How does TMJ cause ear pain. What are the symptoms of TMJ-related ear pain. How long can TMJ ear pain last. What triggers TMJ ear pain flare-ups. How is TMJ-related ear pain diagnosed and treated.

The Connection Between TMJ Disorders and Ear Pain

Temporomandibular joint (TMJ) disorders can often lead to ear pain, a symptom that many people find perplexing. This connection stems from the close anatomical relationship between the jaw joints and the ears. The temporomandibular joints are located just in front of each ear, and the muscles that control jaw movement extend into the ear region.

When TMJ disorders occur, they can affect not only the joints themselves but also the surrounding muscles and tissues. This can result in pain that radiates to the ears, creating discomfort that may be mistaken for an ear infection or other ear-related issues.

Anatomical Factors Contributing to TMJ Ear Pain

• Proximity of TMJ to the ears
• Shared nerve pathways
• Interconnected muscle groups
• Referred pain mechanisms

Mechanisms of TMJ-Induced Ear Pain

TMJ disorders can cause ear pain through various mechanisms. One primary way is by placing excessive stress on the muscles involved in jaw function. The masseter and temporalis muscles, which are crucial for chewing and jaw movement, are particularly susceptible to this stress.

When these muscles become overworked or strained, they can create tension and pain that extends to the ear area. Additionally, inflammation and swelling originating from the TMJ can spread to the surrounding tissues, including those in and around the ear.

Key Muscles Involved in TMJ-Related Ear Pain

1. Masseter muscle
2. Temporalis muscle
3. Lateral pterygoid muscle
4. Medial pterygoid muscle

Identifying TMJ-Related Ear Pain

Distinguishing TMJ-related ear pain from other types of ear discomfort can be challenging. However, certain characteristics can help identify the source of the pain. TMJ-induced ear pain often coincides with other jaw-related symptoms, such as clicking or popping sounds when opening or closing the mouth, difficulty chewing, or facial pain.

Can TMJ ear pain be unilateral? Yes, TMJ-related ear pain can occur on one side or both sides, depending on which joint is affected and the extent of the disorder. If you experience persistent ear pain accompanied by jaw symptoms, it’s advisable to consult a dentist or TMJ specialist for a proper diagnosis.

Common Signs of TMJ-Related Ear Pain

• Pain that worsens with jaw movement
• Accompanying jaw stiffness or limited range of motion
• Tenderness in the jaw or facial muscles
• Ear pain without signs of ear infection

Characteristics of TMJ Ear Pain Sensations

The sensation of ear pain caused by TMJ disorders can vary widely among individuals. Some people describe it as a dull, persistent ache, while others experience sharp, intense pain. The nature of the pain often depends on the underlying cause of the TMJ disorder and the specific tissues affected.

Is TMJ ear pain constant or intermittent? TMJ ear pain can be either constant or intermittent. Some individuals may experience ongoing discomfort, while others might have pain that comes and goes, often triggered by jaw movement or stress.

Possible Descriptions of TMJ Ear Pain

• Dull, throbbing ache
• Sharp, shooting pain
• Burning sensation
• Pressure or fullness in the ear
• Pain that radiates from the jaw to the ear

Duration and Variability of TMJ Ear Pain

The duration of TMJ-related ear pain can vary significantly from person to person. Some individuals may experience short-lived episodes of pain, while others might contend with chronic discomfort lasting weeks or even months. The persistence of the pain often depends on several factors, including the underlying cause of the TMJ disorder, individual physiology, and the effectiveness of treatment measures.

Do TMJ symptoms worsen over time if left untreated? In many cases, untreated TMJ disorders can lead to worsening symptoms over time. This is why early intervention and proper management are crucial for preventing the progression of the condition and alleviating associated ear pain.

Factors Influencing TMJ Ear Pain Duration

1. Severity of the TMJ disorder
2. Individual pain tolerance
3. Presence of other health conditions
4. Effectiveness of treatment approaches
5. Lifestyle and stress levels

Triggers and Exacerbating Factors for TMJ Ear Pain

Various factors can trigger or worsen TMJ-related ear pain. Stress is a common culprit, as it often leads to increased jaw clenching and muscle tension. Changes in weather, particularly barometric pressure fluctuations, have been reported to affect TMJ symptoms in some individuals. Additionally, certain activities or habits can exacerbate the pain.

Can diet affect TMJ ear pain? Yes, diet can play a role in TMJ symptoms. Consuming hard or chewy foods may strain the jaw muscles and joints, potentially triggering or worsening ear pain. Adopting a soft food diet during flare-ups can help alleviate discomfort.

Common Triggers for TMJ Ear Pain Flare-Ups

• Excessive jaw movement (e.g., chewing gum, yawning)
• Stress and anxiety
• Poor posture
• Teeth grinding or clenching (bruxism)
• Sleeping in positions that strain the jaw
• Weather changes

Diagnosis and Treatment of TMJ-Related Ear Pain

Accurate diagnosis of TMJ-related ear pain typically involves a comprehensive examination by a dentist or TMJ specialist. This may include a physical evaluation of the jaw, assessment of jaw movement, and possibly imaging studies such as X-rays or MRI scans. Once diagnosed, treatment approaches can vary depending on the severity and underlying cause of the TMJ disorder.

Are there non-invasive treatments for TMJ ear pain? Yes, many cases of TMJ-related ear pain can be effectively managed with non-invasive treatments. These may include lifestyle modifications, stress reduction techniques, physical therapy, and the use of oral appliances to improve jaw alignment.

Common Treatment Approaches for TMJ Ear Pain

1. Pain management techniques (e.g., heat/cold therapy)
2. Jaw exercises and stretches
3. Stress reduction strategies
4. Dental splints or night guards
5. Physical therapy or massage
6. Medications (e.g., anti-inflammatories, muscle relaxants)
7. Botox injections for severe cases

Long-Term Management and Prevention of TMJ Ear Pain

Managing TMJ-related ear pain often requires a multi-faceted, long-term approach. While acute symptoms can often be addressed with short-term interventions, preventing recurrence and managing chronic cases typically involves ongoing care and lifestyle adjustments.

Can TMJ ear pain be permanently cured? While complete cure may not always be possible, many individuals can achieve significant long-term relief from TMJ ear pain through proper management and preventive measures. The key lies in identifying and addressing the underlying causes of the TMJ disorder.

Strategies for Long-Term TMJ Ear Pain Management

• Regular jaw exercises and stretches
• Maintaining good posture
• Avoiding excessive jaw movements
• Managing stress through relaxation techniques
• Using a night guard if teeth grinding is an issue
• Regular follow-ups with a TMJ specialist
• Modifying diet to avoid hard or chewy foods

Understanding the connection between TMJ disorders and ear pain is crucial for effective management and treatment. By recognizing the symptoms, identifying triggers, and working with healthcare professionals, individuals suffering from TMJ-related ear pain can find relief and improve their quality of life. Remember that each case is unique, and what works for one person may not work for another. Patience and persistence in finding the right combination of treatments and lifestyle changes are often key to successfully managing TMJ ear pain.

What Does Ear Pain From TMJ Feel Like?

Home » What Does Ear Pain Caused by TMJ Feel Like?

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Table of Contents:

How do TMJ disorders cause ear pain?
How do I know if my ear pain is from TMJ?
What does ear pain from TMJ feel like?
How long does TMJ ear pain last?

TMJ disorder is a condition characterized by dysfunction of the jaw joints, resulting in pain and other symptoms such as crepitus (clicking or popping sound). TMJ disorder is often associated with ear pain as the temporomandibular joints are connected to the masseter muscles, which run from the rear part of the cheek to the lower jaw. There are several different types of TMJ disorders, and some types tend to cause ear pain more often than others.

How do TMJ disorders cause ear pain?

TMJ disorders can cause ear pain by placing extra stress on the muscles involved in jaw function, but also from inflammation and swelling spreading from another area to the ears. The muscles involved in the functions of the jaw include the masseter, the temporalis, the lateral pterygoid muscle and the medial pterygoid muscle. All of these muscles are fundamental for the jaw’s proper functioning; any stress placed on any one of these muscles can cause facial pain or ear pain. The muscles most associated with ear pain include the masseter and the temporalis muscles, which are located above (temporalis) and below (masseter) of the ear.

How do I know if my ear pain is from TMJ?

Ear pain is a common symptom and can have a number of different causes, including TMJ disorder. One of the most common symptoms of TMJ disorder is ear pain as the jaw joints can become dislocated or the muscles in the ear can spasm due to dysfunction of this joint. Some people experience ear pain that is not related to a TMJ disorder but is caused by another condition, such as a middle ear infection or sinus pain. It is important to see a dentist when experiencing ear pain to determine its cause and the best course of treatment.

What does ear pain from TMJ feel like?

Ear pain caused by a TMJ disorder might be a dull, ongoing irritation or it could be a sharp, searing pain, depending on its cause and the affected tissues. The pain may worsen with jaw movement, although this is not always the case. Inflammation and swelling due to TMJ disorder can spread to the ear, causing ear pain and discomfort. Additionally, straining the muscles connected to the TMJ, such as the masseter and temporalis, can result in ear pain as well as tension headaches and pain behind the eyes.

How long does TMJ ear pain last?

Each individual will have their own causes and symptoms of TMJ disorder, so it is impossible to predict how long the pain will last as well as how severe the pain will be. There are several factors that play a role in the duration of ear pain, including how long the pain has already been present. Other factors include individual physiology, overall health, the treatments received, and the pain tolerance of the individual. It is also important to note that in times of stress or illness, or even during weather changes, TMJ disorder symptoms can flare up, prolonging their total duration. If ear pain from TMJ disorder lasts longer than a week or interferes with the ability to perform everyday activities, it should be addressed by a qualified dentist as soon as possible in order to restore health and live a good quality of life.

If you are experiencing ear pain from TMJ disorder, come to Koala® Centers For Sleep & TMJ Disorders for knowledgeable and personalized care.

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When It Looks Like a Duck, But Isn’t a Duck- Hiding Behind Ear Pain

When you think of ear pain, you probably think it’s an ear infection, but did you know that not all ear pain results from an infection?

One of the most common yet underdiagnosed reasons for ear pain is temporomandibular joint disorders, or TMDs.

Although TMDs often stem from an issue with your jaw joints (TMJs), they can cause ear pain and other ear issues.

The TMJs are what connect your jawbone to your skull. They allow your jaw to move up and down, back and forth, and even enable it to slide left to right when you speak, chew and swallow.

In this blog, we explain why the TMJs are linked to ear pain and other problems with the ear and how to find relief.

As we said, the TMJs are the joints that connect the lower jaw (mandible) to the skull at the temporal bone. The TMJs are made up of the bones and cartilage of the joint and a small cartilage disk inside the joint.

When the TMJs become worn or the disk in the joint becomes damaged or out of alignment, the results can be painful.

While the causes of TMDs are often unclear, in most cases, discomfort in the TMJs can occur due to an injury to the jaw, osteoarthritis (bruxism), teeth grinding and a misaligned bite. Some people also develop TMD as a result of excessive gum chewing. To learn more visit our page on TMJ disorder.

There are three primary types of TMDs:

• Myofascial pain. This is the most common type of TMJ disorder and is frequently caused by a misaligned bite. The primary symptom is aching pain deep in the muscles of the jaw joint.
• Internal derangement of the TMJ: This situation is usually a result of injury or trauma to the joint.
• Degenerative conditions: Degenerative joint conditions such as osteoarthritis can negatively impact the TMJs.

The pain of TMJ disorders can be dull or sharp. Some patients report that their pain is constant, while others experience sudden bursts of pain.

For some, their pain can become more noticeable over time. Typically it may show up when you move your jaw during talking, chewing, swallowing or yawning.

Beyond ear and jaw pain, other TMD symptoms include soreness in the muscles and tissue along the side of your head. This soreness can spread to your neck, temple, cheek, face and lower jaw. Many people feel pain in their teeth as well.

Other common symptoms of TMD include:

• A clicking/popping sound when opening and closing the mouth
• Locking of the joint or feeling as if the jaw joint is going to lock
• Difficulty opening the mouth or jaw stiffness
• Ringing sound in the ear known as tinnitus

If you have pain in your ear, we recommend that you talk to your doctor if these other symptoms are present.

Back to ear pain. Why does your ear hurt if you have TMD? Ear pain is associated with TMD because the TMJs are located near the ear canal.

When a joint is inflamed, it can cause pain in the ear. It can also lead to a ringing sound in the ear, also known as tinnitus. Ear pain associated with TMD is often a sharp, stabbing sensation.

When most people have ear pain, they think they have an ear infection and visit their doctor or an ENT specialist, but when no infection can be found, they become frustrated with no answer while they’re dealing with ear pain.

Treatment for disorders of the TMJs varies and depends on the cause of your case and how severe it is. For mild cases, self-care remedies to reduce soreness and tension in the joint may help. These remedies include:

• Eating soft foods
• Relaxation techniques
• Exercises designed to help your jaw muscles relax
• Avoiding chewing gum and very chewy foods
• Alternating moist heat and ice on the jaw to bring relief
• Avoid clenching or tensing your jaw
• Apply moist heat to the area

Anti-inflammatory medications (NSAIDs) such as ibuprofen or naproxen and muscle relaxants can also help relieve uncomfortable TMD symptoms.

But, for long-term relief, we recommend that you talk to us about your treatment options. In many cases, we can help relieve your TMJ pain with an oral appliance that can help correct problems with the upper and lower teeth, which is often the cause of issues with the TMJs.

Are you experiencing unexplained ear pain, ringing in the ears or spells of dizziness? If your earache is a sign of TMJ disorder, the good news is that we can help.

Call us today to schedule a consultation.

Temporomandibular joint dysfunction as the most common cause of facial pain: current state of the problem

Orofacial pain is widespread in the population. Patients with facial pain seek medical advice from many specialties, including dentists, maxillofacial surgeons, neurologists, internists, and otorhinolaryngologists. Diagnosis of pain in the face can cause a serious difficulty for the doctor.

Pain in the face can be caused by a variety of reasons. In the International Classification of Head and Facial Pain, 3rd revision (ICHD-3 beta), pain syndromes in the facial area are given in Chapter 11 “Headache or facial pain associated with the pathology of the bones of the skull, neck, eyes, ears, nose, sinuses, teeth , oral cavity or other structures of the face and neck” and in chapter 13 “Painful cranial neuropathies and other facial pains” [1]. It should be noted that almost all sections in Chapter 11 use the term “headache (HA)”; only one section mentions facial pain as such (11.8). Chapter 13 refers to pain syndromes as “neuralgia” or “neuropathy.”

Most of the syndromes listed in the ICGB are not often encountered in the practice of a neurologist. One of the common mistakes in interpreting the cause of facial pain is the overdiagnosis of trigeminal neuralgia (TN) followed by prolonged and ineffective treatment with carbamazepine. At the same time, TN has been shown to be a relatively rare cause of facial pain [2].

This article focuses on temporomandibular joint dysfunction (TMJD). Today, TMD is regarded as the most common cause of chronic facial pain not associated with dental disease [3]. Facial pain associated with pathology in the region of the temporomandibular joint (TMJ) occurs in 19—26% of the adult population, and in women it is observed 1.5 times more often than in men [4, 5].

Clinical picture

Patients with TMD may experience pain in the face, maxilla and mandible, neck and shoulders, and in and around the ear. The pain may be constant or appear when chewing, talking, opening the mouth. Often the pain is also accompanied by a feeling of tiredness in the face and swelling.

In addition to facial pain, patients may experience headache, neck pain, earache, toothache, burning and stabbing sensations in the face, and shooting and puncture sensations. In addition to pain, there are also more rare and therefore even more difficult to diagnose symptoms: noise, ringing or congestion in the ears, non-systemic dizziness, and even itching or tingling in the head and neck. Pain may develop gradually, but many patients report an abrupt onset of pain and accompanying symptoms.

Difficulty chewing, inability to open the mouth wide, crackling/clicking when opening or closing the mouth, and blockage of the mandible are all indications of damage to the TMJ itself and facilitates diagnosis.

Diagnostics and differential diagnostics

Previously, TMD was considered exclusively as a pathology of the TMJ and as a consequence of subluxation of the lower jaw, arthritis, arthrosis or trauma of the TMJ, as well as occlusal disorders [6, 7]. However, in 2014, the TMD Diagnostic Criteria for Clinical Practice and Research (DC/TMD) was adopted by the International RDC/TMD Consortium Network and Orofacial Pain Special. interest group). In accordance with these criteria, TMD is divided into two groups: pain and intra-articular pathology; their combination is also possible [8].

A large number of patients with TMD have a painful form, i.e. pain in the area of ​​masticatory muscles, while the pathology of the joint itself is not detected. The literature describes pain in the face associated with myofascial dysfunction of the facial muscles [7, 9]. The authors indicate that during palpation of the muscles on the side of pain, a dense texture and muscle tension, especially masticatory and facial muscles, as well as severe pain and myofascial trigger points, were noted. On palpation of the masticatory muscle, the pain spreads to the upper and lower jaws, upper and lower molars, to the ear, to the frontal region, to the TMJ, to the neck. On palpation of the temporal muscle, pain radiates to the corresponding half of the head, forehead, upper teeth, and orbit. Since the prevalence of the painful form of TMDJ exceeds the prevalence of the intra-articular form [10], most patients can and should receive effective care from a neurologist. Thus, facial pain in a patient is most often caused by hypertonicity and myofascial pain syndrome in masticatory muscles without pathological changes in the structures of the joint itself.

When a patient presents with facial pain, the neurologist needs to conduct a proper examination (palpation) in order to diagnose and optimally treat such patients. This will avoid unnecessary referral of patients to dentists and ENT doctors and unnecessary and often painful examinations.

New criteria for the correct diagnosis of TMD are presented in the table.

Criteria for the diagnosis of TMD DC/TMD for use in clinical practice and research (adapted from [8])

Thus, according to the diagnostic criteria for TMD for clinical use, pain disorders are not associated with the pathology of the TMJ itself and can be represented by myalgia, arthralgia and HT associated with TMD. These criteria are based on the data of the anamnesis and clinical examination (palpation of the temporal and masticatory muscles) and do not require mandatory imaging studies. In myalgia, pain may be felt in the jaw, temple, ear, or anterior to the ear and usually changes with mandibular movement, chewing, or parafunctional activity. This means that pain in the face, ear, anterior and near the ear, as well as tinnitus may be symptoms of TMD and not indicate the presence of ENT pathology.

In the case of local myalgia, the pain felt by the patient is reproduced by palpation of the temporal and masticatory muscles within their palpable area. In myofascial pain syndrome, pain extends beyond the palpable area within or outside the palpated muscle (myofascial pain syndrome with referred pain).

It should be noted that for a complete diagnosis, it is necessary to follow the correct muscle palpation protocol: 3 points in the temporal muscle (anterior, middle and posterior sections) and 3 points in the masticatory muscle region (the beginning of the muscle, its body and its attachment site) [11]. Palpation is carried out with one or two fingers on each side separately or on both sides at once (depending on the convenience of the patient), the duration of pressing to determine myalgia should be at least 2 s, if it is necessary to determine the subtype of myalgia, at least 5 s. In practice, it is also possible to palpate the masticatory muscle by pressing it with the researcher’s thumb in the patient’s mouth and with the rest of the fingers outside.

To determine the presence of arthralgia, it is necessary to confirm that the pain felt by the patient in the face is localized in the TMJ region and is reproduced during provocative tests: palpation in or around the condylar process of the mandible or with maximally active or passive mouth opening, lateral movement or protrusion of the mandible .

In the case of localization of pain in the parotid region anterior to the auricle, it can be difficult for the clinician to determine the specific structure involved. In this case, it is necessary to determine whether the pain is localized in the region of the condylar process of the lower jaw (arthralgia) or the masticatory muscle. In the latter case, one of the types of myalgia will be diagnosed. To determine the location of the condylar process of the jaw and confirm the source of pain felt by the patient, it is necessary to palpate the anterior region with the mouth closed. In case of difficulty, palpation should be performed when opening the mouth or protruding the lower jaw forward (Fig. 1).

Rice. 1. Palpation to locate the condylar process of the mandible. a – with a comfortable closing of the mouth; b – with protrusion of the lower jaw.

To find the points of palpation of the masticatory muscle, ask the patient to clench and then unclench his teeth. In this case, the definition of the boundaries of the palpated muscle is greatly simplified (Fig. 2).

Rice. 2. Palpation of the masseter muscle to determine the form of TMD. a – the place of the beginning of the muscle; b – muscle body; c — zone of muscle attachment.

Palpation of the temporal muscle is much easier. It is necessary to palpate at least 3 points in the anterior, middle and posterior portions of the muscle (Fig. 3). In case of difficulty in finding the boundaries of the temporal muscle, it is necessary to ask the patient to clench his teeth.

Rice. 3. Palpation of the temporal muscle in order to determine the form of TMD. a – anterior portion of the muscle; b – the average portion of the muscle; in — a back portion of a muscle.

Another type of pain form of TMD is TMJ associated with TMD. In ICHD-3, beta HT associated with TMD is referred to as secondary cephalalgia and is described as “HT caused by a disorder involving structures in the TMJ area” [1]. The first two items are non-specific criteria confirming the secondary nature of the pain; only item 3 contains TMD-specific characteristics: GB is provoked or exacerbated by active jaw movements, passive movements in the usual range of jaw mobility, and/or provocative tests with temporomandibular structures, such as pressure on the TMJ and surrounding masticatory muscles. However, the commentary on the diagnostic criteria contains a recommendation from the International Headache Society to use newer and more accurate criteria developed by the RDC/TMD International Network Consortium and the Orofacial Pain Research Group to fully diagnose and clarify the causes of pain associated with TMD.

Differential diagnosis of HT associated with TMD includes other forms of primary and secondary cephalgia. When conducting a differential diagnosis, it is necessary to rely on the known diagnostic criteria for these cephalalgias. In the case of strictly unilateral HA, it is necessary to exclude migraine and cervicogenic GB. Patients with migraine are characterized by provocateurs of a painful attack that are not typical for TMD, migraine symptoms accompanying an attack (nausea, vomiting, phono- and photophobia), often a hereditary history of G.B. To confirm the diagnosis of cervicogenic HA, rotational tests and diagnostic blocks of cervical structures are used [1]. In the case of bilateral localization of pain, difficulties may arise in the differential diagnosis with tension headache, combined with tension of the pericranial muscles. In this case, the inspection and palpation shown in Fig. 1-3 are of key importance for diagnosis.

Intra-articular forms of TMD are somewhat less common in the practice of a neurologist. It should be noted that in many cases the identified intra-articular pathology is combined with the pain form of TMD and is not isolated.

In the presence of damage to the TMJ itself, there are several forms of TMD. With various forms of displacement of the intraarticular disc with reduction, different intracapsular sounds are noted during palpation of the joint and movements of the lower jaw: crunching, crackling, clicking. Disc displacement without reduction is usually caused by spasm of the lateral pterygoid muscle [12]. When the disc is displaced without reduction, there is a pronounced restriction of mouth opening and a violation of the ability to eat. In the case of degenerative pathology of the disc, a coarser (similar to grinding) and long sound can be noted – crepitus caused by friction of the damaged intraarticular disc. Blockage of the TMJ when the mouth is open and the inability to close the mouth without an assisted maneuver are indicative of mandibular subluxation.

Examination rules for the diagnosis of intra-articular form of TMD are shown in fig. 4. To confirm the diagnosis of various intra-articular forms of TMD, it is necessary to conduct an MRI examination of the joint.

Rice. 4. Palpation aimed at detecting sounds in the TMJ. a — when opening/closing the mouth; b – lateral movement of the jaw to the right; c – lateral movement of the jaw to the left; g – protrusion of the lower jaw. Palpation is carried out sequentially on each side.

Etiology and pathogenesis of TMD

The etiology of TMD is multifaceted and is a combination of psychological, postural, orthopedic, genetic, biopsychosocial and occlusive factors that disrupt the functional balance in the structures of the TMJ itself and the surrounding muscles [6, 13, 14].

The view on the pathophysiology of TMD cannot be considered finalized. In 1934, James Costen gave the first systematic description of this group of diseases, indicating occlusion failure as the main cause. For many years, it was believed that the cause of myogenic and articular disorders in TMDJ is malocclusion (occlusal disorders, missing teeth, suboptimal prosthetics, chewing on one side and other causes) and parafunctional activity (night and/or daytime bruxism), which leads to increased load on the TMJ and muscles that provide chewing (temporal, chewing, medial and lateral pterygoid). A significant role was also assigned to injuries of the face and lower jaw and emotional disorders. In particular, the presence of symptoms of depression doubles the likelihood of developing the arthralgic form of TMD, and anxiety disorders often accompany myalgia in TMD [15, 16]. Some authors [7] point to the role of orthopedic disorders (for example, short leg syndrome) in the genesis of TMD. An orthopedic examination in a significant number of patients (66%) reveals asymmetries of the shoulders, shoulder blades, shortening of one leg, which causes a compensatory change in posture and muscle imbalance throughout the entire spine. The “forward head posture” also has a serious influence on the occurrence of the myogenic form of TMD [17].

However, in recent years, a number of authors have expressed doubts about the exclusive role of dental pathology in the development of TMD. Point to the frequent combination of TMD and various types of GB. In patients with TMD, the most common primary form of HA is migraine (55.3%), the prevalence of HA is 30.2% [18]. According to other authors [19], the prevalence of TMD in patients with chronic daily HA is 58.1%.

In recent years, in the works of leading Russian and foreign researchers of chronic pain [20—22], for the first time, suggestions were made about possible central causes of TMD, in particular, about the role of a possible dysfunction of pain control systems. Thus, it has been shown that the prevalence of the pain form of TMD in chronic migraine significantly exceeds that in episodic migraine. The authors hypothesized that pain and myofascial pain syndrome in TMD may be caused by impaired processing of pain impulses in the CNS and are not associated with peripheral/dental factors.

Treatment

Based on the current understanding of the pathophysiology of TMD, a range of treatments have been developed. In neurological practice, TMD treatment includes a wide range of non-drug and pharmacological approaches:

1. Patient education. Educating patients about the causes and form of TMD and the importance of behavior modification (eg, actively focusing on not clenching teeth) is important. In case of acute pain, it is necessary to recommend a temporary refusal to eat solid food and open the mouth wide.

2. Non-steroidal anti-inflammatory drugs (NSAIDs) are often the first choice and are effective in managing TMD pain. Among a large group of NSAIDs, the drug nimesulide (nise) deserves special attention. The difference in clinical efficacy and tolerability of different NSAIDs may be due to different selectivity for inhibition of COX-1 and COX-2. Nimesulide is predominantly a COX-2 inhibitor with a wide range of additional actions, which helps to explain its specific anti-inflammatory and analgesic activity. More than 200 clinical studies have evaluated the effectiveness of nimesulide in a wide range of pain syndromes (tooth extraction and other dental operations, GB, back pain, joint pain, dysmenorrhea). In these studies, nimesulide systematically demonstrated a reduction in inflammatory pain significantly superior to placebo and at least equal to or in some cases even more effective than other NSAIDs [23].

The main clinical benefit of nimesulide is the time to onset and duration of pain relief. Compared with other NSAIDs, nimesulide has a faster onset of analgesic action, namely 15 minutes after ingestion [24], it should also be noted that a rapid onset of action was noted in patients with chronic pain syndrome.

A significant advantage of this drug is a lower relative risk of complications of the upper gastrointestinal tract compared with non-selective NSAIDs due to the predominant effect on COX-2. However, a single dose of nimesulide provided higher efficacy and a faster onset of analgesia than comparable single doses of selective COX-2 inhibitors such as celecoxib and rofecoxib [25]. When comparing nimesulide with the non-selective NSAID diclofenac, the drug showed comparable efficacy, but better overall tolerability [26].

The overall risk of severe liver reactions associated with the use of NSAIDs is low. The incidence of liver damage associated with the use of nimesulide is within the frequency range for other NSAIDs [23].

The use of all NSAIDs is associated with some cardiovascular risk and in patients with arterial hypertension, hypercholesterolemia and cardiovascular disease, all NSAIDs should be used with caution, especially in the elderly. Risks and benefits should be assessed on an individual basis and the lowest effective dose is recommended for the shortest possible period of time. Many data indicate that nimesulide demonstrates a low overall risk of cardiovascular events such as myocardial infarction or congestive heart failure [27].

An international panel of experts concluded that, when used appropriately, nimesulide remains an extremely important and safe treatment option for various conditions characterized by the presence of acute inflammatory pain, due to the rapid onset of analgesic action and a proven positive benefit/risk profile [23].

Nise is recommended for TMD at a dose of 100 mg twice daily. The duration of its use, like other NSAIDs, should be limited to the minimum necessary time.

3. Gymnastics . After applying a cold compress, exercises are performed to stretch the masticatory muscles, then a warm towel must be applied.

4. Cognitive behavioral therapy and biofeedback are also highly effective.

For chronic TMD it is recommended:

1. Administration of the tricyclic antidepressant amitriptyline (up to 75 mg/day). The choice of amitriptyline as a first-line drug is due to the relatively high risk of developing bruxism while taking selective serotonin reuptake inhibitors [28].

2. Referral of the patient to the dentist for the selection of a special muscle relaxant splint (especially in the case of nocturnal bruxism) and assessment of the presence and correction of occlusal disorders.

3. In case of myofascial pain syndrome, it is possible to inject anesthetic into trigger points in masticatory, temporal and pterygoid muscles.

4. Treatment with botulinum toxin type A for the painful form of TMDJ, which has demonstrated high efficacy in a large number of studies [9, 29]. Such therapy can not only achieve long-term and sustainable relaxation of the muscles of the masticatory group and relieve pain associated with myofascial pain syndrome in these muscles, but also a temporary remission of nocturnal bruxism, which will reduce the risk of developing an intra-articular form of TMD.

5. Carrying out complex treatment of comorbid diseases, in particular depression, anxiety disorders, chronic pain.

6. In case of proven presence of intra-articular form of TMD, dysfunction of the jaw and lack of effect of conservative therapy, the patient should be referred to an oral surgeon [30].

TMD is considered today as the most common cause of chronic facial pain not associated with dental disease. It has been shown that facial pain in many cases is caused by hypertonicity and myofascial syndrome in masticatory muscles without pathological changes in the structures of the joint itself. Since the prevalence of the painful form of TMDJ exceeds the prevalence of the intra-articular form, most patients can and should receive effective care from a neurologist. For a complete diagnosis of the nature of TMD, one should rely on the DC/TMD diagnostic criteria for clinical use. These criteria are based on the history and clinical examination (correct palpation of the temporalis and masticatory muscles) and do not require mandatory imaging studies. If typical symptoms of intra-articular pathology (primarily sound) are detected, an MRI of the joint is indicated to confirm the diagnosis.

TMD is currently considered a disease with a multifactorial etiology. Myofascial pain syndrome in the muscles of the masticatory group can be considered as a manifestation of a violation of antinociceptive functions, i.e., it is a reflection of central sensitization and a violation of downward pain control.

Treatment of the painful form of TMD at the first stage should be carried out by a neurologist. Recommendations for the treatment of TMD include patient education, NSAIDs, cognitive behavioral therapy, and biofeedback. For chronic pain, amitriptyline, injections of anesthetics and botulinum toxin type A, as well as referral to a dentist and maxillofacial surgeon are also possible.

The authors declare no conflict of interest.

Ear congestion – causes, in which diseases it occurs, diagnosis and methods of treatment

Fungus

Allergy

Sulfur plug

Otitis

Adenoids

Hearing loss

Rhinitis

Tumor

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04 February

Ear congestion: causes, diagnosis and treatment.

Definition

The congestion of the ear or ears occurs as a result of a violation of sound perception and is characterized by various sensations, including deafness, a feeling of squeezing and heaviness, too strong sounding of one’s own voice. Ear congestion, regardless of the causes of its occurrence, is difficult for the patient to tolerate and, as a rule, requires the help of a specialist.

Types of stuffy ear

Congestion in one or both ears may be accompanied by pain, tingling, noise or ringing in the ears, dizziness. In some cases, congestion disappears after the act of swallowing.

A dangerous symptom is ear congestion with the addition of fever, headache, discharge from the ear (purulent or bloody), sensation of a foreign body.

Ear congestion does not always indicate a pathological process. This condition can be caused0012 water in the ear, pressure drop during air travel or deep diving. Sometimes too strong and incorrect blowing simultaneously from two nasal passages leads to blockage of the ear (ears), which is associated with an increase in pressure in the middle chamber of the ear due to a sharp intake of air from the Eustachian tube. Taking some medicines (antibiotics, psychotropic substances) has a toxic effect on the ear, causing congestion and hearing loss.

Diseases in which ear congestion may develop Attempting to remove earwax yourself with the help of improvised objects significantly increases the likelihood of pushing the plug deeper into the ear and sticking wax on the eardrum (this increases the risk of injury to the eardrum, leading to complete or partial hearing loss). In these cases, the state of congestion in the ears is accompanied by excruciating pain, noise, dizziness and nausea.

Mycotic or fungal infection of the external auditory canal . Infection with fungi can be complicated by narrowing or blockage of the ear canal with the appearance of a feeling of stuffiness in the ears. Hearing aids, in-ear headphones, as well as inflammatory diseases of the ear exacerbate the spread of fungi in the ear. The main signs of the disease are itching, ear congestion and the resulting hearing loss, an increase in the sound of one’s own voice in the diseased ear.

Damage to the external auditory canal and structures of the middle ear may be accompanied by hearing loss and congestion. Bleeding and the formation of a blood clot that clogs the ear canal lead to a deterioration in sound conduction. In addition, trauma to the tympanic membrane is possible during cleaning of the ear canal, a sharp drop in pressure, a strong blow to the outer ear. In this case, there is a sharp pain, which is replaced by congestion, ringing, noise and hearing loss.

Acute inflammatory diseases are accompanied by edema and sometimes purulent contents. They can lead to ear congestion and hearing loss. In particular, with otitis media (tympanitis) the tympanic cavity and auditory tube are involved in the inflammatory process. Swelling, narrowing the lumen of the auditory tube, and suppuration of soft tissues cause ear congestion and hearing loss. As a rule, the infection penetrates into this sterile cavity from the Eustachian tube, which is directly connected to the nasopharynx.

In children of the first and second years of life, acute otitis media can occur when breast milk or milk formula enters the nasopharynx during regurgitation.

In older children, otitis media and congestion can be caused by inflammation of the adenoids – lymphoid tissue responsible for local immunity of the nasopharynx and closing the openings of the auditory tubes in the nasopharynx. The anatomical proximity of the adenoids and the auditory tube ensures the rapid transfer of infection from the nasopharynx to the ears. In addition, enlarged adenoids can block the openings of the auditory tube, which causes a feeling of congestion.

Allergic reactions can also lead to acute inflammation and swelling of the middle ear.

Otitis externa is characterized by inflammation of the external ear canal. Congestion in the ear in this case occurs due to swelling of the tissues of the ear canal.

If the disease is caused by the ingress of a foreign body into the ear canal , then swelling and congestion are complemented by a picture of severe irritation. The patient complains of severe itching, pain, feeling of fullness, heat in the ear area. The pain is aggravated by chewing movements.

With furunculosis of the external auditory canal, the picture of the disease is aggravated by a closed space, where the inflammatory process develops. The growing pain in the ear is complemented by its irradiation to the corresponding half of the head. The patient cannot lie on the affected side. Due to the strong swelling of the tissues of the external auditory canal, sound conduction to the diseased ear is disturbed, there is a feeling of congestion.

To the number of anatomical and postoperative defects , which cause ear congestion, include deviated septum, narrowing of the nasal passage due to hypoplasia of the wings of the nose, stenosis of the external valve of the nose.

Violation of nasal breathing leads to the frequent occurrence of a runny nose, infection of the nasal sinuses and, as a result, to the transition of the inflammatory process to the auditory tube.

Ear congestion in these cases appears on the side of the narrow nasal passage. The same consequences occur after operations in the nose.

Sensorineural hearing loss occurs due to damage to any part of the auditory nerve. Most often, this is an irreversible phenomenon, the symptoms of which include imbalance, dizziness, nausea, congestion and noise in the ear, poor perception of low sounds. The causes of sensorineural hearing loss can be transferred infectious and vascular diseases, tumor processes, injuries, toxic effects of various substances.

Meniere’s disease is a non-purulent disease of the inner ear, which is accompanied by its congestion. An increase in the volume of lymph in the labyrinth of the ear leads to increased pressure and attacks of progressive deafness, tinnitus, and sudden dizziness. In most cases, one ear is affected first. The disease begins either with attacks of dizziness, or with hearing impairment, which is completely restored between attacks. However, after a few years, hearing loss becomes irreversible.

Myofascial pain syndrome, diseases of the temporomandibular joint . Patients with myofascial pain syndrome, which is associated with impaired activity of the masticatory muscles and limited mobility of the lower jaw, may also complain of ear congestion. In addition, the disease is accompanied by headaches and facial pain, difficulty opening the mouth, clicking in the temporomandibular joint.

The root cause of the syndrome is a spasm of the masticatory muscles. A similar clinical picture is also given by diseases of the joint itself, caused by malocclusion.

Atherosclerosis of cerebral vessels, rise in blood pressure . Congestion in the ears with damage or vasoconstriction is due to a deterioration in the blood supply to all tissues, as well as a violation of blood circulation in the inner and middle ear.

Vasomotor rhinitis, or runny nose during pregnancy occurs under the influence of hormonal changes and is characterized by impaired vascular tone and secretion of mucous secretion. With allergic rhinitis, the clinical picture of the disease is almost the same, but the provoking factor is not hormones, but a specific allergen. Swelling of the mucous membrane and narrowing of the nasal passages lead to impaired patency of the auditory tube and cause ear congestion.

Tumors in the ear canal, auditory tube and inner ear – the most dangerous cause of ear congestion. Among them should be called cholesteatoma – a tumor-like formation, which consists of epidermal cells impregnated with cholesterol. Cholesteatoma is characterized by slow but steady growth. Formed in the middle ear, it can spread to the outer and inner ear, causing congestion and a feeling of heaviness in the ear, purulent discharge, swelling and redness of the auricle.

Which doctors to contact in case of ear congestion

If ear congestion occurs, you should contact an otorhinolaryngologist. Further consultation may be required.
therapist,
pediatrician,
gynecologist, neurologist, cardiologist, allergist.

Diagnosis and examination of ear congestion

To diagnose the disease that caused the ear congestion, a careful questioning of the patient, examination of the external ear and ear canal to the tympanic membrane, audiometric examination is necessary. The infectious nature of the disease is determined on the basis of the clinical picture, otoscopy data and culture of the discharge.

An injury in the ear area is diagnosed using CT radiography.

X-ray of the skull

X-ray examination of the skull to detect violations of the structure and integrity of the bones of the skull of various nature.

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Diagnosis of cholesteatoma is carried out by a doctor on the basis of otoscopy and radiological methods (radiography and computed tomography). Myofascial syndrome and dysfunction of the temporomandibular joint are diagnosed according to radiography and CT of the joints, as well as electromyography.

What should I do if my ear is blocked?

If ear congestion occurs regularly, you should not postpone a visit to the doctor or try to eliminate this condition yourself.

Ear congestion treatment

Elimination of ear congestion is possible only with the treatment of the disease that caused it.

In the case of its infectious nature, antibiotic therapy, anti-inflammatory and analgesic therapy is necessary. Myofascial syndrome and temporomandibular joint dysfunction require bite correction and anti-inflammatory treatment. For tumors and injuries in the ear area, surgical treatment is indicated. With neurological and vascular nature of congestion and hearing loss, vascular and vitamin therapy are connected.

Sources:

1. Clinical guidelines “Otitis externa” (children). Developed by: Union of Pediatricians of Russia, National Medical Association of Otorhinolaryngologists, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. – 2021.
2. Clinical guidelines “Otitis externa” (adults). Developed by: National Medical Association of Otorhinolaryngologists. – 2021.
3. Clinical recommendations “Otitis media acute”. Developed by: National Medical Association of Otorhinolaryngologists. – 2021.
4. Meniere’s disease: Clinical guidelines. – National Medical Association of Otorhinolaryngologists. – Moscow – St. Petersburg, 2014.
5. Sensorineural hearing loss in adults: Clinical guidelines. – National Medical Association of Otorhinolaryngologists. — Moscow, 2016.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests.