S
Susan is a 59-year-old female who started having jaw pain and headaches at about 12-15 months. She suffered from COVID early last year and since then has been having dizziness, ear fullness, jaw pain and headaches. Initially, she thought her symptoms would go away but her symptoms have gradually worsened. Her fever and cough did resolve in 2-3 weeks. She was referred by her ENT physician to me for an evaluation. Fortunately or unfortunately, her examination was almost normal except for diffuse muscle tenderness. Not having a clear clinical diagnosis (something that could be fixed) is frustrating. Interestingly, when I applied a topical anaesthetic under her jaw, her ear fullness alleviated and her jaw and head pain improved. My diagnosis for her was muscular pain complicated with long COVID. The presence of long COVID or chronic COVID is similar to the presence of an autoimmune disorder wherein the body reacts adversely to benign stimulus on a daily basis.
In an Italian study, 87% of COVID patients had some symptoms at a 2-month follow-up. These range from fatigue, joint pain and trouble breathing. Over the last year, I have seen several patients like Susan who fit this criteria. My treatment philosophy in these situations depends on the diagnosis, understanding which factors will have a beneficial effect on an individual patient and figuring out a treatment plan. I explained to Susan the complexity of the issue and also explained to her that it is not necessarily a progressive problem. Her treatment plan has included self-care, an occlusal orthotic and acupuncture once a month for 3 months. Self-care included warm compresses over the ears, and temples for 15 minutes twice daily, mindful breathing (she enjoys meditation and yoga) three times daily and daily supplementation with Bosellia/Tumeric 300mg/300mg. It has been about 6 months and her pain is almost alleviated; her dizziness is less intense. Her sleep continues to be a major issue and she is following up with her primary physician. Overall, she has shown great improvement but clearly not enough. Our body is quite dynamic and improvement of pain, headaches, dizziness, fatigue and other symptoms involves educating the patient and making 
a multifaceted approach with a realistic outcome goal.
https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
Image attribution: https://www.nature.com/articles/s41598-021-95565-8
