EpistemisTemporomandibular pain referred to the ear
Specialty: Otolaryngology.
Why it occurs
- Temporomandibular joint dysfunction due to centric or eccentric nocturnal bruxism
- Severe dental malocclusion with unilateral asymmetric joint overload
- Synovitis or arthritis of the temporomandibular joint due to direct mandibular trauma
- Spasm of the masticatory muscles (lateral pterygoid, masseter or temporalis) that share innervation with the ear through the trigeminal nerve
Initial workup
Detailed otoscopy to confirm the total normality of the tympanic membrane and duct (reflex otalgia), palpation of the posterior and lateral pole of the temporomandibular joint while the patient opens and closes the mouth, evaluation of the range of oral opening and presence of noises (clicks or crepitations), and simple radiography (Schüller projection) or MRI of the temporomandibular joint.
red flags
Presence of pathological otoscopy (e.g., tympanic perforation with suppuration or visible cholesteatoma), progressive unilateral hearing loss, associated facial paralysis, severe trismus of acute onset with deviation of the jaw, or firm palpable mass in the territory of the ipsilateral parotid gland.
Standard management
- Non-steroidal anti-inflammatories in a short regimen such as naproxen — 500 mg orally every 12 hours with food
- Muscle relaxants such as diazepam in low doses — 2.5-5 mg orally at night for 7-10 days
- Use of a night muscle relaxant discharge splint custom-made by a dentist
- Local physical therapy with dry heat and circular massages in the masseteric area.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4