RF Rhizotomy and Ear Pain

I’m a single man living in Arizona with 60 years under my belt. My TGN started in the middle of 2014 with slight jolts along the right side bottom of my jaw, triggered by touching my lower right lip. My mother had TGN in the very late ‘70s, so I recognized the symptom right away. Her terrible pain was relieved 100% around 1980 by an RF rhizotomy done by Dr. Tew in Ohio, and now 90 she’s been pain free since.

My pain went away at the end of 2014 though, so I didn’t pursue treatment. In June 2015 it came back however, and I started on Gabapentin. That didn’t quite do it, so I was put on Oxcarbazapine as well. Unfortunately I developed a terrible rash because of these (I know it was the Gabapentin and think the Oxcarbazapine made it worse), and so around February of 2016 was put on Baclofen instead and told to look into surgery options.

The first place I went to I’ll call the clinic. Six weeks before the first available appointment, but the Baclofen was doing OK so I stuck it out. Day of the appointment it was recommended I have an MVD done and I agreed. Over the next few hours however, the reality of a 3-month recovery scared the heck out of me. I’d be alone at home with no support from family or friends. Also, the thought of a hole in my head versus a needle in the cheek like what cured my mom just freaked me out. So I cancelled the MVD and asked for another appointment to discuss the options further. Another six weeks for the next available appointment!!! The Baclofen was still working OK, so again I stuck it out. I explained my concerns about the MVD recovery and desire for the rhizotomy, but was eventually told they wouldn’t do the latter.

In June I went to the institute, where I got an appointment within a week. Options were discussed and I agreed to try the Gamma Knife procedure, which was done at the end of that month. The procedure itself was a breeze, but my wrist was sore for a couple of weeks afterward, apparently from a problem with the IV needle. The TGN pain gradually went away though, and by the end of August it was gone.

Around Halloween, I awoke with a sharp pain. It was back. Frequency and intensity both increased over the next three months and on the 20th of last month, I had a thermal rhizotomy done at the institute. Moderate numbness of my cheek, jaw, the side of my face, half of my tongue and down my throat a bit. Immediately there was a terrible pain in my ear, and sensitivity around the temple. My cheek feels sore as well, but I understand all this soreness and pain should decrease and be gone in a month or three. Worst part is the TGN pain is still there and as bad as ever. Now two weeks after the rhizotomy, it’s hard to talk, chew and swallow. So I’m back on the Baclofen at 20mg, four times a day but I still have cringing pain randomly throughout the day.

What do I do now? I understand that another rhizotomy should take care of it, as they err on the side of less numbness. That makes sense. Do I wait until my ear and jaw stops hurting before I do another procedure?

Should I seek yet another facility, the first having lost my trust and the second having failed twice (although I really don’t fault them for the results)? I understand the thermal rhizotomy procedure is somewhat of an “art”. Should I seek a facility that specializes in it regardless of whether my insurance will pay for it or not?

If a second rhizotomy results in more numbness of my tongue and throat, I’m worried about problems swallowing and choking as I eat most of my meals alone. Are such problems typically encountered with rhizotomies involving the lower branch of the trigeminal nerve?

I’m also concerned about diminishing options. Is an MVD still an option after a Gamma Knife and two rhizotomies?

Hi Eidetic
I am just a sufferer,new to this whole thing.But with the same 60 years under(or over) my belt.
Sometimes weekends are a little slower on the board-but there are some amazing people with amazing advice here.And I am pretty sure they will reply soon.I just want to say welcome and really hope things get better for you soon.

I have had a Rhizotomy on right side of face long time back and it has brought me permanent relief from pain. But I must caution you that this operation will bring you permanent irreversible numbness on the operated side. The surgeon must be skilled not to injure your motor nerves so that mastication power is preserved.
I got used to numbness with time, initially it bothered me. This type of surgery is a last resort when every thing else has failed I mean medication, gama, MVD, alchohol injection etc.
The surgeon usually avoid it. As far as swallowing food I have no problem.
Good luck

I am sorry to hear of your TN problems. I too am an older TN suffer. Six months ago I had two rhizotomies. The first one didn’t work. The second one about two weeks later stopped the electric shocks and I am still with the numbness and the other side effects that go with it. Hearing about your mother gives me hope. However, I am praying you will find the relief needed to feel comfort again. My problem comes from having an inoperable brain tumor but I hope you have some viable options. Good luck.
Gloria

I had two rhizotomies; one before and then after the Vascular Decompression Surgery.

All failed.

If you know you make scar tissue… look at a scar and if it spreads or thickens it will in your head too. That will make TN nerve crazy again so why do it.
An Italian neurosurgeon at The Cleveland Clinic explained this to me.
Your second rizodomy can leave you with a dripping nose and burning face without stopping the TN. These are very common side effects.

I recommend waiting a while to see if it improves so you know what is a side effect and from what. Also it never hurts to get another opinion. However, I do not recommend Johns Hopkins as the communication styles of the neurosurgery team is awful before, during and after surgeries.

As with any medical procedure, I would always recommend going with the most skilled and experienced professional available. Especially when nerves are involved. I would simply not compromise.

It you are open to it, it can also be helpful to explore non-surgical options first. My wife had MVD. It provided 8 months of relief before the pain came back. Since then, she has looked at the possibility that her trigeminal pain is not due to compression, but some other trauma to the nerve. Its an exploratory process that requires patience. Right now she is looking at treating as an issue of a virus settling in the nerve. This would help explain a number of things, such as the association between stress and increasing pain, the pain coming in and out of remission, etc.

Three months ago, amidst an extended and very difficult period of pain, she received scrambler therapy from Dr D’Amato in Rhode Island. That seemed to put her in remission. It does look like she might be coming out of remission again now. The pain is still low, but if it increases we are very open to the option of returning for a 2-3 day refresher treatment. 2-3 days of that every three months in order to live with out pain is a very easy decision, as the treatment has zero side effects.

What is scrambler therapy and how is it done? Thought I had heard of all available treatments, since I have been dealing with this TN monster since 1995! Guess I missed something…lol Glad your wife is getting relief from it. Does she take any medication at all? Thanks.

Unlike medications, which try to change the signal that the nerve is sending to the brain, scrambler therapy teaches your brain to simply reinterpret the signal not as pain, but as “everything’s normal here”. Because the brain thinks the nerve is telling it that all is normal, it never activates the pain sensation.

Couple of things to keep in mind:

  • it won’t work if you had MVD and any kind of metallic material was used to “plug the hole”. (My wife’s neurologist used an acrylic patch).
  • if the root cause is not fixed, eventually (in some cases can be fairly quickly) the brain figures out something is indeed wrong and goes back to interpreting the signal as pain.
  • even when the pain is truly neuropathic, periodic refresh treatments can still be required.
  • most insurance will not cover it.
  • a lot of folks using the equipment that are not trained. Do not go to one of them. We used Dr D’Amato. He has clinics in Rhode Island and in Florida.
  • For some reason some people are very, very responsive to this treatment. Others not at all. Many lie somewhere in the middle.

John Hopkins recently did a research paper on this treatment, and found it to be highly effective for neuropathic pain. Probably the best part though is there are zero side effects (other than a thinner wallet). Again though, like anything else, it is certainly no guarantee of success.

Regarding your question, my wife is not on any meds. In fact to start the treatment you must have all the meds out of your system, as it requires the nerve to be sending an unaltered signal.

Hope that helps. If you have more questions, just let me know.

Thanks for the info. I have had MVD with mesh implant though.

The teflon pad won’t interfere, but a metallic plate to patch the bone would.

Yes, it’s a metal mesh to patch the hole in the bone.

Thanks to everyone who responded here. I decided to have a second RF rhizotomy done at the institute, as with the first. It appears to have done the trick, as I no longer have the pains associated with TGN. My lower jaw is really numb, but I can feel the hairs of my beard when I touch them. The whole side of my face too, but my eyelid and cornea were not affected.

My ear is a bit swollen still and hurts enough to prevent me from sleeping on that side, but I can tell it’s decreasing slowly and know it may be a few months to recuperate. My jaw muscle on that side is very weak, but again I understand it may be six months before it starts coming back. My tongue tingles a bit and I have to learn to eat without biting it or the cheek on that side, but I’ll take that over the TGN pain every day (and I might have to for the rest of my life).

I’ll make updates to this thread as time goes on, to document the issue with my ear. It was a surprise to me. In all of my readings about rhizotomy treatment for TGN, I hadn’t seen anything describing it. I read plenty about the risk to the cornea, but not the ear. Fingers crossed tightly hoping it heals.

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Hi
WOW
Congratulations
I cannot believe how quickly you had that done!
You are definitely not in Canada.
There would be a bit more of a wait.
I hope you continue to improve and that this gives you the comfort that you deserve.

Good news and better news. The good news is that the soreness in my right ear is essentially gone now, and the muscle in that jaw is starting to get stronger. The better news is that I didn’t die in the process.

Last week I had a heart attack. I managed to call 911, they found blockage and installed a stent. Apparently had to be shocked back to Earth twice during the procedure. I think back though, to going through the Gamma Knife and rhizotomy procedures with all having the presumption that everything was fine inside me for it. I’ve always had relatively low blood pressure and pulse, and I guess that led to a false sense of security. Anyway, the plan now is to heal, change, and thrive.

Oh my gosh, that is wild! So glad to hear you are okay. So the heart attack had nothing to do with the rhizotomy?

No. It was all about my diet for the past 40 years.

Thank You for coming on and telling us.You must have an awesome support system.If I end up at hospital with something like that I can imagine my sisters telling the doctors to just let me go “she has suffered enough”.
You take the time you need,re-charge and at least you will be good by summer.Yay.Congrats.There must be more work for you to do down here.

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Hello Jean_Marie, i know you message was sent some time ago,I somehow missed it. Interested to know your surgeon? I had a rhizotomy done at John Hopkins about 4 years ago. I would like to keep all options open in case another one is needed.
How are you doing at this point? Hope all is well.
Thanks for your reply. Gloria37