Eleven-year-old Julie came in again with repeated right ear pain. This had been going on and off for the past three months. Each time the ears were found to be clear, hearing tests and tympanogram tests were always normal. The ENT specialist agreed that there was no ear disease. It is more likely that she is suffering from TMJ syndrome.
Temporomandibular Joint Syndrome is not an uncommon diagnosis as the cause of "ear pain" in older children and adolescents. The patient cannot easily distinguish pain emanating from the middle ear, external ear, or jaw joint.
The TMJ is the joint between the jawbone (mandible) and the temporal bone of the skull. Every time the jaw is moved, this joint is used. It is utilized thousands of times a day for routine actions, such as chewing or talking. Thus, any malfunction of the joint becomes a major source of irritation.
As parents, you can help differentiate the cause of the ear pain, but the diagnosis rests in the hands of the examining physician.
Ear infections are usually marked by pain that is constant—interfering with the child’s routine. Usually younger children also have a fever. Most often the child’s hearing is decreased in the infected ear. Frequently, there is nasal stuffiness and drainage, or the ear itself may exude a thick discharge. Upon examination, the physician will find an inflamed eardrum or ear canal. He may visualize fluid behind the eardrum, or demonstrate its presence with an abnormal tympanogram tracing. Furthermore, an audiogram (hearing test) will show decreased hearing in the affected ear.
In contrast, a patient with TMJ syndrome is found to have a normal eardrum and ear canal. The audiogram and tympanogram are also normal. The pain is almost always unilateral and fever is never a part of the picture. Nasal stuffiness is conspicuously absent, and frequently a headache is associated. In many cases popping or clicking sounds can be heard when the jaw is moved.
The cause of TMJ syndrome can be related to malocclusion of the jaw, asymmetry of the bite, trauma to the joint due to jaw injury, recent or current orthodontic treatment and overuse strain of the joint such as constant vigorous gum chewing.
Since Julie is experiencing continued pain and yet has a normal eardrum and external canal, and her audiogram and tympanogram are normal, it is presumed that she has TMJ syndrome. She will now be referred to an orthodontist who specializes in TMJ syndrome.