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Q. I have pain in my cheeks near my ear and pulse tinnitus. Kindly help me.

Answered by
Dr. Krishna Swaroop Achanta
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 19, 2021

Hi doctor,

I have had pain in my cheeks near my ear for the past year. I know it was from TMJ, so I tried to quiet it down with some exercises. I never went to the dentist until recently because of the COVID. Next thing about three months ago, I got pulse tinnitus in my ears the whole day, and I continue to have it. I went to two ENTs and one neurologist. One ENT said it could be from TMJ. I had pulse tinnitus. I have had CT angio of the brain and neck and MRI, MRA and MRV, and temporal bone CT. Nothing has shown up. I continue with jaw pain and pulse tinnitus. I went to my dentist, and she made a night splint about one month ago. I wear it every night. Do you think inflammation could be in my jaw bone leaning near a blood vessel? I am so upset. Not sure where to go next. I have tried Advil a few times a day. Have you seen this before? Would a round of a steroid take it away? Should I go to a maxillofacial surgeon? What would they do? This is so upsetting. I am continuing to wear a nightguard. Kindly give your opinion.

#

Hi,

Welcome to ilciniq.com.

The continuous jaw pain signifies even after a month that either your facial muscles and joints are tight or that you may be suffering from an underlying condition like osteoarthritis. The tightness of the joint or muscle accompanied by tinnitus may be what the dentist might be confusing with just a TMJ (temporomandibular joint) disorder.

For a long-term solution, I would recommend that you have your bone density levels and calcium checked by the physician. If there is no arthritis after physical examination, then you will need to consult the ENT (ear, nose, and throat) surgeon only. They can only help you physically in the long run.

I am giving certain precautions and management that you need to follow apart from wearing the splint, so definitely try and follow it.

Firstly relieve your stress. Try meditation and yoga or any alternate form of daily relaxation or breathing techniques that will prove helpful to your general health (increases the oxygen flow and saturation to the joint tissue). Secondly, maintain strict oral hygiene and use a remineralization toothpaste like Enafix or Elsenz or any toothpaste that contains sodium monofluorophosphate or potassium nitrate with triclosan regularly to prevent dental wear and tear that can cause extra pain and pressure to the joint. Use a Chlorhexidine mouthwash every day. Ask your physician for further Calcium supplements or antioxidants like SM fibro (Minerals and Carotenoids) to improve the healing process in your body for both your bone joint and the ear canal. If severe pain exists, then apply a cold pack to the joint region or moist heat. Avoid overheat or normal heat. Include plenty of vitamins and a fibrous-rich diet full of antioxidants, as I suspect your immune response to treatment is poor. Dietary changes are needed.

Continue wearing the night splint and visit your dentist every three months for a check-up. Visit the physician to get the bone density checked. Follow simple preventive measures given below to prevent joint pain.

I hope this was helpful.


Hi doctor,

Thank you.

1) What antioxidants could help with the pulsatile tinnitus in my ear?

2) What antioxidants could help ear inflammation if there is inflammation from TMJ as I do not have an ear infection?

3) Can I apply a heating pad to my face?

4) Are there tests for TMJ that diagnose it?

5) Could TMJ cause pulse tinnitus?

Kindly give your opinion.

#

Hi,

Welcome back to icliniq.com.

I understand your concern. Pulsatile tinnitus is difficult to live with, along with jaw pain, and in more than 30% of cases, there is no cause found. In CT (computed tomography), usually, if any tumors were there, they would have been detected. But as you have got all the neuro investigation done, there is still something called intracranial hypertension that occurs more in the elderly, a form of pressure inside the skull that causes it and is not detected in radiographic imaging. There is no probable medical cure for tinnitus due to such cases.

An antioxidant like SM fibro and fruits or veggies rich in antioxidants like artichokes, sweet potato, potato, broccoli, cabbage, kale, spinach, lettuce, peaches, berry fruits, watermelon, papaya, etc., will help you greatly combat the fight for jaw pain. Becosules (Calcium Pantothenate, Vitamin B12, Folic acid, Thiamine Mononitrate, Riboflavin, Pyridoxine Hydrochloride, Niacinamide, Ascorbic acid, Biotin) or vitamins will help too along with antioxidant. That is because the nerve pressure and healing in the joint or muscle are directly proportional to the intake of antioxidant that reduces stress and pain.

And yes, TMJ disorders are linked to tinnitus. But the differential diagnosis will be unknown if there is no significant disease radiographically in a number of cases.

You can certainly apply a heating pad but low heat for 15 minutes three to four times a day but alternate with cold packs too after applying moist heat. That stimulates blood flow and relaxes the joint space.

In many cases, to conclude, both TMJ disorder and pulsatile tinnitus without any underlying disease is common indeed and you need not be anxious or panic about the pain. Relax and improve upon your breathing flow, and acutherapy, naturopathy, and yoga will all help correct nerve pressure disorders that cause TMJ tinnitus linked to disease. Dietary antioxidants, regular antioxidant pill once a day (SM Fibro), heat and cold pad alternation only to the joint below the ear (not over the face), night guard, and proper oral hygiene are the only long-term solutions if there is no diagnosis radiographically. But I also suggest you have your calcium and bone density checked that can sometimes aggravate TMJ disorders.

The important part of staying with tinnitus is you need to be calm and keep yourself free from anxiety and stress as it can be very intolerable long term. Use headphones while sleeping or defocus from your surrounding noises when trying to sleep. A good nine to ten hours of sleep may improve the prognosis of tinnitus.

I suggest taking Hifenac MR (Aceclofenac, Paracetamol, and Chlorzoxazone) tablet whenever you feel the jaw pain exceeds twice a day after food.

I hope this was helpful.



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