When ear pain and TMJ pain appeared together

A de-identified clinical story about right ear pain occurring together with TMJ pain during chewing and yawning. Conservative jaw care was selected first, and the initial change was reviewed three days later while ear-related causes remained part of the differential diagnosis.

The course of one patient cannot establish the cause of ear pain or prove a treatment effect. Similar symptoms can arise from ear disease, dental or salivary-gland conditions, neurologic pain, or jaw-related structures, and the evaluation should reflect that range.

Key observations

Recent right ear pain had been present for about two to three weeks.

Pain while chewing was rated VAS 5 to 6.

Pain while yawning was rated VAS 5 to 7.

The first follow-up was three days after the initial care.

Does ear pain always come from the ear?

Ear disease is an important first consideration. Otitis externa, otitis media, and other ear conditions can cause pain, so ear symptoms should not be dismissed.

The temporomandibular joint lies immediately in front of the ear, with masticatory muscles and sensory nerve pathways nearby. Pain arising from the joint or muscles can sometimes be perceived in front of or inside the ear; this is one form of referred pain.

This does not mean that all ear pain comes from the TMJ. Ear disease, dental and salivary-gland disorders, neurologic pain, and other causes should be distinguished first. It is then useful to ask whether ear and jaw pain change together with chewing, yawning, or opening.

Symptoms reported at the first visit

The patient's main concerns were the following.

Pain around the right TMJ while chewing

More pain while yawning or opening wide

Right ear pain beginning about two to three weeks earlier

Mild discomfort in the left TMJ as well

According to the history, jaw discomfort had been present for more than 20 years, and a sense of limited opening had continued since high school for roughly 30 years. The patient felt that pain began after dental treatment the previous year and had continued for about six months.

The timing of dental treatment and pain onset was relevant history, but temporal order alone did not establish that the treatment directly caused the pain. Current teeth, occlusion, jaw movement, muscle condition, and daily habits needed to be assessed together.

The patient also reported clenching during sleep and previous botulinum-toxin treatment without a clearly perceived benefit. A past treatment feeling ineffective did not determine the next step; the current condition was reassessed.

Pain levels at the first examination

Ear pain: VAS 2

Pain while chewing: VAS 5 to 6

Pain while yawning: VAS 5 to 7

The ear pain was relatively recent, while right-joint pain was more prominent during jaw movement. This combination was a clue to examine jaw function, but it did not establish the cause of the ear pain.

What was assessed and selected first?

The examination considered opening range and jaw path, tenderness of the joints and masticatory muscles, changes in pain with chewing and yawning, clenching habits, and the response to previous care.

Because clenching and muscle tension were present, future botulinum-toxin treatment was discussed as one possible option. It was not performed at the first visit. Conservative TMJ care was selected first, with a plan to review the early response before deciding the next step.

This sequence does not imply that one treatment is always superior. The choice and timing depend on current pain, function, examination findings, prior response, and patient-specific risks and preferences.

Initial changes three days later

The patient reported that the ear pain was no longer felt.

Pain while yawning changed from VAS 5 to 7 to VAS 2.

Pain while chewing was almost absent while the medication effect was present and was VAS 2 to 3 as the effect decreased.

The de-identified photographs recorded opening range during the clinical process. The ruler angle and camera view should not be used to create a new measurement; the documented measurements, pain reports, and functional changes must be interpreted together.

This was an early follow-up three days after the first care, not a final outcome. The patient remained under observation.

Ear pain decreased first and pain with chewing and yawning also improved, but this temporal association did not prove that the ear pain originated from the TMJ.

How ear pain and jaw function can be related

The TMJ is located directly in front of the ear, and sensory information from the joint and masticatory muscles travels through trigeminal pathways. In some patients, joint or muscle pain can therefore be perceived around the ear.

If the following features occur together, jaw-function assessment can be considered while ear-related causes are still evaluated.

Ear-front and jaw pain worsen together while chewing.

Yawning or opening wide increases pain.

Opening is restricted or the jaw catches.

Joint sounds occur together with pain.

Clenching or grinding is present.

Palpation of the joint or masticatory muscles reproduces familiar ear-area pain.

Warning signs that require ear or emergency evaluation first

Sudden hearing loss or rapidly worsening hearing on one side

Pus, other discharge, or blood from the ear

High fever with marked swelling or redness around the ear

Severe vertigo, unsteady walking, or repeated vomiting

Facial weakness, sensory change, or other neurologic symptoms

Ear pain or hearing change after trauma

With these findings, ENT or emergency evaluation should come before considering a jaw-related explanation.

What this case shows and does not show

The patient had long-standing restricted opening and jaw discomfort, with recent right ear pain added to the pattern. Conservative care was selected first rather than repeating botulinum-toxin treatment immediately.

Three days later, ear pain was not felt and pain during chewing and yawning had decreased.

This single case cannot generalize the cause of ear pain or the effect of treatment.

It does show why, when ear pain changes with jaw movement and occurs with joint pain, restricted opening, or clenching, clinicians may assess the ear and jaw system in parallel rather than assuming one cause.

References

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Durham J, Newton-John TRO, Zakrzewska JM. Temporomandibular disorders. BMJ. 2015;350:h1154. DOI: 10.1136/bmj.h1154.

de Leeuw R, Klasser GD. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 6th ed. Quintessence Publishing; 2018.

Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. Journal of Dental Research. 2016;95(10):1093-1101. DOI: 10.1177/0022034516653922.

Okeson JP. Management of Temporomandibular Disorders and Occlusion. 8th ed. Elsevier; 2020.