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Ear Pain  Can Be Hard To Diagnose

Dear Dr. Roach: Please, please help me. I’ve visited my allergist, the ear-nose-throat specialist and my own internist. None of them has ever heard of my problem and don’t know how to help me. Starting in 1990, every couple of months I would get an awful pain on one of my ears if I had been lying on it during the night. It would happen to either ear, whichever one I lay on. I went to an ear-nose-throat specialist then, who did not know what to make of it.

The pain is so intense that it wakes me. It is not inside the ear but around the edges of the entrance to it. It is so painful that I can’t touch it. It will be throbbing. The only thing that will make it go away is when I stand up. Within 30 minutes, it is gone. I even tested it by massaging behind the ear (once I could bear to touch it), and it seemed to make the pain go away faster. The ENT said my ears are healthy.

I am very much afraid that the day will come when I will no longer be able to lie down in my bed to go to sleep. I just had an MRA done, and the reading shows no “growths,” according to my doctor’s office. This ear pain is starting to affect my daily living, since I don’t seem to be able to get the restful sleep I need. — L.T.

Answer: Without doing an exam, obviously I can’t be sure, but I wonder if you have relapsing polychondritis. “Relapsing” means that it comes and goes, and “polychondritis” means there’s inflammation of different cartilage in the body. The firm, flexible tissue in the ears is cartilage, as is the firm tissue in your nose and your windpipe. Relapsing polychondritis is a rare disease, often with a long delay in diagnosis due to its rarity and intermittent nature. It can affect just one or two areas, as might be the case with you, but it also can affect joints and critical organs, like lungs, heart, kidneys and blood vessels.

It appears to be an autoimmune disease, one in which the body’s defense system attacks its own cartilage. Usually, there is some redness or swelling of the cartilage. Treatment varies with severity of the disease. Sometimes anti-inflammatories work wonders; other times, people need very powerful immune-suppression drugs. A rheumatologist is most likely to be familiar with this condition.

I found a nice support group at http://health.groups.yahoo.com/group/Rpolychondritis/.

Dear Dr. Roach: I’ve had pain on the soles of my feet since 1999 due to injury to my sciatic nerve and to diabetes. My regular doctor and physical therapist have offered no solutions. It has kept me awake at night and limping during the day. A year ago, a nurse friend recommended vitamins B-6 and B-12. To my amazement, within a couple of weeks, most of the pain was gone. Today it is completely gone, although the soles of my feet are still numb. I told my doctor and therapist, and they had no explanation. — J.H.

Answer: I get many, many letters from people complaining of neuropathy, mostly noting that the medications don’t work or have too many side effects. But it’s important to know that there are dozens of causes for neuropathy (which just means something’s wrong with the nerve), and what works for one person may not work for another. One of my neurology colleagues told me that diabetics are at a higher risk for every kind of neuropathy. I think this is significant in your case, because I suspect there may be several reasons for your neuropathy.

Diabetic neuropathy is seen especially in people whose diabetes is longstanding or has not been well-controlled. It causes numbness (this very important; a diabetic may not recognize an injury to the foot) and later may cause pain. Every diabetic should have regular foot exams and be tested for diabetic neuropathy.

Many kinds of medicines are used to treat this, including medicines that are also used for depression and epilepsy. Some people require several medicines, and even then, the treatment doesn’t always work well.

Vitamin B-6 has been studied for diabetic neuropathy and isn’t generally effective for most people; however, it is safe in reasonable doses (say, 25 or 50 mg). Vitamin B-12 deficiency can cause severe neurologic conditions. We often treat B-12 deficiency with injection. However, most people can get all they need from oral vitamin B-12 if enough is given (usually 1 mg). A trial of B-6 and B-12 is reasonable for people suffering with neuropathy. It may help, and is very unlikely to harm.

Email: ToYourGoodHealth@med.cornell.edu.