Unilateral ear fullness and temporary hearing loss diagnosed and successfully managed as a temporomandibular disorder: A case report

Background and Overview. 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. Case Description. Thepatientdidnothavesubstantialsymptoms 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 computedtomographyscanrevealedmoderatedegenerativechanges observed bilaterally in the TMJs. A diagnosis of localized osteoarthritis (OA) of the TMJ (TMJ-OA) and masticatory myofascial pain wasgiven.Theauthorsprovided3monthsoftreatmentthatincluded 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 and Practical Implications. 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