ASK DR. JACKSON

Common sense answers to frequently asked questions from a community ENT physician.

Dear Dr. J: My ear hurts. It hurts so badly that I’ve been to the doctor several times. They say they think my ear is infected, but antibiotics are not helping like they should. My ear feels plugged and I hear a high-pitched ringing noise. The pain goes down the back of my neck and between my shoulders. Help!

It’s probably not your ear

ENT doctors see this problem all the time. We get consulted if you are diagnosed with an ear infection and medication doesn’t help. Antibiotics work quite well for most ear infections. Antibiotics that were prescribed for ‘ear infections’ that turned out to be an unrecognized tonsil, salivary gland, or dental infection work well, too, even when they are given for the wrong diagnosis. When antibiotics don’t work, you may find out that your ear pain has nothing to do with an infection. As it turns out, there are lots of things that cause ear pain that are not related to the ear.

Your symptoms sound like TMJ, a jaw-joint pain that comes from grinding and clenching your teeth. Temporomandibular joint strain is one of the leading causes of adult ear pain and is frequently misdiagnosed as infection.

But Dr. J, everyone says it’s an infection! And I’ve never been one to grind my teeth. Wouldn’t I know if I did?

There are lots of telltale signs that you may grind your teeth, something that we refer to as ‘bruxism’. One of these is pain in the back of the skull and the neck radiating down between the shoulder blades. (This is because no one clenches their teeth without also flexing/tightening the muscles in the back of the neck and shoulders.)

Waking up with a ‘crick’ in your neck, a painful problem in which you feel as if you can’t rotate your head or flex/extend your neck without pain, is another.

Of course, if you break your teeth and then bust up the crowns used to repair, you probably grind. (Your dentist may not tell you this because you are his ‘cash cow’.)

But my ears feel full and ring, Dr. J. Doesn’t that mean my ear is the problem?

Just because your ear feels full doesn’t mean you have an infection. There is a lot of inflammation from the stresses of bruxism. There are muscles that move your lower jaw back and forth, left to right, right to left, and they are located straddling both sides of the eustachian tube. When these muscles are inflamed and tight, the eustachian tubes feel blocked. Interestingly, this same inflammation is blamed for the associated ringing noises you hear in your ear. So, what do I do, Dr. J? You’re not a dentist. Who can help me?

The best thing I can do is confirm that it’s TMJ strain instead of something more worrisome. There are some scary things that radiate pain to your ear (the subject of another article). I can get you started with TMJ treatment. I’ll educate you to wear a night guard to bed and prescribe anti-inflammatories and muscle relaxants to take you out of pain. (Don’t be surprised if you wake up next to your night guard lying in drool next to you the first couple of mornings. Be patient and keep trying. You will eventually train yourself to keep it in.)

Keith Jackson, MD is a graduate of Medical College of Georgia and Emory Medical School, where he completed his Residency in ENT. Dr. Jackson practiced as an ENT specialist in Atlanta at Northside, Scottish Rite, North Fulton, and Saint Joseph’s Hospitals until moving to Lake Rabun in 2020. Currently, he is in full-time ENT practice at Mountain Lakes Hospital in Clayton, Georgia. His interests include music and art. Dr. Jackson is a Rotarian and enjoys giving back to the community.

As an interesting aside, a lot of males will clench and grind their teeth because they insist that they can only sleep if they are freezing cold. An open window even in winter, a fan blowing over their shirtless chest, they will lay there on top of the sheets. Shivering and freezing, they clamp their jaws and tighten their necks and muscles between the shoulders. Treatment for them is easy. Put on a pajama shirt and get warm.

Most women sleep warm, covered in comforters. They grind because their ‘Id’ is out of control. (We males can’t relate.) Even when treated, they chew through night guards. This is the most difficult group of patients to manage. When the issue is severe, a TMJ specialist with a dental degree would be the best health professional to consult. But they are hard to find.

If you have ear pain and aren’t getting answers as to why treatment isn’t effective, seek out an appointment with an ENT. As said earlier, there are scary things that cause ear pain, and they need to be ruled out.

Keith Jackson, MD is a graduate of Medical College of Georgia and Emory Medical School, where he completed his Residency in ENT. Dr. Jackson practiced as an ENT specialist in Atlanta at Northside, Scottish Rite, North Fulton, and Saint Joseph’s Hospitals until moving to Lake Rabun in 2020. Currently, he is in full-time ENT practice at Mountain Lakes Hospital in Clayton, Georgia. His interests include music and art. Dr. Jackson is a Rotarian and enjoys giving back to the community.