Unilateral ear fullness and temporary hearing loss diagnosed and successfully managed as a temporomandibular disorder: a case report.
BACKGROUND
A 73-year-old woman had a 4-month history of debilitating left-sided otic fullness, hearing loss, and a watery sensation in her ear without obvious cause. She had consulted with an otolaryngologist who cleared the ear of all middle ear pathology and then placed ventilation tubes in the tympanic membrane to relieve her symptoms of ear fullness. The ventilation tubes did not produce long-lasting relief so she was referred to the dental clinic.


METHODS
The patient did not have substantial symptoms of jaw dysfunction or jaw pain and was clearly bothered more by her ear symptoms; she exhibited the following signs and symptoms: limited mandibular range of motion (37 millimeters), crepitation in the left temporomandibular joint (TMJ), active trigger points in the left superficial masseter, and severe pain on palpation in the left TMJ (lateral and dorsal). A panoramic radiograph and maxillary computed tomography scan revealed moderate degenerative changes observed bilaterally in the TMJs. A diagnosis of localized osteoarthritis (OA) of the TMJ (TMJ-OA) and masticatory myofascial pain was given. The authors provided 3 months of treatment that included self-applied physical therapy (stretch and thermal packs), full-arch stabilization splint, trigger point injection, and a TMJ injection using triamcinolone acetonide (20 milligrams).


RESULTS
The patient reported a 90% improvement in her TMJ and ear-related symptoms as a result of the treatments. The authors speculated that TMJ-OA and myofascial muscle disorders are potentially contributory to a tensor tympani muscle dysfunction, which could explain her ear fullness and hypoacusis.


CONCLUSIONS
Diagnosis and management of TMJ dysfunction (pain on palpation, OA, and limitation of motion) should be considered when patients have symptoms of unexplained ear fullness and have been cleared for ear infection or other ear-related pathology.
Diego
D
Dalla-Bona
Thomas
T
Shackleton
Glenn
G
Clark
Saravanan
S
Ram
D000368:Aged; D018771:Arthralgia / Q000209:etiology; D003131:Combined Modality Therapy; D005260:Female; D034381:Hearing Loss / Q000209:etiology*; D006801:Humans; D007759:Labyrinth Diseases / Q000209:etiology*; D010003:Osteoarthritis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011862:Radiography, Panoramic; D013705:Temporomandibular Joint Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed
Ear pressure; hearing loss; temporomandibular joint; temporomandibular joint disorder