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Old 12-17-2012, 04:00 AM   #1
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ETD caused by TMJD? Help!

I am at a loss about where to post this, so here I am on the TMJ board because it is the one possible lead that I am chasing up at the moment.

My problems began several months ago, when I suddenly experienced a stuffy ear when I woke up. I had a loud buzzing in the ear and felt slightly deaf. This came and went over several weeks. I went to a doctor and he cleared out my ear of earwax, and referred me to an ENT when it didn't make any difference.

I ended up seeing the ENT when I was symptom-free. He gave me a hearing and an impedance test and both came back normal. But barely a week later, I was having the ear fullness again and I ended up seeing a different ENT. This one told me that my symptoms sounded like Eustachian Tube Dysfunction. He prescribed a steroid nasal spray and said something about possible allergies. Now it is winter and as far as I know, my sinuses aren't blocked and I don't feel particularly stuffy. Is it still possible to have allergies when your nose feels clear???

Anyway I used the antihistamines and nasal spray but the symptoms kept waxing and waning. The ENT also told me to use the valsalva maneuver to pop my ears, but it rarely ever worked for me. Without any rhyme or reason, I would get a terrible day or two, followed by a series of good symptom-free days.

However by now, I was also getting the ear buzzing/fullness accompanied ALWAYS by a feeling of tightness/pressure around my ear, just on the jaw joint in front of my left ear. Whenever the tightness started, I knew the buzzing would begin soon after. It was never a bad pain, just a sort of tenderness or discomfort. I began to wonder if I had TMJD after a while. But I have NO jaw clicking, no jaw pain while opening. I do clench my teeth at night though, periodically, and sometimes during the day too. I went to the dentist and got an NTI splint made to wear at night to stop bruxing.

The dentist said that my jaw deviated slightly to the RIGHT when I opened/closed my mouth, but my problems are on my left. He said it was common for many people to have deviation and didn't suggest a TMJ problem. However, he did say I had terrible occlusion though, my bite was WAY off, because of poor dental work over the years... I also had a lot of cavities etc. and he is fixing them for me as well as slowly improving my occlusion with restorative dental work (my poor teeth really need it).

My symptoms are still coming and going, and my left jaw muscles feel like they are suddenly in spasm when the ear symptoms begin. It is bizarre and I wonder if I just need to be patient, wait for my occlusion to get sorted out, and wear my nightguard dutifully every night... and wait for it to slowly improve? I am going absolutely NUTS with this as I don't know what else could be wrong with me. I've read various posts on this board from people like Lefta, Hbep and MichaelV with similar problems (ETD/TMJ) and I hope someone around can help throw a few suggestions my way.

Will physiotherapy help? Will medication....?

Sad and confused :-(

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Old 12-17-2012, 07:20 PM   #2
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Re: ETD caused by TMJD? Help!

At one point, I woke up and my right ear was "stuffy". After a few weeks, I went to my ENT. He couldn't find anything physically wrong. I went to my Audiologist. I found out I had some new hearing loss, but nothing physically wrong with my ear. As the months progressed, my tinnitus was intermittent, but it really flared at times. I can't remember the exact timeframe, but somewhere in there, I started having some really intense ear pain. It felt like a constant bad ear infection. I went back to my ENT and he still didn't see anything physically wrong. The best he could do at that time was give me a script that helped me sleep for a few nights because the pain had been keeping me from sleeping.

One day, during yet another internet search, I came across the possible TMJD connection. I went to see my dentist and he said it was a possibility. He recommended a TMJ specialist who confirmed the TMJD, but who really didn't do anything to help. After huge search, I finally found an awesome Functional Orthodontist who specialized in TMJD and sleep dentistry. The treatment process has been slow, but it has been effective for me. About 3 months into treatment, my ear finally popped. Overall, it was about a year after my "stuffiness" started. I'm in the process of re-establishing my bite.

I have never had any jaw pain per se. My testing showed my TMJ discs had slipped forward which resulted in my lower jaw being pushed back into my ear causing the problems. Ironically, while my right ear is the one causing all the problems, my left side is actually much worse.

I do have a history of extremely bad allergies, but I'd been treated for them for years they were fully under control when I started having the problems. My ENT/Allergist didn't see any signs of allergies impacting my problem. At one point he offered to put in tubes to try to help with the stuffiness, but I wanted to explore other options first and found the TMJ connection before going that way.
Asthma, Allergies, severe LPR/GERD, TMJD, Hearing Loss, Ulnar Impaction Syndrome, Shoulder Impingement, Plantar Fasciitis, DeQuervains, Hypermobility, possible Ehlers Danlos Syndrome

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Old 12-17-2012, 08:13 PM   #3
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Re: ETD caused by TMJD? Help!

What is the training of your dentist? Is he trained in treating bites appropriately vs. treating teeth. I've seen a lot of stories who had their TMJD made worse by their dentists when they have had other dental work done. Restorative dental work may not be enough if your arch and bite are significantly off.

My recommendation, through my experiences and years on these boards, is that you seek out a good Functional Orthodontist who has extended training in treating TMJD before you do a lot more with your dentist. A well trained Functional Orthodontist will be able to evaulate your bite and your other issues and discuss your options. They can make good recommendations of the types of splints that may work best for you. They can also help with your general dentistry if you want.

Prior to these problems, I knew I was a bruxer. I would grind my teeth while I was sleeping at night. I have some teeth that are worn down from that. My dentist made me a sleep splint (flat plane occlusal splint) which I wore faithfully for about 7 years. When I was evaluated by my current orthodontist, he pointed out that the flat plane splint was actually contributing to my TMJD by the positioning my jaw was in when I was asleep. I've tried NTI's twice and found them to be HORRIBLE. My muscles would spasm like crazy and it really didnt' do anything to help. What a waste of money for me.

What has worked for me:
  • Use of a lower mandibular repositioning splint during the day. My pain gradually decreased and my stuffiness went away. The splint encouraged me to bite "correctly". Which for me meant that I had to bring my lower jaw forward and a bit to the right.
  • Use of an upper nighttime splint with a wedge that came down behind my lower jaw to keep my jaw forward while I am sleeping. It also kept me from bruxing at all.
  • Visits with a Physical Therapist who did trigger point work on my mouth, neck and shoulders. This helped with the constant spasms that were connected with my TMJD.
  • Short time use of muscle relaxers when the spasms were really bad.

Once my muscles were loosened and I was comfortable with the repositioning splint, my orthodontist discussed my options with me. 1. He was willing to do restorative dental work only. This option wouldn't address my arch development though so I didn't choose that at this time. 2. I could continue to wear the repositioning splint as long as I wanted or I could try to wean off it. I ended up wearing the splint until I had money for another option. I knew weaning off the splint would cause my original symptoms to return so I didn't choose that. 3. Orthodontic braces to widen my arch and position my teeth in a good bite. I chose to go with this since I wanted something that would be best in the long term. I will have a small amount of dental work done after the braces come off since I need to have caps where I wore the teeth down from the bruxing.

My recommendation from experience: See a TMJ specialist before moving forward with your dental work. You should have some testing done to confirm if you have TMJ issues first. If you have TMJD issues, I'd recommend the repositioning splint to help get your jaw forward from your ear. Most repositioing splints are worn 24/7 so you would have it in to protect your teeth from the bruxism.

There is a great book that I found on TMJD. It is fairly new. I wish I'd had it to read before I started my journey. It is called The TMJ Healing Plan by Cynthia Peterson, PT. It is fairly inexpensive and extremely informative on TMJD, strategies you can do at home and some professional treatment options.

My story is told throughout threads on this board. I hope this helps.
Asthma, Allergies, severe LPR/GERD, TMJD, Hearing Loss, Ulnar Impaction Syndrome, Shoulder Impingement, Plantar Fasciitis, DeQuervains, Hypermobility, possible Ehlers Danlos Syndrome

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Old 12-27-2012, 09:33 PM   #4
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Re: ETD caused by TMJD? Help!

MountainReader, thank you for your comprehensive reply. My dentist just has general training, I believe, although he has been practising for 40 years. He's a great dentist, but thinks that unless I have outright jaw pain, I don't really have TMJD. He also fitted me with the NTI device. He told me that my bite was totally off, malocclusion etc. because I had a lot of old dental work that was BADLY done and my teeth did not meet up at all. He has started some restorative work to redo some of those old fillings and will have to crown some teeth - a slow process, alas! I can't wait so long to get this sorted out especially if the NTI isn't working for me.

I have been using the NTI splint a week and I find that I can still clench with it! My ear symptoms have been intermittent so far - on and off every couple of days, and the NTI has made no difference so far. I don't know if I should just persevere with it or stop using it until I can consult my dentist again.

My problem is obtaining a diagnosis. I live in the UK, and I am wary of approaching any dentist calling themselves a TMJ specialist, because too many of them are keen on expensive orthodontic work or even surgery. I will try to get my dentist to refer me to a specialist dental hospital where there are oral and maxillofacial specialists who can give me a diagnosis, but that will take time.

In the meantime I visited a cranial osteopath who specialised in TMJ disorders, hoping to get some explanations. He evaluated my jaw movements and said that my jaw deviated somewhat to the RIGHT when I opened/closed my mouth. He said that it meant my weaker joint was the right one, whereas my ear symptoms are on my left! However, I do get an increase in ringing in both ears when my muscles are in "spasm" right ear rings and my left ear clogs up. It feels like the left jaw muscles are completely in spasm. He did say jaw deviations are not necessarily an indication of TMJD....he said a displaced disc would tend to result in a particular deviation pattern when one opens/closes the mouth.

What tests did you undergo to see that your discs were displaced? Did you need an MRI or X-ray to get a definite diagnosis?

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Old 12-27-2012, 10:06 PM   #5
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Re: ETD caused by TMJD? Help!

Thank you MountainReader!
I posted as TRex earlier from a different computer, as I forgot my password... oops.

I am in the UK and am worried about seeking a dentist who refers to themselves as a TMJ specialist, there are numerous ones who espouse different treatment methods, all exorbitantly expensive and some involving surgery. I am reluctant to do full-mouth restorative work or to pay for expensive orthodontics unless I have some confidence that it is all going to work. Right now, I don't have a clue who is reliable...

My best bet is to get my dentist to refer me to a dental hospital here where there are specialist oral/maxillofacial dentists who can diagnose me. They tend to go for very conservative treatments, i.e splint therapy and maybe medication (muscle relaxants) and physiotherapy possibly.

My own dentist is probably not too well versed on TMJD.

I have a bruxism problem, been clenching for years and years. I gave myself a massive toothache about 4 years ago but since then, haven't really had any noticeable problems from clenching, until now.... I never wore any splints. I am disappointed to hear the NTI isn't as successful as some dentists make them out to be. I've read that they don't work for quite a lot of people, and tend to be successful mostly with people with migraines. I've never had a migraine from bruxism.

Did your PT do massages inside the mouth as well?

And do you have to have X-rays and MRI scans for a diagnosis, or are they really not necessary?

I have ordered the book from Amazon, thanks for the recommendation and thanks again for the helpful reply.

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Old 02-22-2013, 03:27 AM   #6
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Re: ETD caused by TMJD? Help!

Jumpwomble, I am interested to know how you have got on. My symptoms quite similar to yours with muffled hearing right side, various crackling/popping/snapping noises when moving jaw even slightly and stiffness rather than pain right side when opening jaw. When I speak my hearing volume can change depending on my jaw position which is very distracting. Symptoms since October 2011!
To cut a long story short was diagnosed by ENT surgeon (private insurance) with ETD due to rhinosinusitis and after 12 months of suffering he advised a grommet insertion which although relieving pressure feeling did nothing for the noises on jaw movement and variable hearing quality as to be expected with TMD.
Then saw facial-max surgeon (private insurance again) who after brief exam confirmed my diagnosis of TMD with "minimal" anterior displacement of disc. He advised some treatment I was already trying such as antinflammatory medication and to try night splint though he went into no detail about the splint.
My private dentist has referred me to another private dentist in the same company who specialises in TMD and who can fit repositioning/stabilization splints. He charges £250 for 45mins and a splint will cost more than £1000!
Mixed evidence for effectiveness of splints so decided to see osteopath 1st though I have used £80 fitted night guard for last few nights to see if will help.
Would be interested to know how you are getting on with your treatment and if you have had any success accessing NHS hospital dental treatment.

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