Persistent ear fullness and reduced-hearing sensation despite normal hearing tests

A de-identified long-term story about recurrent ear fullness and a subjective sense of reduced hearing occurring with headache and pressure around the eyes, nose, and face.

Several ENT evaluations reportedly found no specific abnormality, after which jaw function and masticatory muscles were assessed and each symptom was tracked separately.

Across nine visits, injection treatment was recorded six times, and a TMJ appliance was introduced at the eighth visit.

Headache and eye, nose, and facial pressure had begun decreasing before appliance use; afterward, the remaining ear fullness and subjective hearing difficulty decreased again. The patient later estimated about 80% improvement in the feeling of reduced hearing.

This was not an 80% improvement in measured hearing, normalization of measured intraocular pressure, proof of Costen syndrome, or proof that the TMJ was the sole cause. Sudden hearing loss is a different situation and requires prompt ENT evaluation.

Why this case was documented

The point is not simply that ear fullness decreased. Ear blockage and reduced-hearing sensation repeatedly worsened together with headache, pressure around the eyes, nose and face, and difficulty concentrating severe enough to interrupt work.

After jaw and muscle assessment and treatment, headache and eye, nose, and facial pressure decreased first. The residual ear symptoms changed later, particularly after appliance use began.

The symptom combination resembles historical reports by James B. Costen, but similarity is an observation rather than a diagnosis or validation of a single mechanism.

When the ear symptoms began

Symptoms began in the right ear around September 2020 and appeared in the left ear from 2021. At the first visit in September 2025, the left ear was almost always full while the right was intermittently full.

Worse episodes included bilateral headache, a feeling of rising eye pressure, pressure in the nose on the same side as the worse ear, facial swelling or upward pressure, eye-area discomfort, and reduced concentration.

Ear fullness was usually about 5/10 and reached 8 to 9/10 during exacerbations; eye-area discomfort could reach about 7/10.

On severe days, the patient had to stop working and close the eyes until symptoms settled. The notable pattern was that ear symptoms changed together with headache and pressure around the eyes and nose rather than remaining isolated to one area.

Normal hearing tests do not erase the symptom or prove a jaw cause

The patient reported several ENT evaluations from 2020 to 2022, including hearing tests, with no specific ear abnormality identified.

The patient also described a later oral-medicine consultation, but this account was based on memory; the original records and exact wording were not independently reviewed here.

Two distinctions matter: absence of a detected abnormality does not mean that fullness and subjective hearing difficulty are unreal; it also does not mean that the symptoms therefore originated from the TMJ.

Ear and hearing status should be assessed first. If no clear ear cause is identified and jaw pain, muscle tension, or changes with jaw movement coexist, an additional jaw and masticatory-muscle evaluation can be considered.

Subjective reduced hearing and objective hearing loss are different

People may describe ear fullness as distant, muffled, or reduced sound even when hearing thresholds do not change. Conversely, a symptom dismissed as simple fullness can be an early sign of true hearing loss.

Ear fullness and subjective hearing difficulty are patient-reported symptoms. Objective hearing loss is established with tests such as pure-tone audiometry. Sudden new hearing change in one ear should be checked promptly by ENT before considering a jaw explanation.

For this case, the accurate phrase is that the subjective feeling of hearing less decreased, not that hearing loss was treated or hearing recovered by 80%.

Sudden hearing change requires prompt ENT evaluation

Suddenly not hearing the television, needing a much higher volume, a clear difference during phone calls, distorted speech, sudden unilateral fullness, or rapidly increased tinnitus can indicate a time-sensitive ear condition such as sudden sensorineural hearing loss.

New unilateral hearing loss, new or suddenly louder tinnitus, vertigo or imbalance, difficulty understanding speech, facial sensory change or weakness, speech change, or an unusual severe headache should not be attributed to the TMJ first.

A hearing aid is not the first decision after sudden reduced hearing. The ear canal, eardrum, middle ear, and hearing should be assessed, and hearing rehabilitation is discussed only after the type, degree, cause, and course are clarified.

Repeated jaw movement intended to clear the ear

When fullness became severe, the patient repeatedly twisted the jaw sideways as if equalizing pressure. Pain then developed in the joint on the same side, sometimes in both joints, although ordinary eating and opening were not clearly uncomfortable.

The behavior may have increased loading of the joints and masticatory muscles. The patient's sensation alone could not establish that the condyle was displaced or the joint was dislocated.

Forcefully twisting the jaw or repeatedly moving to the end range to clear the ear can create additional joint or muscle pain and should be avoided.

What similarity to Costen's historical reports means

In 1934, otolaryngologist James B.

Costen reported a group of ear and sinus-area symptoms associated with disturbed TMJ function, including fullness, reduced-hearing sensation, ear pain, tinnitus or dizziness, headache, orbital or eye pressure, sinus-like symptoms, and jaw or muscle discomfort.

The present symptom pattern resembles that report, but Costen syndrome is not now used as a single standard diagnosis explaining all such symptoms. Modern practice separates TMD, muscle pain, headache, ear disease, and neurologic or ENT conditions.

Costen's proposed 1930s anatomy, including excessive posterior mandibular movement and lost vertical dimension, cannot be accepted unchanged as established modern fact. Similarity here is historical and descriptive, not diagnostic.

Historical posterior support, vertical dimension, and the present appliance

Costen's early patients often had tooth loss, poor dentures, overclosure, or inadequate posterior support.

He reported ear-symptom change after dentures or restorations increased support and vertical dimension, but those reports lacked modern controls, standardized audiometry, and three-dimensional jaw-position measurement.

A TMJ appliance places a planned occlusal surface between the teeth, temporarily increasing the vertical separation while worn and changing contact sequence, closing position, and muscle loading.

It is a reversible condition during wear, unlike permanent tooth reduction or prosthetic reconstruction.

Story 38 and Costen's reports share only the limited observation that subjective symptoms changed after tooth-contact height and mandibular functional conditions changed. They involved different treatments and do not prove objective hearing restoration.

Because other treatments had already reduced headache and eye or nose symptoms before appliance use, the appliance or occlusal elevation cannot be identified as the sole cause of the overall improvement.

Why hyoid bone syndrome was considered only as a differential reference

Hyoid bone syndrome is a rare pain condition centered on localized tenderness near the greater horn of the hyoid, with throat and neck pain that may spread to the ear, face, or mandible.

The present record did not document characteristic hyoid tenderness, swallowing-provoked throat pain, or reproduction of familiar pain by hyoid palpation, and no hyoid-directed treatment was performed.

The literature was included only to show that similar ear and facial pain distributions can arise from different sources and require differential assessment.

Early symptom changes were not linear

The team tracked ear fullness, subjective hearing difficulty, eye-pressure sensation, nose and facial pressure, swelling or upward facial sensation, headache or migraine, joint and muscle pain, and repeated jaw movement separately.

Eye-pressure sensation decreased from a subjective 10/10 to about 3/10, later rose to about 7/10 for a period, and then became infrequent. Facial and nasal pressure and headache decreased earlier, while ear fullness remained longer.

Improvement and recurrence alternated, and the symptoms changed at different speeds. A short-term response was therefore not treated as the final outcome.

Nine visits and appliance use from visit eight

Nine visits occurred from September 2025 through July 31, 2026. Six included injection treatment; other visits involved non-injection jaw and muscle care and observation.

Travel distance made visit intervals irregular, so long-term patterns were considered rather than a single response.

From visit eight, the appliance temporarily elevated the occlusion during wear. Remaining ear fullness and subjective hearing difficulty then decreased rapidly again, and on July 31 the patient estimated about 80% improvement compared with the earlier state.

The temporal sequence is best described as cumulative care reducing headache and eye, nose, and facial symptoms first, followed by further reduction of residual ear symptoms after the appliance was introduced.

It does not isolate the appliance as the direct treatment for ear symptoms.

How the 80% statement should be written

The patient estimated that the subjective sensation of hearing less had improved by about 80%. This is different from an 80% change in pure-tone thresholds or objective hearing function.

The eye-pressure statement likewise referred to pressure felt around the eyes, not measured intraocular pressure. Glaucoma or true pressure elevation requires ophthalmic examination.

Eye pain, visual-field change, redness, or severe headache with vomiting may require ophthalmic or emergency evaluation before a jaw explanation.

How the main symptoms changed

Ear fullness and reduced-hearing sensation

Long-standing bilateral symptoms persisted through several stages, then were subjectively rated about 80% better after cumulative care and appliance use. No objective hearing-test improvement was documented.

Eye-pressure sensation

It fell from a subjective 10 to 3, later fluctuated upward, and eventually became much less frequent. It was a felt pressure, not measured intraocular pressure.

Headache

Bilateral headache and eye discomfort worsened with ear symptoms. Headache decreased earlier in treatment and was largely absent around the third visit, although intermittent migraine later recurred.

Nose and facial pressure

Pressure in the nose on the affected side and facial swelling or upward-pressure sensation decreased early and later became difficult for the patient to recall occurring at all.

What current evidence says about TMD and ear symptoms

Ear fullness, ear pain, tinnitus, dizziness, and subjective hearing difficulty are reported in people with TMD. A 2017 systematic review and meta-analysis found otologic symptoms were common, while a 2022 evidence-based review concluded that direct causation remains uncertain.

Co-occurrence does not establish cause. Ear disease should be checked first; jaw assessment can be added when ear evaluation is unrevealing and joint or muscle symptoms or movement-related change coexist.

Treatment response should be judged by reproducibility and long-term changes across separate symptoms, not by one short-term change.

Clinical meaning and limitations

The case shows why complex ear, headache, eye, and nose symptoms should be separated and followed when multiple specialty evaluations do not identify a clear cause. It does not conclude that an appliance solves ear fullness.

Six injections, non-injection care, observation, lifestyle changes, natural fluctuation, and later appliance use all occurred during the course. Their individual contributions cannot be isolated from this one record.

The case does not prove a sole TMJ cause, objective hearing recovery, treatment of true intraocular pressure, a single appliance effect, or an identical result for another patient.

A practical evaluation sequence

First assess the ear and objective hearing with ENT.

Seek prompt ENT care for sudden unilateral hearing loss, severe tinnitus, vertigo, or imbalance.

Assess eye pain or visual change separately with ophthalmology when indicated.

If ear evaluation is unrevealing and jaw pain, muscle tension, or movement-related change coexist, consider jaw assessment.

Do not forcefully twist or repeatedly move the jaw to its end range to clear the ear.

Track ear fullness, subjective hearing difficulty, headache, eye pressure, nose or facial pressure, and jaw pain separately.

Do not establish cause from a temporary response; follow reproducibility and long-term pattern.

Medical and privacy note

This article reconstructs a de-identified clinical record for education. It does not replace diagnosis of ear, eye, neurologic, or other disease and does not generalize a treatment effect.

The 80% statement refers to subjective hearing discomfort, and the eye-pressure statement refers to felt pressure around the eyes. Neither is an objective audiometric or tonometric result.

Sudden unilateral hearing change, severe tinnitus, vertigo, eye pain, visual change, weakness, speech change, or an unusual severe headache requires prompt relevant medical evaluation rather than self-diagnosis as a TMJ problem.

References

Costen JB. A Syndrome of Ear and Sinus Symptoms Dependent upon Disturbed Function of the Temporomandibular Joint. Ann Otol Rhinol Laryngol. 1934;43(1):1-15. DOI: 10.1177/000348943404300101.

Costen JB. Neuralgias and Ear Symptoms Associated with Disturbed Function of the Temporomandibular Joint. JAMA. 1936;107(4):252-255. DOI: 10.1001/jama.1936.02770300006002.

Michael LA. Jaws Revisited: Costen's Syndrome. Ann Otol Rhinol Laryngol. 1997;106(10):820-822. DOI: 10.1177/000348949710601003.

de Toledo IP, et al. Prevalence of Otologic Signs and Symptoms in Adult Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis. Clin Oral Investig. 2017;21(2):597-605. DOI: 10.1007/s00784-016-1926-9.

Hernandez-Nuno de la Rosa MF, et al. Is There an Association Between Otologic Symptoms and Temporomandibular Disorders? An Evidence-Based Review. JADA. 2022;153(11):1096-1103. DOI: 10.1016/j.adaj.2021.07.029.

Kusdra PM, et al. Relationship Between Otological Symptoms and TMD. Int Tinnitus J. 2018;22(1):30-34. DOI: 10.5935/0946-5448.20180005.

Maciejewska-Szaniec Z, et al. Incidence of Otologic Symptoms and Evaluation of the Organ of Hearing in Patients with Temporomandibular Disorders. Med Sci Monit. 2017;23:5123-5129. DOI: 10.12659/MSM.902515.

Karacay BC, Korkmaz MD. Investigation of Factors Associated with Dizziness, Tinnitus, and Ear Fullness in Patients with Temporomandibular Disorders. J Oral Facial Pain Headache. 2023;37(1):17-24. DOI: 10.11607/ofph.3286.

Kapos FP, et al. Temporomandibular Disorders: A Review of Current Concepts in Aetiology, Diagnosis and Management. Oral Surg. 2020;13(4):321-334. DOI: 10.1111/ors.12473.

Brown LA. Hyoid bone syndrome. South Med J. 1954;47(11):1088-1091. DOI: 10.1097/00007611-195411000-00013.

Ernest EA III, Salter EG. Hyoid bone syndrome: a degenerative injury of the middle pharyngeal constrictor muscle with photomicroscopic evidence of insertion tendinosis. J Prosthet Dent. 1991;66(1):78-83. DOI: 10.1016/0022-3913(91)90357-3.

Chandrasekhar SS, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngol Head Neck Surg. 2019;161(1 Suppl):S1-S45. DOI: 10.1177/0194599819859885.