At least once a day, someone comes into our offices complaining of ear pain. Most of our patients think that they have an ear infection based on assumption (the pain is coming from the ear region after all!) or becuase their primary care physician indicated as such. Some patients are indeed diagnosed with ear infections but it may come as a surprise that most ear pain has nothing wrong with the ears.
The most common cause of ear pain in an adult is the temporo-mandibular joint or TMJ. The temporo-mandibular joint is located extremely close to the ear canal and middle ear. The muscles that surround the temporo-mandibular joint and 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 tell us 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 that the molar teeth do not fit together that well (called a mild malocclusion). When the teeth do not fit together perfectly, biting can cause stress at the jaw joint because an abnormal or uneven force is being applied to one or both of the joint spaces. 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 temporo-mandibular joint has been stressed because the mouth was held open for a long period of time. There may be some muscle or ligament strain that starts it. 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 temporo-mandibular joint 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 temporo-mandibular joint disorder is treated, the tinnitus and ear pain will resolve.
How to Treat Ear Pain
The conservative treatment for ear pain caused by temporo-mandibular joint 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. We also recommend prescription-strength anti-inflammatory medications such as ibuprofen around-the-clock for about a week to reduce the inflammation in that area. These measures should help resolve the TMJ flare. Also helpful is the use of a mouthguard or bite plate, especially during sleep. Mouthguards relieve stress from the joint and our TMJ patients have reported instant relief after use. Mouthguards are available over-the-counter and are quite affordable. There are custom bite plates as well that your dentist can make for you which are much more expensive but also more clinically effective.
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.