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Answer to your Health Question

Question:

I am a 65 year old female and for the last year or so I have been experiencing strange sensations on the left side of my face.

The eustachian tube feels momentarily blocked i.e. when I lean forward to stand up from a seated position there is a "buzz" in my ear, the left eyelid feels as if it is flickering or twitching (but it isn't), the left cheek is often flushed.

This happens about three or four times a day, and usually towards the end of the day.

There is also some pain and tenderness in front of the ear, and sometimes the glands on the left side of my neck are swollen.

I have Rheumatoid arthritis (diagnosed in 2005).

Are the above symptoms related, even though they occur unilaterally?

If not, what could be the problem?

I worry the there might be a space occupying lesion or something in the parotid.

Wendy

Answer:

Dear Wendy,

The trigeminal nerve comes out just below the ear and handles the sensation and the facial muscles on each side.

A common cause of facial pain includes Trigeminal neuralgia.

Trigeminal neuralgia affects the trigeminal nerve, one of the largest nerves in the head.

The most frequent cause of trigeminal neuralgia is a blood vessel pressing on the nerve near the brain stem.

Usually, the pain is felt on one side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one after the other.

They may come and go throughout the day and last for days, weeks, or months at a time. At times,the attacks can disappear for months or years. The disorder is more common in women than in men and rarely affects anyone younger than 50.

Magnetic resonance imaging (MRI) can be used to determine whether a tumor or multiple sclerosis is irritating the trigeminal nerve. Otherwise, no test can determine with certainty the presence of trigeminal neuralgia. Tests can, however, help rule out other causes of facial disorders.

If medications are ineffective or if they produce undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity.

Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation.

A. Vilches and M. J. Burke from Burnley General Hospital, UK, sent a Letter to the Editor of Rheumatology the journal of the British Society for Rheumatology on January 2001 presenting one case of TSN or Trigeminal sensory neuropathy in a patient with RA or rheumatoid arthritis

The title of the letter was: Trigeminal sensory neuropathy and rheumatoid arthritis: case study of a rare association , and they said that the differential diagnosis of TSN was wide and in many cases remained unexplained and they found a lengthy duration of symptoms over a period of several years with little change or improvement


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