I am often asked to examine an ear that has been hurting several days and is slowly getting worse. Usually there has not been any fever, no cold symptoms and no recent water in the ear. Many times the examination of the ear is normal. The only positive finding is pain to palpation just in front of the ear when the person opens their mouth.
This is classic Temporomandibular Joint pain. The TMJ, as it is often called, is the attachment hinge for the lower jaw or mandible. When the joint is overused – too much gum, very chewy foods, prolonged dental procedures, injury, constant clenching of teeth during sleep – the joint and the tendons associated with the muscles that move the joint can become inflamed. This pain will manifest as an “ear ache”.
How can this pain in or near the ear be caused by stress? Frequent clenching of the jaw is a habit of many people. Often this is a stress related problem that causes the person to bite on pens, pencils, or fingernails. This often happens during sleep also with grinding of the teeth, and clenching of the jaw. The joint itself may become inflamed along with the cartilaginous disc that pads the joint. The muscles and tendons that move the mandible become sore and ache. That can lead to not only ear ache but also headache. The person may experience swelling on the affected side and may hear clicking or grinding noises in the affected ear.
If other causes of pain and headache have been excluded, treatment consists of pain relief, behavior modification (to quit biting nails, pens, etc…) and consultation with a dentist. This condition can be a temporary aggravation or a major cause of morbidity. In this article I have covered only the highlights of diagnosis and therapy. You should consult your physician about questions and health problems you are experiencing.