Ear pain is miserable. Anyone who has experienced extreme discomfort in the ear canal is not likely to forget it any time soon.
Allergy testing is the first step any ear pain sufferer should consider. Middle ear infection (otitis media) is the most common cause of ear pain. However, believe it or not, many earaches are caused by jaw joint issues known as TMJ disorders.
While it seems counter-intuitive that jaw problems could cause ear pain, such pain is actually a common symptom of temporomandibular disorder (TMD).
What is TMJ/TMD?
TMD is a condition in which the temporomandibular joint (TMJ) is misaligned.
To understand how TMD functions, picture the jaw as a hammock. This hammock is strung between two trees (in this case, the joints). If someone lies in the middle of the hammock, the result is comfortable and balanced. But if the same person settles too close to one tree or the other, the hammock becomes uncomfortable and imbalanced.
TMJ symptoms can include ear pain, ears hurting when chewing, clicking when you open or close your mouth, jaw locking, headache, facial muscle soreness, an ear ache causing jaw pain, ringing in your ears, and even hearing loss.
According to the National Institute of Dental and Craniofacial Research, recurring TMD affects 5-12% of the population. It is more common among younger people, and twice as many women as men suffer from this malady. TMD can present itself in several ways:
- Degenerative joint disease - Rheumatoid arthritis or osteoarthritis in the joints of the jaw.
- Displaced disk, disjointed jaw, or damage to the condyle.
- Myofascial pain - The most prevalent form of TMD, involving pain or discomfort in the muscles and connective tissue of the shoulder, neck, and jaw.
What Causes TMJ/TMD?
The exact causes of TMJ are unknown. Some research suggests a possible link to female hormones, which would explain why so many more women suffer from the condition than men.
ENT doctors do identify one common link in many cases of TMJ, though: psychological stress leading sufferers of TMJ to clench or grind their teeth, often in their sleep. Over time, this sustained jaw movement causes misalignment in the jaw and inflames the TMJ, leading to ear pain, among other symptoms.
A 2003 study also found that some cases of malignant external otitis (MEO), an infection of the otitis externa (outer ear), can also lead to the development of TMJ. The study involved forty-two MEO patients who were observed over eight years. Six of those patients (14%) developed TMJ soon after being admitted for MEO. Four of those six patients suffered from controlled Type 2 diabetes, which may be a contributing factor.
Why Does TMJ Cause Ear Pain?
The TMJ is located on both sides of the skull, roughly 0.5 centimeters from the ear canal. When these joints and surrounding muscles become inflamed or irritated, the nerve paths that register that pain are connected to the eustachian tube, which equalizes pressure around the eardrum.
The sufferer of TMJ/TMD experiences this discomfort as ear pain. This phenomenon of discomfort felt in a body part other than the affected area is known as referred pain.
Because of the placement of the TMJ and the wide nerve path connected to it, TMD can also manifest as pain in the head, face, neck, and shoulders.
Diagnosis and Treatment of TMJ/TMD
Ear nose and throat doctors are the only professionals who can diagnose and treat TMJ/TMD.
ENT doctors turn to various treatments for TMJ, including prescription, over-the-counter, and non-medicinal options.
Regarding prescription and over-the-counter remedies, some sufferers react better to anti-inflammatories like steroids or NSAIDs; others get better results from drugs that target neurotransmitters, like tricyclic antidepressants.
Ear nose and throat doctors may suggest that a patient try the following practices to reduce TMJ-related pain:
- Proper Nutrition
- Reduce Stress
- Examine Posture/Daily Activities for Triggers
- Eating Soft Foods
- Using an Ice Pack
- Gently Stretching the Jaw
Interventions That Help Improve TMJ
Exercises an ENT doctor may recommend are designed to stretch muscles and ligaments, rest the lower jaw in a different position, strengthen muscles in the jaw, and relax jaw muscles.
Jaw Muscle Relaxation Technique
Gently rest the tongue behind your upper teeth; allow your jaw muscles to relax as you part your teeth.
TMJ Muscle Stretch
Place your tongue on the roof of your mouth. Open your mouth slowly until your tongue is about to drop. Hold for 15 seconds.
Rest on a Pen
Lightly rest your front teeth on a pencil or pen.
Opening Jaw Exercise
Create gentle resistance by placing your thumb under your chin. Open and close your mouth gently against the resistance ten times.
Closing Jaw Exercise
Create gentle resistance by placing your hand on your chin, pressing lightly downward. Close your mouth against the resistance ten times.
Side-to-Side Jaw Exercise
Open your mouth and gently move your jaw left to right and back, stretching slightly on each side.
There are specific massage techniques, therapeutic ultrasound, joint mobilizations, exercises and treatment protocols available to patients that would like to see our physical therapists in Total Balance clinic at the West End location.
See an ENT Doctor for TMJ/TMD
While some at-home treatments may help temporarily relieve some of the pain associated with TMJ, it is essential to consult an ENT doctor to truly address the condition. Visit Virginia Ear Nose & Throat for more information about TMJ treatment or to set up an appointment to see an ENT in Richmond, Colonial Heights, or Mechanicsville, VA.