Ear Pain and the Jaw joint (TMJ)

Ear pain is usually due to problems which arise in structures surrounding the ear rather than from the ear itself. This is due to the fact that the Ear receives nerve supply from five different nerves. Therefore when examining and investigating for causes of ear pain the ENT specialist usually looks for causes arising from areas such as the temporomandibular joint (jaw joint), the teeth, the nasopharynx (back of the nose ], the tongue and throat.

In this article we will discuss about the TMJ (the jaw joint), Why and how it causes ear pain/ facial pain and ways to manage it.

What is the TMJ (temporomandibular) joint?

The jaw joint is also called the TMJ (temporomandibular joint) and any problem with this joint is commonly termed as TMJ dysfunction. The Lower jaw (Mandible) is attached to the skull through a complex arrangement of muscles ligaments and cartilage. The lower jaw is able to not only open and close as a hinge but it can also move sideways, forward and backward and also rotational movements in both clockwise and anti clockwise directions. This is achieved by many muscles which work on the jaw joint and therefore when there is any problem related to the jaw joint it can manifest as pain in any of these muscle groups. Since the TMJ is situated just in front of the ear canal and it shares a common wall, most of the time the ear pain is due to TMJ dysfunction rather than an ear infection

What causes TMJ dysfunction and pain?

The most common cause of pain arising out of TMJ dysfunction is due to the muscles that work on the TMJ. The two other reasons that can lead to pain from TMJ dysfunction are 1) injury either to the jaw bone or cartilage within the joint (may also be due to wear and tear) and 2) arthritis of the Jaw joint.

Both injury to the jaw joint and arthritis [either osteoarthritis or rheumatoid arthritis ] are not very common and most patients suffer from pain due to the soreness of the muscles acting on the jaw joint. Hence most patients usually describe their pain as a deep aching pain which is fairly constant and last few days or weeks and sometimes months.

Various conditions such as malocclusion (improper bite), Bruxism [grinding of teeth or jaw clenching habit], increased stress or psychological conditions, bad chewing habits or even overuse of the jaw joint ( e.g. chewing gum) can lead to soreness of the jaw / neck muscles

It can occur in any age group but is seen more commonly in young adults and in women more than men.

What are the symptoms of TMJ dysfunction?

Due to the TMJ being situated right in front of the ear canal ear pain is the most common symptom that the patients present with. The earache is mistakenly thought to arise from an infection in the ear. The pain is usually described as a deep dull ache which is fairly constant throughout the day and sometimes can be worse in the morning especially in patients who have a habit of grinding their teeth in their sleep.

Some patients notice headaches especially if they are also having stress or other psychological triggers. They may also have pain behind their eyes, behind their ears or even in muscles of the neck and shoulder or even the head, especially in the region of the temples.

Occasionally they can have a sharp pain in the area of the jaw joint which is usually noted when they open their mouth or move the jaw to talk, yawn or even swallow. They may also notice clicking or grating noises when they move their jaw. In some patients they may notice limited range of movement of their lower jaw or even a locked jaw.

How is TMJ Dysfunction diagnosed?

Most often the diagnosis is based on the symptoms and the examination in the clinic. Usually no specific tests are necessary however if simple measures such as described below do not resolve the symptoms then further investigation becomes necessary. This can be in the form of blood tests, X-Rays, a CT scan or even an MRI scan of the neck and the jaw joint.

How to manage or treat pain from TMJ dysfunction?

It is always a good idea to see an ENT specialist or a dentist who can correctly diagnose a possible cause for your TMJ dysfunction. Your dentist can suggest treatments for malocclusion or bad chewing habits.

The simplest way to manage a TMJ dysfunction is to rest the Jaw and to strengthen the jaw muscles by doing some remedial exercises

It is very important to use regular painkillers to not only control the pain but also to help relieve the spasm that is commonly seen in the muscles of the jaw.

Application of heat in the form of hot water bottles or a wheat bag over both the jaw joints helps to warm the muscles up before doing any exercises of the jaw.

Initially the jaw muscles should be exercised for a very short period of time and after a week or 10 days the frequency of the exercises can be increased as tolerated otherwise the exercises themselves can aggravate and worsen the pain. Your doctor will explain to you different exercises which help stretch the muscles and also strengthen the muscles.

Relaxation exercises or meditation and Mindfullness techniques can also be helpful

It is also very important to ensure that a soft diet is taken for a few weeks at least so the jaw can be rested. Once the pain reduces and it feels comfortable, gradually foods that are harder to chew can be gradually reintroduced into the diet.

Most patients will find significant relief with the above measures however a few patients may need further intervention which may be either in the form of physiotherapy, Dental treatment or even surgical procedures on the jaw joint