 |
||||||
 |
||||||
|
|
||||||
 |
||||||
|
Ear symptoms: Tinnitus (ringing), congestion, muffled sounds or stuffiness TMD has been called the “great impostor” for a good reason. This condition manifests itself in so many different ways; the treating doctor can be easily chasing a phantom. If the ear symptom you experience has not been resolved after a visit to the Ear Nose and Throat physician, the problem could very well be TMD.
TinnitusRinging and roaring noise in the ears may be from several causes. Loud noise, clogging of the external auditory canal with ear wax, inflammation of the ear drum, over dose of medications such as Aspirin are all possible sources of tinnitus. But a large number of cases are due to TMD.Tinnitus arises from the traction on the malleus by Pinto's ligament (disco-malleolar ligament) and/or associated musculature to the ear and Eustachian tube (tensor tympani and tensor veli palatini from throat) as well as other triggers particularly medial Pterygoid muscle. These triggers must be released. Tensor tympani is a tiny middle ear muscle that is attached to the malleus. When contracted, the tension is increased on the tympanic membrane. Its nerve supply is from the Mandibular nerve, a branch of the Trigeminal Nerve (fifth Cranial Nerve). Pinto’s ligament connects the articular disc of the TM Joint to the malleus bone of the ear. (Middle ear)
Ear PainWhen the ear aches inside, most patients conclude that it is an ear infection and go see their primary physician or ENT specialist. If an otoscopic examination is normal, the source of the ear pain could be TMD. As discussed above the muscles that are associated with the ear are mostly controlled by the Trigeminal nerve. Poor alignment of the jaw can lead to spasm of any of these muscles leading to “ear pain”. So instead of prescribing an antibiotic as a shot gun treatment for this phantom ear infection, a TMD evaluation is appropriate.While the Eighth cranial nerve enables hearing, one of the sensory branches of the Fifth cranial nerve – Trigeminal innervates the middle ear leading to the referred pain.
Stuffiness of the ear / Ear congestionThe Eustachian tube is a membrane lined tube that connects the middle ear space to the back of the nose. Its primary function is to ventilate the middle ear, ensuring that the pressure inside the ear remains at near normal ambient air pressure. The secondary function of the Eustachian tube is to drain any accumulated secretions, infection, or debris from the middle ear space. Several small muscles located in the back of the throat and palate, control the opening and closing of the tube. Swallowing and yawning cause contraction of these muscles, and help to regulate Eustachian tube function. If it were not for the Eustachian tube, the middle ear cavity would be an isolated air pocket inside the head that would be vulnerable to every change in air pressure and lead to an unhealthy ear.Normally, the Eustachian tube is closed which helps prevent the inadvertent contamination of the middle ear by the normal secretions found in the back of the nose. A tube that is always open is called a patulous Eustachian tube. Patients with this rare condition are plagued by chronic ear infections. A much more common problem is a failure of the Eustachian tube to regulate pressure effectively. Partial or complete blockage of the Eustachian tube can cause popping, clicking, and ear fullness. As Eustachian tube function worsens, air pressure in the middle ear falls, and the ear feels full and sounds are muffled. Eventually, a vacuum is created which can then cause fluid to be drawn into the middle ear space (termed serous otitis media) If the fluid becomes infected, the common ear infection (supperative otitis media) develops. Ears can feel stuffy and congested when the Eustachian tube is blocked. This can happen with swelling and inflammation as when there is an infection. It can also happen when the tiny muscle that controls the opening – called Tensor veli palatini is in spasm. When the jaw alignment is poor, the muscles of mastication and associated posture muscles have to compensate. This constant compensation can lead to muscles spasms and trigger points. By Neuro muscularly correcting the jaw relation often leads to the resolution of the various symptoms…including ear symptoms from this cause. |
||||||
|
||||||
Another way TMD gives rise to ear pain is due to the remnants of Pinto’s ligaments that connected the posterior portion of the glenoid fossa (the socket of the TM Joint) to the middle ear. In TMD, the condylar head is often posteriorized – pushed backwards - leading to increased pressure in this area causing ear pain.