear is bothering me today and I still feel congested all the time. Any tips/advice you could offer that may help addition to the antibiotics I'm already taking. Also, I'm taking Lexapro and Buspar for the anxiety.

Thanks in advance!
 
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Rod Moser, PA, PhD replied to Frustrated84's response:
Just hang in there with the ENT until this problem has been solved. Again, plain penicillin is not the strongest antibiotic on the shelf, so please make sure to follow up at the end of your current course of treatment.
 
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Frustrated84 replied to Rod Moser, PA, PhD's response:
He didn't even schedule a follow-up appointment -- I'm just supposed to come back if need be. He wrote the penicillin prescription for another month, so I guess I should just keep taking it. Gosh, it's frustrating as I don't know exactly what to do and it worries me. I'm taking the Lexapro and Buspar for social anxiety order. I'm never going to be able to be a good advocate for myself as I'm so nervous when going to the doctor. At the point I am now, I afraid that I'm making a big deal over this when it's not that bad. I don't know, I don't trust my thoughts or any decisions that I make. Now, the antibiotics may be causing some stomach trouble for me -- or maybe it's me worrying about it. I posted about that in another discussion, sorry. I've been having pain in the upper center portion of my abdomen on an empty stomach. It goes away after eating. Also, I'm having frequent burping and hiccups.

I really appreciate you taking time to post on here. You have given me more attention and put more thought in to my case than my doctor has. I swear, neither one of the ENT's at that office have spent more than 5 minutes with me. Maybe that's standard, I don't know. Being how nervous I get, I'm never going to be able to communicate my symptoms or address my concerns well. It's frustrating! I hate having to trust other people and not getting answers.
 
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Rod Moser, PA, PhD replied to Frustrated84's response:
I did answer your other posting....

You anxiety is definitely playing a contributory (not causative) role in how you are feeling and reacting to these symptoms.

Your doctor really should be spending more than five minutes with you, however. Too bad you don't pay him by the hour....

If you are anxious at your medical visits, take someone with you....someone a bit more assertive who can help you get the answers you need.
 
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Frustrated84 replied to Rod Moser, PA, PhD's response:
I apologize for having 2 threads going. Yeah, it would probably be beneficial if I took someone along with me. I guess I'm just embarrassed to do so. Again, thanks for taking time to respond. I need you to be my doctor, then maybe I would get some answers.
 
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Rod Moser, PA, PhD replied to Frustrated84's response:
I would certainly spend more than five minutes!
 
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Frustrated84 replied to Rod Moser, PA, PhD's response:
Well, that would certainly be an improvement! I guess I'll just keep waiting this out, take the antibiotics, and keep my fingers crossed that whatever is going on doesn't kill me. All I want is to feel good again and I'm not sure that is going to happen. Is it normal to have both of your ears make a popping/clicking noise everytime you swallow? Maybe the choice of antibiotic (Penicillin V Potassium) is due to the fact that my doctor is probably 75 years old, haha. Sorry for being so whiny, I just wish someone could tell me what to do or handle this for me. Hope you have a good day!
 
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Rod Moser, PA, PhD replied to Frustrated84's response:
Some older physicians do practice older medicine....using drugs they are more familiar with, even though there may be better ones available.

You are doing just fine managing your own medical care, but you do need to be more assertive. Remember that the doctor is working for YOU....and you are paying for his/her services.
 
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Frustrated84 replied to Rod Moser, PA, PhD's response:
It scares me a bit that you don't think I'm necessarily being treated with a medication that you would recommend. I'll be sure to make another appointment if I don't feel as though this is getting better. Assertiveness is something I intend to work on in therapy, which I've just recently started.

One more question that I do have...my right ear is still bothering me some. When I had went back to the ENT he said that the ear infection had cleared up but I still had the sinus infection. All he mentioned was that my ear canal was red. I'm still having random dull pains that are in front of my ear, at the jaw area, and behind my right eye. Could all that be caused by the sinuses?
 
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Rod Moser, PA, PhD replied to Frustrated84's response:
Yes, your pain can be caused by sinusitis....or, it could be inflammation in your ear canal, like the ENT mentioned. To make matters more complicated, a person can have more than one medical issue going on at the same time. All symptoms may not be "linked" to one diagnosis.

I practice evidence-based medicine, so my comment about your doctor using plain 'ol penicillin VK for sinusitis was puzzling. This is not standard of care, but perhaps he had a reason. You would need to have him justify his choice -- a practice in assertiveness.


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