Quite often pain in the ear originates outside the ear - a condition called 'Referred Otalgia'.
One of the most common causes of Referred Otalgia is pain arising out of a malfunctioning Temporo Mandibular Joint (TMJ).
The TMJ is a 'hinge joint' connecting the lower jaw (mandible) with the base of the skull (the Temporal Bone). The joint moves the jaw in various directions which include opening and closing the jaw, forward and backward movement as well as a grinding movement (like the ones cows use when chewing grass).
The mandible is attached to the base of the skull with the help of ligaments and muscles.
Since the joint opens in close proximity to the External Ear, pain in the joint may present itself as Otalgia (Earache).
Causes
1. Trauma - Macrotrauma such as a hit during boxing or as a result of road traffic accident etc may damage the jawbone, dislocate the joint or damage the cartilage or ligaments of the joint.
Microtrauma such as teeth grinding (Bruxism), and clenching can cause TMJ problems over a period of time.
2. Arthritis - all the usual causes of joint degeneration and inflammation like Osteoarthritis or Rheumatoid Arthritis etc can also cause TMJ problems.
Presentation
The patient of TMJ Syndrome will present with
- pain in the jaw
- pain in the ear
- difficulty in opening jaw, chewing, yawning
- blocked sensation in the ear
- Tinnitus
- clicking sound on moving the jaw
Treatment
Treatment consists of
- Educating about the nature of the problem and advising precautions like avoiding the use of chewing gum, supari or any hard substance etc.
- Medication to relax the muscles of the joint
- Botulinum Toxin injections locally
- Appliances to prevent Bruxism like Night Guard etc.
So, it is important to remember that pain in the ear may be arising from outside the ear and treatment will depend upon the cause.
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