Ringing or buzzing in the ear-A Case Presentation

A 45-year-old white female was referred for tinnitus (ringing or buzzing) in the left ear and facial pain that had been present for the previous two years. She had first sought treatment from her family doctor and an Ear, Nose, and Throat specialist. Both doctors had told her nothing could be done. She then went to a periodontist who thought her problem might be TMJ. An arthrogram (dye injected into the TM joint and an X-ray taken) was performed on the left TM joint and showed a disk perforation. The disk is a small piece of cartilage that cushions the upper part of the jaw bone as it meets the skull. The patient was then referred to several dentists and told that surgical treatment was necessary. The patient and her husband both had psychiatric treatment for depression earlier. The TMJ Scale Report for this patient reflected elevated overall TMJ symptoms, as well as heightened pain, pain on pressing, joint noises, and the teeth feeling ill-fitting. In addition, emotional problems, stress and the propensity for chronic illness were all highly elevated. A physical examination confirmed that multiple facial muscles and the TM joint were painful to the touch, and that both joints produced clicking at about 15 mm of opening. Crepitation or joint grinding sounds were also noted. These finding, combined with TMJ Scale results, led to a diagnosis of MPD–myofacial pain dysfunction, anterior disk displacement with perforation and tinnitus (see Glossary) Comment: This is an example of multiple TM disorders complicated by emotional factors and stress. This patient was undergoing treatment with a TMJ specialist. (Published in the TMJ Scale Manual)