Q: A friend of mine has high blood pressure, type II diabetes, works two jobs, and is under a lot of stress. Last week while experiencing dizziness, she also had an ear ache that was more a sharp, stabbing pain instead of a constant ache. Is it possible this could be caused by her high blood pressure?

A: Does she often have periods of dizzy spells that have gone undiagnosed because she has neglected to tell her primary care physician? If she has them regularly, that should be known as well so appropriate investigation can occur. Generally speaking, high blood pressure causes a buzzing or ringing of the ear(s), not the stabbing pain you make reference to, so I would be inclined to lean toward her blood pressure readings not being the primary cause for her discomfort.

When the ear is the main source of pain, it is referred to as primary. As an example, otitis media and otitis externa will reveal an abnormal examination and are considered primary. When an ear examination is normal and the ear is not the source of pain, the condition is referred to as secondary and the cause can be very difficult to determine. TMJ (temporomandibular joint syndrome), dental disease, arthritis of the cervical spine and others are considered secondary.

Let’s review a few ear issues. Acute otitis media will reveal a red and bulging tympanic membrane that can vary in color. To further complicate things, the discoloration may involve only part of the tympanic membrane. Otitis externa a/k/a swimmer’s ear, commonly leads to redness and inflammation of the ear canal. Even a mild case may reveal tenderness when an otolaryngologist (ear, nose and throat specialist) pulls or presses on specific areas of the ear. TMJ will present with pain and crepitus and the degree of pain may increase with chewing. Changes in barometric pressure as can occur with deep sea diving or descending in an airplane will reveal a hemorrhagic tympanic membrane; there may be blood or fluid in the middle ear. Tonsillitis and pharyngitis can cause referred pain to the ear. Tonsillitis will cause pain, difficulty swallowing, jaw and throat tenderness, and more. Pharyngitis (throat infection) can be bacterial or viral in nature. The bacterial form we know as strep throat will typically reveal enlarged tonsils with white spots and swollen lymph nodes in the front of the neck. The viral form will reveal a red throat and red eyes. Your friend should make an appointment with a specialist to rule out primary and secondary causes for the pain.

If she is under extreme stress, it can certainly manifest with symptoms of dizziness, headache, muscle tension and pain, chest pain, fatigue and a whole host of other issues. We all process things in a different manner. Her symptoms of ear pain may have been coincidental and will not occur again; however, I would prefer she remain on the safe side and be seen professionally. She should have her blood pressure checked and perhaps some laboratory testing done. She should bring a list of all her medications for review at the same time.

Then, she should take appropriate steps to de-stress. This is easy for an outsider to say who doesn’t experience the same pressures she does. Working two jobs she likely has little time for anything else but yoga, Tai chi or meditation might help appreciably. Arising 10 minutes early or staying awake 10 minutes later in the evening might afford her the time she needs. Perhaps she was once physically active and might prefer to jog around the block at a bizarre hour. You can certainly help by offering to watch her children, do the dishes for her before work, or even walking with her each day. Stress can play a gigantic role in anyone’s life and can affect health appreciably. Make sure she gets professional help to rule out any unknown medical conditions. Then help her to help herself. You’ll both be glad you did.