Tuesday, April 4, 2017

Ear Infection or Is It Really TMD?

Ear Infection Or Is It Really TMD?

Forty million people suffer from temporomandibular joint disorder.  However, it often gets misdiagnosed with something else, like ear infection.  Most patients think that they have an ear infection because pain is in the ear.  However, the most common cause of ear pain in an adult is the temporo-mandibular joint (TMJ). The TMJ is located extremely close to the ear canal and middle ear.  The muscles that surround the TMJ, the fascia, and ligaments that hold the bones in place are intricately connected with the ear and the nerve that supports the ear. Frequently the pain (in one ear or both) has persisted for several weeks and may even come and go.  Very often, hearing hasn't been affected but there will be a stuffy or clogged feeling in the ear.  Ear pain is often worse at night or in the morning. Some patients even complain that their ear pain is worse when they chew or yawn.

Most people with TMJ disorder have some kind of predisposing factor. The most common factor is poor posture which consists of a forward head posture, “hunched” upper back, and rounded shoulders.  They will usually have tenderness along the base of the neck, jaw, and mouth.  In addition, the molar teeth do not fit together that well.

Whether it’s the teeth that do not fit together or tension of muscles from abnormal posture, increased force is applied at the jaw joint.  Very often, people with TMJ have what doctors call bruxism which means that they either clench or grind their teeth.  Tooth clenchers tend to clench during the day when they are concentrating or thinking hard about something.  The tooth

grinders tend to do it at night while they are sleeping.  This is a completely involuntary behavior which is mildly stress-related.  Ear pain can also be caused by a dental procedure such as root canal or gum cleaning.  During these procedures, the TMJ has been stressed because the mouth was held open for a long period of time. Interestingly, many people with this problem will also experience tinnitus or ringing in their affected ear.  We do not really understand why the tinnitus is more active during times of TMJ stress; however, because it is a higher brain function, it may be that problems with the ear simply bring the brain’s attention to this part of the body and tinnitus results. The good news is that after the posture and TMJ disorder is treated, the tinnitus and ear pain will usually resolve.

How to Treat Ear Pain

The conservative treatment for ear pain caused by TMJ disorder is very simple.  First, we recommend a soft diet which means no heavy chewing of foods such as raw fruits and vegetables, hard-crusted bread or tough meat.  We recommend soft foods such as noodles, scrambled eggs, well-cooked meat and vegetables to reduce the strain on the jaw joint during eating.  Of course, we recommend no chewing of gum or other recreational chewing.  We recommend the application of warm packs a couple of times a day to help relax some of the musculature in that area.   These measures should help resolve the initial TMJ flare.   After the initial flare, we recommend seeing a physical therapist that specializes in TMD to determine the cause of the problems, in addition to resolve any pain that’s still lingering. 

TMJ can cause other problems in the head and neck, as well.  Often, people who clench at night will awake with aches across their cheeks or in the lower jaw.  Inflammation of the fascia surrounding the jaw joint can also cause pain that radiates from the ear area up into the temporal muscle in the temple and/or into the neck muscles.  Sometimes, people will even think that they have a sinus infection because of the combination of facial pressure and ear pain that they experience.

Other common causes of ear pain are swimmer’s ear or excessive wax impaction, which are disorders of the ear canal.  Also, less common in adults is otitis media which is an infection of the middle ear. This is the same kind of ear infection that babies and young children often get.

If you are suffering from any of the symptoms listed above, we can help you! 

PTW’s Andrew Seo, DPT provides expert clinical care and is a manual therapy specialist PT at our Montgomeryville Clinic, located on Upper State Road.   For an initial evaluation, call Andrew at 215-855-1160 today for an appointment as soon as possible, no prescription needed!