What is the next course of treatment for my swollen right ear, jaw lumps, and throat lumps, given my current prescription of Prednisone (40 mg QD for 5 days) and Methylprednisolone (Methylpred Sodi Succ, A-Methapred) 125mg Intramuscular (IM) injection?

Management of Swollen Right Ear, Jaw Lumps, and Throat Lumps

You need urgent evaluation by an otolaryngologist (ENT specialist) or emergency department as your symptoms suggest a severe inflammatory reaction that requires immediate attention beyond your current steroid treatment.

Current Situation Assessment

Your symptoms of:

• Swollen right ear (closed shut)
• Lumps on jaw and throat
• Extreme pain
• Current treatment: Prednisone 40 mg daily for 5 days and Methylprednisolone 125 mg IM injection (one-time dose)

These symptoms suggest a significant inflammatory process that could be:

• Severe allergic reaction
• Immune-related adverse event
• Infection (bacterial or viral)
• Inflammatory disorder

Immediate Management Plan

Step 1: Emergency Evaluation

• Seek immediate medical attention if you haven't already done so
• The swelling affecting your airway (throat lumps) could potentially become life-threatening

Step 2: Diagnostic Workup

• Complete examination of ear, jaw, and throat
• Blood tests to evaluate:
  • Inflammatory markers (ESR, CRP)
  • Complete blood count with differential
  • Liver function tests

Step 3: Treatment Modifications

1. Corticosteroid Adjustment:

   • Your current prednisone dose (40 mg daily) may be insufficient for severe symptoms
   • Increase prednisone to 1-2 mg/kg/day (typically 60-120 mg daily) for severe inflammatory reactions 1
   • Continue for 5-7 days then taper gradually over 2-4 weeks based on symptom resolution

2. Additional Treatments:

   • Add an H1 antihistamine (cetirizine 10 mg daily or diphenhydramine 25-50 mg every 6 hours) 1
   • Consider adding an H2 blocker (famotidine 20 mg twice daily)
   • NSAIDs for pain management if not contraindicated 1

3. If No Improvement Within 48-72 Hours:

   • Additional immunosuppressive therapy may be needed
   • Specialist consultation with rheumatology or immunology

Monitoring and Follow-up

• Daily assessment of:

  • Swelling progression/regression
  • Pain levels
  • Ability to swallow/breathe
  • Temperature

• Return immediately to emergency department if:

  • Increasing difficulty breathing
  • Inability to swallow
  • Spreading of swelling to other areas
  • Fever development

Important Considerations

• The FDA label for prednisone notes that dosage requirements are variable and must be individualized based on disease severity and patient response 2
• For severe inflammatory reactions, higher initial doses (60 mg or more) may be required 2
• Short-term high-dose steroids carry fewer risks than prolonged treatment
• Gastrointestinal protection with a proton pump inhibitor is recommended while on high-dose steroids

Potential Pitfalls

1. Inadequate steroid dosing: Your current dose may be insufficient for the severity of symptoms
2. Delayed specialist evaluation: ENT evaluation is crucial to rule out airway compromise
3. Missing an underlying infection: Antibiotics may be needed if bacterial infection is suspected
4. Abrupt steroid discontinuation: Any steroid treatment should be tapered to prevent rebound inflammation

The recurrent nature of your symptoms ("swollen shut again") suggests this may be a chronic condition requiring long-term management strategy beyond the acute treatment.