The Enhanced Doctor-Chapter 558 Headache looking at the nose?
"Brother Zhang, should we conduct a comprehensive ovarian examination for the patient? I’m wondering if we missed a teratoma because it’s too small to be detected?" Liu Banxia pulled Zhang Xiao aside.
"I considered the case you treated before too. But it’s hard to make that call because the symptoms are so ambiguous. Even if we conduct an MRI, we might not be able to find it," Zhang Xiao said. "The teratoma antibody wasn’t detected, and her intracranial pressure is normal. Unless we perform an intraoperative ultrasound of both ovaries, but we can’t just rely on guesses."
Liu Banxia grimaced. That was indeed the situation. Intraoperative ultrasounds weren’t taken lightly, and even if we went the extra mile for it, how would we explain it to the patient if nothing showed up? Given the patient’s mental state, wasn’t that kind of examination too rash?
"Doctor, is there any other way?" the patient’s husband spoke up at this point.
There were numerous doctors in the room: two attending physicians, one resident, and seven interns. Yet, confronted with this question, none could provide an answer.
"Doctor, can I suggest something?" the patient’s husband continued. "When we were at other hospitals for check-ups, doctors there mentioned a brain surgery, something about cutting a part open? Could we do that?"
"What? Cingulotomy? Are you out of your mind?!" Zhang Xiao exclaimed, unable to remain calm. "This is an extremely dangerous surgery. It could lead to many complications. This is the brain we’re talking about. If we can avoid surgery, we should."
Perhaps Zhang Xiao’s voice was a bit loud. The patient glanced in their direction with evident impatience, though she remained silent.
"Sigh... I know, but she’s suffering from depression now," the patient’s husband sighed. "She’s suffering so much in her current condition; it’s hardly living, don’t you think? Even though the surgery has significant risks, isn’t it also a potential treatment for depression? Couldn’t it also help with her pain?"
"Isn’t living another couple of years, even like this, better than enduring such misery now? I can’t even sleep properly anymore. I have to constantly watch her, afraid she might do something impulsive."
"Our children have been taking turns staying with her at night for over two years now. It’s not just our lives; our children’s lives have been completely disrupted too."
Silence once again fell over the patient’s room. This, too, was a problem. One could even say the husband’s desperate consideration was for the patient’s sake. The previous young patient with superior canal dehiscence... what an impact that had on her family’s life, and her symptoms were only intermittent. This patient, however, had to endure constant, high-level pain.
"Let’s research this further," Liu Banxia said. "There are many possible causes for her pain. Please give us another chance to run more tests. We may find something we previously overlooked. What do you think?"
The patient’s husband nodded. "I don’t mind the tests or the cost. We still have some money and our pensions. There’s no need to burden our children." He paused, then pleaded, "Doctor, I beg you... find a way to alleviate her pain. If this goes on, I might lose my mind before she gets better."
"Rest assured. We’ll do everything in our power," Liu Banxia said. This statement, though perhaps just words of comfort, felt like a significant promise to the patient’s husband and added considerable pressure on Liu Banxia himself.
"Brother Zhang, Brother Peng, what do you think could be causing this? Let’s set aside organic pathologies for now," Liu Banxia proposed. "Some amputees experience phantom limb pain. Could our patient be experiencing something similar? Even though the manifestation differs, the outcome seems comparable."
"Phantom limb pain is a cognitive disorder, a kind of reshaping in the contralateral cerebral cortex after amputation. A key characteristic of phantom limb pain is its episodic intensification," Peng Bo explained. "Although we initially suspected migraines in our patient, and medication provided some improvement, her pain isn’t episodically intense but consistently severe."
"Personally," Peng Bo continued, "I lean towards some form of minor brain inflammation. Though we haven’t been able to detect it, it might be subtly affecting the pain-sensing nerves."
"Sigh... I also considered that possibility," Zhang Xiao admitted, "but the lumbar puncture was negative. Unless we perform a cranial exploration, which is also extremely risky. It’s not like correcting abnormal behavior, which can be adjusted with targeted electrical stimulation. A blind craniotomy... the risk is too high."
"President Liu, think carefully. Could the headache be triggered by lesions in other parts of her body? Should we perform another abdominal MRI for the patient?" Zhang Xiao suggested.
"I won’t do it! The banging noise makes my headache worse," the patient, who had been silent all this time, suddenly interjected just as Zhang Xiao finished speaking.
Her sudden remark startled everyone. However, it was clear she had an extreme aversion to MRIs.
Liu Banxia frowned. "Does your headache intensify when you hear noises? It isn’t just seeing rapidly changing images that worsens it, right?"
The patient nodded almost imperceptibly, which served as an answer.
"President Liu, any new ideas?" Zhang Xiao asked.
"What do you all think?" Liu Banxia mused. "Could it be due to some lesion in the ear canal? Something similar to superior canal dehiscence? Perhaps a more severe case, causing persistent pain?"
"Surely not?" Zhang Xiao commented. "We gave the patient earplugs before the MRI. She didn’t show any signs of her pain lessening at that time; otherwise, she would have said so."
"Hmm... that’s a good point," Liu Banxia pondered. "Could it be that the brain’s process of handling audio signals is altered? Or is the sound changing the ear pressure, thereby intensifying the pain? However, changes in ear pressure should be paroxysmal, not continuous. My thinking is a bit off track; it’s unlikely to be a continuous transmission of an error signal without any weakening. Still, hearing sounds with a headache does indeed make one irritable. But the patient’s reaction is more than just irritation; it should be considered a symptom."
Zhang Xiao nodded. "Indeed, that could be listed as a symptom. When a person is unwell, they tend to feel discomfort from fast-changing scenes or loud, piercing noises. Our patient’s main symptom is a certain degree of pain, and this might have misled us during the initial assessment. Let’s continue to study this."
Without uttering a word, Liu Banxia covered his ears with two fingers, then, feeling it wasn’t enough, he gently reversed his hands and used his thumbs to block his nostrils. Others mimicked his actions.
However, none of them felt anything unusual.
"If nasal issues could impact the ears, that would be understandable. But can the ear canal affect the brain?" Xu Yino questioned after releasing her hands.
"So we must explore further," Liu Banxia said, walking over to the patient. "Is there any irregularity in the sounds you usually hear? How loud must a noise be to aggravate your headache? Any small hint would help."
The patient glanced at him, her eyes somewhat cold. "It always hurts. There’s always noise, and my ears feel full." 𝒻𝑟ℯℯ𝑤𝑒𝑏𝑛𝘰𝓋𝑒𝓁.𝒸𝑜𝘮
Liu Banxia frowned. What did she mean by "ears feel full"? Discomfort in her ear canal? If it were a typical patient, he would have asked directly. But this patient was different; he needed to consider his questions carefully.
"Any ideas?" Zhang Xiao asked quietly from the side.
"It seems the ear problem we’ve overlooked might be critical," Liu Banxia said. "The patient said it’s always hurting, always noisy. Could it be a mild form of tinnitus? Or auditory hallucinations caused by the headache?"
"Well, it’s hard to say for sure right now," Zhang Xiao stated. "I feel like the headache and the ear issues are connected, but it’s hard to determine the sequence of onset."
"Eh? No, wait!" Liu Banxia exclaimed, his tone excited. "Xu Yino just mentioned that the nasal cavity can affect the ear canal. Have we examined the patient’s nasal cavity?"
Zhang Xiao frowned. "We only did a preliminary check. The patient didn’t show any symptoms of rhinitis or any nasal discomfort. Could the nose really be causing this?"
"It’s worth a shot," Liu Banxia suggested. "We can do a nasal endoscopy. This exam is less invasive than others. What if the headaches are caused by minor lesions near the sinuses that wouldn’t show up on an MRI?"
"We can give it a try. Could you schedule an appointment with the ENT department?" Peng Bo suggested.
Liu Banxia nodded, pulled out his mobile phone, and contacted Du Fancheng from the ENT department.
"President Liu, what made a busy man like you think of calling me?" Du Fancheng asked after answering the call.
"We have a patient who has been suffering from headaches for several years," Liu Banxia explained. "Other tests showed no abnormalities. We were thinking of having a specialist like you examine her nasal cavity. Do you have time?"
"Sure, bring her over. I happen to be free right now," Du Fancheng agreed promptly.
"Alright then, we’ll be there soon," Liu Banxia replied. It was currently break time, and Du Fancheng hadn’t hesitated at all. He was really doing them a favor.
"Doctor, why check her nose when her head hurts? We’ve had it checked before, and they said nothing was wrong," the patient’s husband said, expressing his confusion.
"Right now, this is just a possible theory of ours," Liu Banxia explained. "Since none of us are ENT doctors, we need assistance from a professional ENT doctor to help rule this out. There are numerous nerves in the nasal cavity. It’s possible that earlier examinations failed to detect an issue. If we check now, we might find something more apparent."
In any case, based on the patient’s description, there was some abnormality in the ear canal. It could be related to the cranial nerves or the nasal cavity.
