Beyond the Ear: When Your Earache Isn't From Your Ear
- Lauren Levi DMD MS
- Nov 16, 2024
- 4 min read
The sensation of ear fullness—feeling as though your ear is clogged, pressurized, or stuffy—can be both frustrating and disruptive. Many people first visit their primary care physician or an ENT (ear, nose, and throat) specialist, expecting an ear-related cause such as wax buildup, an infection, or Eustachian tube dysfunction. However, if these possibilities are ruled out, the question remains: What’s causing the discomfort?
If you continue to experience ear fullness after being told the issue isn’t coming from your ear itself, the root cause may lie elsewhere. Conditions involving the jaw, muscles, or nervous system—such as temporalis tendonitis, TMJ arthralgia, muscle spasms, migraines, or autonomic nervous system disturbances—might be to blame. Understanding these non-otologic causes can help you find relief with the help of the right specialist.
Non-Otologic Causes of Ear Fullness
Temporalis Tendonitis
The temporalis muscle, located on the side of the head, plays a crucial role in chewing. This muscle is commonly called the temple. It attaches to the lower jaw (mandible) through a tendon called teh temporalis tendon. When overused or strained—often from teeth grinding (bruxism), clenching, or repetitive chewing—the temporalis tendon can become inflamed.
This inflammation can refer pain to areas near the ear, the adjacent tendon, upper teeth on that same side and even the corner of the eye on that side. The referred ear pain often leads to a sensation of pressure or fullness. People with temporalis tendonitis may also experience headaches or tenderness when touching the side of the head.
Muscle Spasm in the Ear and TMJ Region
The ear is surrounded by small but essential muscles including the tensor tympani and tensor veli palatini, which can cause ear-related sensations when they spasm or become injured.
Tensor Tympani Spasms: This muscle protects the inner ear by dampening loud sounds. Stress, TMJ dysfunction, or heightened sensitivity can cause it to spasm, leading to abnormal sensations like ear fullness or a fluttering sound.
Tensor Veli Palatini Dysfunction: This muscle helps open the Eustachian tube, which regulates pressure in the ear. Dysfunction in this muscle can mimic Eustachian tube problems, causing fullness or discomfort.
TMJ Arthralgia
The temporomandibular joint (TMJ) connects the jawbone to the skull. This complex joint allows movement in multiple directions. TMJ arthralgia refers to pain or dysfunction in the joint, which can be caused by arthritis, misalignment, trauma, or overuse.
Because the TMJ shares nerves with the ear, joint stiffness and inflammation can radiate to the ear, causing sensations of fullness, pain, or pressure. Other symptoms of TMJ arthralgia may include:
Pain when chewing or opening the mouth.
Jaw stiffness or reduced range of motion.
Migraine and other Headache Disorders
Migraine is well-known for causing severe headache, but it can also lead to a range of other symptoms, including ear fullness. This is often due to disturbances in the autonomic nervous system, which controls functions like blood flow, nerve sensitivity, and even how our body reacts to pain.
Vestibular migraines a type of migraine that affects balance, are particularly associated with ear fullness. During a migraine attack, the body’s blood vessels can constrict and then rapidly dilate, which may increase blood flow near the ear. This vascular change can create a feeling of pressure or fullness in the ear. Additionally, migraines can increase sensitivity in the nerves around the ear, further contributing to these sensations.
Research has shown that people suffering from vestibular migraine often experience not only the typical headache symptoms but also dizziness, nausea, and ear fullness. In some cases, these symptoms are linked to the autonomic disturbances that occur during a migraine, such as increased sensitivity of nerves or fluid retention near the ear.
A Real-Life Example
One patient I treated had been struggling with persistent ear fullness for years. She had visited multiple specialists, including ENTs, but all tests ruled out an ear-related cause. She denied history of headache a consistent headache but reported that she felt at times like she had sinus pressure. She also reported that she had been given a night guard in the past and it exacerbated her pain. I referred her for a sleep evaluation and she was ultimately diagnosed with obstructive sleep apnea.
Additionally, after a thorough evaluation, I diagnosed her with undiagnosed facial migraine. The facial migraine was causing autonomic symptoms, including ear fullness, while her obstructive sleep apnea contributed to nighttime clenching and jaw tension as well as prevented her from getting restful, restorative sleep.
By addressing both conditions—with migraine-specific treatments and a mandibular advancement device for her sleep apnea—her ear fullness completely resolved.
Who Can Help?
If you’re experiencing persistent ear fullness that isn’t linked to an ear-related condition, it’s essential to consult an orofacial pain specialist. These specialists focus on diagnosing and treating conditions involving the jaw, face, and related systems. They can work in tandem with other providers, like ENTs or physical therapists, to develop a comprehensive treatment plan tailored to your needs.
Further reading
Brahm, P., et al. (2011). "Prevalence and association of temporomandibular joint symptoms and ear symptoms." Journal of Oral Rehabilitation, 38(9), 702-709.
Jochum, T., et al. (2014). "Myofascial pain in the temporomandibular region: Relationship with ear symptoms and tinnitus." International Journal of Oral and Maxillofacial Surgery, 43(7), 893-898.
López-Muñoz, F., et al. (2009). "The role of the autonomic nervous system in the pathophysiology of migraine." Headache: The Journal of Head and Face Pain, 49(2), 276-283.
Manfredini, D., et al. (2004). "Temporomandibular joint and ear symptoms: A review of the literature." Journal of Craniomandibular Disorders, 17(3), 211-218.
McNeill, C. (1997). "Temporomandibular disorders: Guidelines for classification, assessment, and management." Quintessence Publishing.
Okeson, J. P. (2013). "Management of Temporomandibular Disorders and Occlusion." (7th ed.). Mosby.
Shechter, A., et al. (2013). "Autonomic disturbances in migraine patients with vestibular symptoms." Cephalalgia, 33(10), 817-824.
