The earache can be difficult to diagnose because sometimes the cause is another organ, especially:
- The pharynx (an area of the throat),
- The temporomandibular joint
Earache when chewing, swallowing, or yawning
Earache when swallowing is often provoked by a sore throat. The Eustachian tubes of the middle ear are connected to the throat or nasopharynx. If there is inflammation or throat infection:
- May mucus accumulate inside the Eustachian tube,
- The mucous membranes of the duct system swell.
The consequence is that it does not work correctly and an increase in pressure in the middle ear is caused.
In this case, the patient has pain in the ears when swallowing.
Earache when chewing is the most common symptoms of malfunction of the temporomandibular joint (between the temporal bone and jaw).
This joint connects the jaw to the temporal bone of the head and is the main joint responsible for the movement of:
- Lateral jaw displacement.
Symptoms of temporomandibular joint disorders include:
- A clicking sound when opening and closing the mouth,
- tinnitus (humming) and acute pain in the ear, especially when swallowing, chewing or yawning,
- Mild or moderate headache.
Ear and jaw pain
There are two main causes of earache:
- Primary earache – if the ear is the cause of the pain, usually the examination will detect lesions or abnormalities of the ear.
- Secondary earache – if the ear is not the cause of the pain, the examination will give a normal finding of the ear. The ear has nerve endings originating from the cranial nerves (V, VII, IX and X) and cervical nerves (C2 and C3). Thus, the “pain indicated on the ear” is a difficult diagnostic challenge for the ear, nose and throat doctors.
The cause of primary earache can be seen during the examination with the otoscope; the most common causes are:
- Otitis media
- Otitis outside the ear.
The figure shows the CT scan of a left ear and a magnetic resonance imaging of the right side.
CT Eardrum Hammer Stirrup Anvil
In CT you can see the bony structures well. This diagnostic device shows the images in 3 colors:
- White the bones,
- Black the air,
- Grey the other tissues.
Magnetic resonance imaging produces images of different shades of gray, so you can show the characteristic anatomy of many body structures.
The cause of secondary earache is often difficult to name because the innervation of the ear (the nerves that connect the ear to the brain) is complex and there are several possible reasons for the indicated pain.
The most common causes are:
- malfunction of the temporomandibular joint,
- Dental diseases (abscesses, caries, enclosed wisdom teeth)
- Arthritis of the cervical vertebrae.
Causes of ear or jaw pain include:
Physical trauma such as a blow to the cheeks can injure the temporomandibular joint, causing pain in the ear if the patient swallows or chews.
Teeth grinding is generally defined as involuntary jaw movement (when it is unnecessary) in which the patient grits his teeth day and night for no reason.
This is the main cause of:
- wear of tooth enamel,
- Inflammation of the gums (or periodontitis).
This disorder can also cause:
- temporomandibular joint complaints,
- Pain of the masticatory muscles.
The ear and temporomandibular joint are close together. To understand an idea of the distance, it is recommended:
- Place the index finger on the ear at the level of the ear canal,
- Open and close your mouth,
- Repeat on the other ear.
You can feel the movement of the temporomandibular joint and compare the right with the left side.
If the two movements are not synchronized, this is nothing to worry about, it is normal for the jaw to open on one side rather than on the other.
The earache caused by temporomandibular joint dysfunction must be understood as sensitive functional care.
The nerves conduct the pain signals from the periphery to the spinal cord or brain.
The brain can misinterpret a signal coming from the nerves, just like a patient who:
- feels pain in the left arm during a heart attack,
- After an amputation, feels a phantom pain on a limb.
There is an important connection between the innervation of the ears and the nerves of:
- Oral cavity
These structures have the same embryonic origin, i.e. they develop from the same embryonic tissues .
The ear is innervated by many cranial nerves. These include:
- The fifth,
- The seventh,
- The ninth.
It also receives sensory nerve branches from the cervical plexus; these are nerve roots that originate from the vertebral segment C2 and C3.
However, the temporomandibular joint is also innervated by the ear-temporal nerve, the fifth and seventh cranial nerves.
Ear symptoms caused by dysfunction of the temporomandibular joint are also the most common effects of bruxism:
- Dizziness .
These symptoms of the ear improve with dental treatment.
With pronounced bruxism, patients will be helped:
- Dental protection, dental procedures,
- A behavioral therapy for anxiety and stress that can lead to these disorders.
This is often the cause of ear and jaw pain in children, especially in the morning after awakening.
Alveolitis is the inflammation or infection of the dental compartment. This is the cavity that contains the tooth in the upper or lower jaw bone.
Alveolitis is a possible complication after tooth extraction.
When the dentist pulls a tooth, a blood clot forms in the empty space the tooth leaves behind. In this way, gums and bones can heal.
If no coagel of blood forms, the bones and underlying nerves remain “uncovered” and cause pain:
- In the jaw
- In the ear.
The pain may radiate to other areas of the head, such as:
- Upper jaw
Sinusitis and cold
Paranasal sinuses are cavities that lie between the nose and the middle bones of the skull.
If the paranasal sinuses are blocked by infection (sinusitis), they cause:
- headache in the nose and forehead area,
- Pressure on eyes and jaw.
Other minor causes
- Incorrect chewing – If the temporomandibular joint and muscles are poorly matched, for example if the patient chews only on one side, this causes pain: this pain comes from the masticatory muscles, but you can also feel it in the ears.
- Arthritis – Also, damage caused by arthritis of the temporomandibular joints causes pain that occurs on the jaw and ear.
- A tooth abscess is another common cause of pain in the ears: often pain passes from the tooth area to the ears.
- Parotitis – Parotitis is a viral infection of the parotid gland. The disease is also known as “mumps” and can cause earache when chewing and swallowing.
Cause of earache and throat discomfort
Infections in the throat and nose can spread to the ear and cause an ear infection because the ears and throat are connected from an anatomical point of view:
- The mucous membrane of these organs is the same.
- The Eustachian tube is a virtual channel that connects the rhinopharynx (nasopharynx) and the middle ear.
In the following, some causes are listed, which are the cause of throat and earache:
- Otitis media
- Hay fever
- Inflammation of the palate suppositories
- Tooth infection
- Tobacco smoke: There is a direct effect on the cells in the inner ear and an indirect one for damage to the nose and throat.
The glossopharyngeal nerve is a mixed cranial nerve with the components:
The sensitive fibers (which transmit signals for pain and sensitivity) originate in:
- Eustachian tube
- Middle ear
Symptoms of these ailments resemble, with some difference, trigeminal neuralgia.
Neuralgia of the tongue-throat nerve causes:
Unilateral pain resembling a sting that originates in the throat and radiates into:
- pharyngeal tonsils,
- posterior part of the tongue,
- Eustachian Tube,
- Inner ear.
The pain starts suddenly and has an average duration of 30 seconds.
Usually the stings occur during the day.
Some factors or movements can cause the onset of pain, for example:
- drinking cold liquids,
- Touching cheeks or ear.
As a rule, there is no definite cause of glossopharyngeal neuralgia, but it may be caused by:
- oropharyngeal tumor,
- arachnoiditis (arachnoiditis is an inflammation of the thin skin that covers the brain and spinal cord),
- Multiple sclerosis
- vascular malformations,
It can also occur in the context of trigeminal neuralgia.
Correction of jaw diseases
If the earache is linked to problems with the jaw or temporal temporomandibular joint, different therapies are possible, including:
- Dental splint for teeth grinding – The dental splint, a device above the teeth, is similar to a tooth guard that prevents contact between the teeth at night. In this way, teeth grinding is prevented.
- Surgery– In rare cases, surgical intervention is performed to correct the malposition of the joints.
Some foods should be avoided because they require vigorous and long chewing: this aggravates the patient’s pain.
Soft foods are recommended to avoid worsening the earache:
- Some raw or cooked vegetables,
- Fruit, such as ripe bananas.
One should avoid chewy foods, such as: