About three years ago I had a very severe ear infection. After taking antibiotics and decongestants my sysmtoms grew worse. I change ear doctors and was told my eustachian tubes were completely closed. I was experiencing lots of pain in both ears, though mostly the leftone. I was given steroids and the pain did get a little better, but I was left with a feeling of fullness in my ears, they feel like they are stuck together inside and the pressure is constantly changing in them. When I go up and down mountain passes or ride in planes the pain can be terrible. I have been to 3 or 4 ear specialists. They say the pressure is a little off in my ear but offer no help. The clicking in my ears is so loud my husband can hear it. I have this clicking noise every time I swallow. I have been to dental specialists to rule out TMJ. They think it might be but the procedures he is contemplating is very expensive and I am wondering if it really is TMJ. My dentist has agreed that I grind my teeth at night. My family doctor wants me to go to the House Clinic in Los Angeles to rule out ear problems before I proceed with TMJ specialist (who is a dentist in my are). I want to find out what is really the problem and try to get relief. I have been miserable with this for the last three years.
Please advise.
Thank you.
Answer ------------------------
The symptoms of pressure felt in the ears that is aggravated by changes in altitude is consistent with a eustachian tube dysfunction. Audiometric studies including an audiogram and tympanogram can help to confirm this. The use of decongestants such as pseudoephedrine; short-term (< 3 days) use of topical vasoconstictor sprays such as Afrin; longer-term (several weeks to months) use of topical nasal steroid such as Rhinocort,Nasacort, Flonase, or Vancenase; as well as careful autoinflation of the ears (so-called "popping" of the ears by plugging one's nose and blowing) are the common methods of treating eustachian tube dysfunction. It is occasionally necessary in severe cases to place a small tube in the ear drum known as a tympanostomy tube to provide long term pressure equalization in the middle ear.
While TMJ problems can cause a sensation of pressure felt in the ear, the source of this sensation is related to muscle tension in the muscles of chewing and occasionally with pressure imparted to the jaw joint itself. However, this pressure sensation is not related to air pressure phenomena and there is no reason to expect TMJ symptoms to be consistently aggravated by changes in altitude with their associated changes in ambient air pressure. Based on your description of symptoms, a TMJ disorder is possible but would be low on the list of probabilities as a primary cause of your problem.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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