Some ENT specialists hate to send you home empty handed and may put you on an antibiotic to “see if it helps”. Others may follow their “TMJ protocol”. What is that? Store bought soft mouth guard, soft diet and Non Steroidal Anti Inflammatory Drugs (NSAID) or muscle relaxer medications. Soft mouth guards stimulate INCREASED clenching and often lead to more damage to the TM joints. Some other ENT’s, may refer you to your own dentist to rule out “TMJ”. But because the dental education in this area has remained the same as it was 40 years ago, 90% of the dentists may give a night guard – a piece of plastic between teeth at night time that does not usually solve the problem. Or they may put you on either NSAID’s or muscle relaxers.

Many of the thinking ENT specialists in our area refer such patients to us for a thorough TMD evaluation. Our success rate is over 90% in helping such patients with a long term structural solution rather than short term fixes or worsening of the conditions.

If you find yourself with a nagging ear pain or ear popping, then you’re probably here searching for a solution. There are lots of causes of ear pain and often the solution isn’t as simple as some people think. This article can help you discover more about what may be causing your ear pain.

In the absence of trauma to the area, ear pain, ear congestion or ear aches are usually due to blockages or infections. Swelling and redness of the outer ear could be from infection of this area that requires a physician’s attention. Ear canal blocked by ear wax can be a cause of this pain. Over the counter remedies to clean out ear wax are useful. It can also be from infected ear canal, commonly called ‘swimmer’s ear’. Keeping the ear dry and using a few drops of alcohol and white vinegar mixture are good remedies. If it does not resolve that, a physician’s attention is needed.

Middle ear infections are more common in children than in adults. A Eustachian tube is usually the path of these infections which would need antibiotic therapy to clear up safely. Allergies and cold / flu can also lead to inflammation of the Eustachian tube preventing the normal pressure equalizing function causing pain.

Parotid glad which is a salivary gland in front of the ear can form “stones” in the parotid duct leading to blockage of the salivary flow causing pain in the ear area. If the flow is blocked, it often leads to infection causing pain and requiring an ENT physician’s attention.

Mastoid air cells are bony structures that are part of the skull behind the ear. Due to poor blood supply, Infection of this area is difficult to clear up and cause pain in the ear area. This needs the attention of a physician for antibiotics and occasionally even needing surgery to clear it up.

Perhaps the one “ear pain” cause that most commonly gets misdiagnosed is pain in the ear from TMJ disorder or TMD. It is quite common for us to see patients who have had multiple courses of various antibiotics from their family physicians and even ENT specialists before being referred to us for a TMD evaluation. They may have suffered with months and even years of ear pain before finding out that it was never actually an ear problem at all.

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 through examination of the ear and / or treatment by the Ear Nose and Throat specialist, the problem could very well be TMD.


Ringing 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.

Ear Pain

When 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.

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.

Stuffiness of the ear / Ear congestion

The 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.