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My right cheek is tingling what could this be?

I had an upper respiratory infection mid April, My doctor said led to an ear infection which caused a blocked right ear with fluid behind the eardrum which seems to be seems to be slowly draining away now but has taken a long time. I had a lot of popping and clicking and occassional autophony and tinnitus which is still there but much better than it was. However for the past 3 weeks my right eye seems to be irritated - not quite a spasm but a strange feeling and for the last week my right upper cheek has started to tingle and feel slightly numb. I initially took a 5 day course of antibiotics and then 2 different types of ear drops. Do you have any idea what this might be?

Doctor's Response

Date:Jun / 2010

Thank you for your question.

I am sorry to hear you are feeling so unwell. You describe an episode of upper respiratory tract infection with subsequent ear infection and fluid behind right eardrum with 'popping and clicking' sounds, occassional autophony and tinnitus which seems to be improving.

More importantly, you report 3 weeks history of right eye irritation ('a strange feeling') and over the last week a sensation of tingline and slight numbness affecting right upper cheek. Antibiotics and ear drops have not helped your recent symptoms.

The symptoms you describe can be due to various causes, however, one important cause to consider is that you have irritation of the sensory nerve (Trigeminal Nerve or Cranial Nerve number 5) which supplies the upper cheek. Such irritation may result from a viral inflammation of the nerve by the Herpes or Varicella Zoster Virus. The significant additional issue is that this particular virus can, sometimes, simultaneously affect the eye and even result in Corneal ulceration. The same virus is also known to cause inflammation of the ear canal due to its effect on the sensory nerve branch supplying the ear canal. The entire syndrom is also called "Ramsay Hunt Syndrome". I provide a weblink for further information:  http://www.patient.co.uk/doctor/Herpes-Zoster-Oticus-(Ramsay-Hunt-Syndrome).htm

As I mentioned, although there may be other possibilities; the condition I suspect needs to be diagnosed quickly (clinical examination, including special examination of your eye, sometimes using fluorescene stain and looking with a special violet light which shows any superficial Cornear Ulcer) and treated quickly before any significant damage to the cornea of the eye (usually with Acyclovir or Zovirax - eye ointment/drops plus tablets).

I would, therefore, recommend that you either go to the local A&E for an urgent examination, or if your own GP can see you urgently then do so. I wish you well.

Thank you for using Thanks Doctor. I do hope this information is of use to you.
Yours faithfully,
The Thanks Doctor Team

Patient's Response

Date:Jun / 2010

Sorry i should have mentioned that I had a full eye testing on Friday as I was worried that it might be something to do with the eye. The Opthalmologist did extensive tests on my eyes and said there was no cause for concern in the eyes at all. She did the dye and UV light test as well. However, I don't think it would be Ramsay Hunt syndrome as I have none of the other symptoms? Do you think that the tingling will go away on its own?

Accepted Answer

Date:Jun / 2010

Thank you for your question.

Thank you for providing additional helpful information. There is no replacing direct patient-physician interaction (as during a clinical assessment process) and although this website is a helpful resource, it cannot replace such a clinical process.

Clearly, another clinician has already considered the diagnosis of H Zoster ophthalmicus in your case (as I did initially); and proceeded to exclude this by direct clinical examination as previously suggested.

As your initial differential diagnostic possibility has now been excluded by direct clinical examination appropriately and you continue to have numbness / tingling of your right cheek (with additional history of recent 'ringing sound in right ear'); I would, again suggest that you request further assessment by your GP if your symptoms persist over the next few days.

Whilst your symptoms may well resove 'on its own' - this would be speculation on my part and therefore, given the neurological nature of your symptom further examination by your doctor is advisable. The examination is likely to include inspection of your right cheek, ear and nose to exclude local conditions such as sinusitis, ear infection etc., but more importantly Cranial Nerve 5, 7 and 8 examination for abnormalities. If your doctor finds any abnormalities in your craninal nerve examination (such as reduced tactile sensation over your right cheek), then an early Consultant Neurologist referral is advisable as the roots of Cranial Nerve 5 and 8 originate from posterior brain (cerebro-pontine angle) and further examination and/or CT scan may then become a consideration. Another consideration is a condition called 'Trigeminal Neuralgia' but often tingling of cheek is followed by sharp local pains.

I hope above information is of help to you. Please do not hesitate to reply if you have a further query. Best Wishes.

Thank you for using Thanks Doctor. I do hope this information is of use to you.
Yours faithfully,
The Thanks Doctor Team

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