My jaw is making my ear hurt.

February 14, 2006 1:09 PM

What sort of specialist should I visit to examine/treat me for TMJ?

For the last few years, I've been experiencing intermittent pain centered in the cartilage in front of my right ear. I also think I have some mild hearing loss in this ear, which may or may not be related to the pain. I finally went to my PCP, and a nurse practitioner examined me, said everything inside my ear looks perfectly normal, mentioned the possibility of TMJ, and referred me to an ENT specialist.

I feel pretty sure that my pain (and maybe the hearing loss as well) is related to TMJ; I have a history of jaw-grinding, the pain responds well to heat/warmth, etc. Should I go ahead and see an ENT, or is there a better type of specialist who would be more qualified to treat me?

Although I have a physician's office, my trusted PCP is unavailable for a few months. I turn to the collective wisdom of AskMe to explore alternatives to the nurse practitioner's recommendation of an ENT.

posted by junkbox to Health & Fitness (17 answers total)

Your dentist may be able to point you in the right direction -- perhaps towards an oral surgeon type or maybe even a treatment for the tooth grinding.
posted by penchant at 1:21 PM on February 14, 2006

My suggestion is to talk to a dentist first, and if he or she can't help you, talk to an orthodontist.

My dentist suggested that I have TMJ (said he saw evidence of it) and offered to construct a custom-molded mouthgard for when I sleep. It was going to cost several hundred dollars and I doubt I could sleep with it in, or even remember too, but I may take him up on the offer in the future if my condition worsens. I can deal with the occasional mild headache for now.

I don't know if it's possible to address the causes of TMJ, but it's certainly possible to mitigate the effects.
posted by tweak at 1:21 PM on February 14, 2006

I've been seeing my dentist about TMJ, and she wants me to consult with an orthodontist as well. We also talked about maxillo-facial docs, but she never mentioned an ENT to me. Of course, I have minimal ear pain with mine (mostly constant toothaches & headaches, some other symptoms, too), so maybe that's why the ENT never came up.
posted by katie at 1:29 PM on February 14, 2006

You should consult a dental surgeon regarding TMJ or TMD.

BTW -- a family friend is one of the leading dental surgeons in Richmond, VA (which is where you live according to your MeFi profile). If interested in a referral, I can pass onto you his info (my e-mail is in my profile).

BTW -- I recall having a conversation with him about TMJ -- from which I suffer in a minor fashion. He told me that surgery for such should be a last resort. He also mentioned that he feels too many surgeries are done on people for which other diagnostic avenues would suffice.
posted by ericb at 1:30 PM on February 14, 2006

Talk to your dentist first. My dentist made me a mouthguard, which felt a little weird for a night or two, but then seemed natural. It minimized the effects of teeth clenching while sleeping.
posted by fochsenhirt at 1:53 PM on February 14, 2006

My dentist sent me to a maxio-faxial surgeon.
posted by tayknight at 2:23 PM on February 14, 2006

Okay, bear with me on this - I swear it is true.

I developed TMJ (as diagnosed by my dentist), but did find that it was largely stress-related. My stepmother bought me one of those noise machines that plays white noise, water sounds, etc. Before the day I was to get fitted for some sort of mouth contraption, I played the noise machine (which, fortunately, had a 15- and 30-minute timer and would automatically shut off) as I went to bed.

I swear to you that I my jaw pain subsided by morning and did not return. I went to sleep like this for a long time, but found that even when I spent a night way, for instance, without the sound, I was okay, and I eventually stopped using it.

When I switched jobs and my jaw started bothering me from the stress, I again used the sound machine at night, and it corrected the problem.

While I know that this sort of thing might not work for everyone - and it certainly sounds out there - I would implore you to try this before you hit a doctor and have to wear headgear to bed. Your significant other may thank me, too. :)
posted by bozichsl at 3:42 PM on February 14, 2006

Ack. I went round and round with this problem and found that there were a lot if insurance problems because it is both a dental and medical condition. No body wants to pay for it. I ended up getting a bite gaurd I wear at night and that fixed 95% of my pain.
posted by modavis at 4:46 PM on February 14, 2006

I would get weird itchy pains in my tragus and my doctor told me it was because I grind my teeth (nothing about TMJ necessarily.) I got a mouthguard to deal with the grinding and the ear pain has disappeared. Also, my dental insurance covered 80% of the device, which really surprised me.

Most nights I remember to wear the mouthguard. It was surprisingly easy to get used to.
posted by sugarfish at 7:55 PM on February 14, 2006

My experience is like modavis's. I eventually had surgery on my TM joint in '92, and the insurance rejected it over and over as "cosmetic surgery" despite the fact I'd been eating nothing but babyfood for almost a year at that point.

Junkbox, hope you find a solution that helps you, and quick!
posted by olecranon at 8:22 PM on February 14, 2006

I had an especially nasty attack of TMJ, went to the orthodontist, and he was able to modify an old retainer to help force me to relax my jaw. When I went in to see him, I basically couldn't move my mouth at all. Within hours of wearing the retainer-thingy, I was vastly better, and the whole episode cleared up within a few days.

So if you know an orthodontist who you like, I'd recommend that route.
posted by dseaton at 8:48 PM on February 14, 2006

I had a problem with severe TMJ at one point (due to stress). The dentist and orthodontist were no help at all. They said I needed braces! I felt uncomfortable with their sales tactics and finally went to my primary care doctor and I got the help I needed from an Orofacial doctor. Mine was so bad that I had a permanently locked jaw for several months. They gave me physical therapy, muscle injections, and a mouth guard (so I wouldn't clench my teeth while I sleep). All helped but eventually getting control of the stress from my job changed things. Definitely go to your primary doctor first (if you have an HMO). The dental path is really not the way to go, oddly enough.
posted by nwhycgirl328 at 10:11 PM on February 14, 2006

My experience seems to match what ericb said - I went to an oral surgeon (at the suggestion of my dentist), who said that surgery would be a complete last resort. He created a soft mouthpiece for me that only covered my lower teeth (a full, hard mouthpiece would have cost six times as much). I wore it for a week and was completely cured.

(And this was after about fifteen years of my jaw popping and occasionally locking on me.)
posted by Lucinda at 6:04 AM on February 15, 2006

I was in a car accident in August and had TMJ which was treated by my chiropractor (who did some muscle relaxing/massage in my jaw and treatments). Recently though (4 weeks ago), my TMJ came back (a result of stress and bad sleeping arrangements).

I went to a physiotherapist who specializes in accupuncture (luckily covered by my health plan). Did three visits the first week, and 1 visit per week after (now on 2 visits per month). The accupuncture and massage + the physio exercises have eliminated my problem completely.
posted by burhan at 11:19 AM on February 15, 2006

ENTs, OMFs (oral/maxillofacial surgeons), and various other sorts of dentists deal with TMJ surgically. Some rheumatologists deal with it non-surgically.

I think that it's important to find a practitioner who's experienced with TMJ and comfortable treating it. If I were going to seek such a practitioner, I'd probably look for an OMF.
posted by ikkyu2 at 6:35 PM on February 15, 2006

Oh, wait, I just saw the part about a possible hearing loss on the same side. Go to an ENT - you want to rule out something larger than TMJ syndrome before you get started.
posted by ikkyu2 at 6:36 PM on February 15, 2006

I came across this question too late, but wanted to comment anyway.
I have severe TMJ disorder... I have had six surgeries and am scheduled for my 7th & 8th in May & June which will be total joint replacements.
The percentage of patients that actually need surgery is very low. The best advice given here is that surgery is a last resort. Not only that, but ANY invasive procedures are a last resort (this includes anything that changes your bite or jaw permanently like braces or crowns).
The best things for immediate care to feel better are simple self care techniques like:
- Moist heat (my favorite heating pad is the Thermophore, and is something definitely worth investing in for aches, sprains, etc. Thermophore)
- Soft foods
- Over the counter pain medications such as Aleve or Advil
- Be aware of clenching & grinding. I always tell myself "Lips together, teeth apart." After a while, it becomes a habit.

Finally, your general dentist will be able to steer you in the right direction as far as someone to help you with this.
Also, I own a non-profit organization geared towards patients who have TMJ disorder. If you'd like to talk with others, definitely check out TMJ Friends

Hope this helps, but I also hope that you do not need it and you are feeling better now!
posted by goodwillstacy at 7:55 PM on April 5, 2006 [1 favorite]