What is TMJ? Can an earache be caused by it?

M.

TMJ stands for "temporomandibular joint." This is the joint between the base of the skull and the lower jaw. You can feel this joint if you place a fingertip on the skin immediately in front of your ear canal. Open and close your mouth, and you will feel the TMJ in action.

Your question suggests that you had an earache, saw your doctor and were told "Oh, it's just your TMJ." Might the earache be due to your TMJ? Perhaps. Does the ear pain increase when you do a lot of chewing? When you felt the joint in motion a moment ago, did you feel clicking or grinding? Do you have trouble opening your mouth widely? If the answers to any of these questions are yes, then you may, indeed, have a TMJ problem.

Most, but not all, TMJ problems are forms of arthritis. Myofascial pain dysfunction (MPD) syndrome can have similar symptoms (pain with chewing, limitation of the ability to open one's mouth and headache), but the pain originates not in the joint, but in the tendons of the chewing muscles.

The initial treatments of both MPD and TMJ syndromes are similar. The patient is advised to eat a soft diet, avoid grinding or clenching the teeth, apply warm packs when the area is tender and use nonsteroidal anti-inflammatory drugs. Sometimes, muscle relaxants are prescribed. If the patient is suspected to have MPD, massage of the chewing muscles may be helpful. If these simple measures do not provide relief, the patient should be referred to an expert in the treatment of TMJ/MPD problems. Usually, this would be an oral surgeon, but a dentist or ear, nose and throat specialist (ENT) may become involved in treatment.

But let's get back to your earache. Your doctor may have told you it was TMJ because he or she examined your ear and failed to find anything wrong with it. Is your doctor an ENT? If not, I would see an ENT, since nonspecialists frequently miss subtle causes of ear pain.

If your ear actually IS normal, and yet you have an earache, what could the explanation be? Unfortunately, many different problems can cause ear pain. Sometimes, the brain can't quite figure out what's hurting, and it interprets a problem in one area as pain in a different area. This phenomenon is known as "referred pain."

Many problems in the head and neck can result in referred ear pain, including TMJ problems, dental infection, inflammation of the thyroid, and tumors or infection of virtually any of the following structures -- the parotid salivary gland, tonsils, base of tongue, throat, voice box, esophagus, windpipe or thyroid.

Did your doctor examine you well enough to be sure that you do not have one of these other problems? In particular, if you have a history of heavy use of tobacco and/or alcohol, it is crucial that you be examined in detail to make sure your ear pain is not due to a cancer in the areas listed above. An ENT is the most appropriate specialist to conduct such an examination.