case study of patient with TMJ, ear pain, & tinnitus
21 year old female came in for right jaw pain leading to headache. Situation started with left jaw pain 4/18/19 (8 days prior), severe pain level 10/10, she woke up with it and went to doctor who said it was TMJ. She was prescribed muscle relaxants and ibuprofen which did not help much. Left jaw pain dissipated 4/16/19, but then right jaw pain started 4/21/19 and pain level is 7/10 currently. Pain radiates downward into jaw. “Pressure” along TMJ joint, with “stabbing” pain inside the ear. RIGHT EAR HEARING LOSS. Currently only taking ibuprofen which slightly helps. Doctor states no ear infection. Jaw pain has affected energy levels. 6/10. She has been waking up at night due to pain and discomfort. Right occipital headache 5/10 currently. Radiates to neck and trapezius area. “Heaviness” in the neck area.
Patient also states chronic nasal congestion. Right nostril feels clogged. Could be from allergies states patient.
Eczema along collarbone area and sometimes along cubital creases. Dry skin. Patient’s bloodwork states testosterone levels are high, low HDL and high triglycerides. High insulin, high AST, ALT and hemoglobin.
Acupuncture Treatment Summary
1. 4/26/19 Initial treatment
2. 5/1/19 Right jaw pain improved. Today, no pain in the area, however left side started becoming painful a few days ago. Comes and goes but currently 7/10.
3. 5/3/19 Left jaw pain improved after previous treatment, 2/10 today but right jaw pain started yesterday. Currently 7/10 and yesterday was 10/10. She took Advil but still has throbbing pain that is worse when she moves her jaw centerline or to the right. She feels the area is inflamed. Pain radiated down back of neck and front of neck yesterday. Right jaw pain improved after previous treatment after one day. Today, no pain in the area, however left side started becoming painful a few days ago. Comes and goes but currently 7/10.
4. 5/6/19 Patient states jaw overall has felt relief over the weekend. Left jaw pain improved after previous treatment, 2/10 and right jaw no longer has constant pain. Instead she has radiating pain that comes and goes throughout the day that started yesterday, 3x yesterday. Worse with pressure with distracts her from sleeping well at night. Patient states the area feels less inflamed and she can moved her jaw with less pain. Currently no pain but 5/10 when sharp radiating pain happens. Patient also states right shoulder tension over the weekend 4/10
5. 5/10/19 Patient was pain-free for 2 days and had better rest. Right side shooting pain from jaw and ear to neck started again Wednesday morning upon waking. Pain continue to worsen on Thursday and she has not slept well the past 2 nights. Currently no shooting pains, but pressure and inflammation feeling on right ear and jaw area, 5/10. Patient hears “wind sounds” in the right ear. Patient states right neck also feels tight, starting from occipital region to trapezius. 4/10. Left side feels ok.
6. 5/13/19 NO MORE RIGHT JAW PAIN
7. 5/17/19 Left ear and jaw pain
8. 5/20/19 Patient’s left ear and jaw tender to touch. She had radiating pain from the left ear down the left neck 2 times on 5/18/19. She continues to have hearing loss in the left ear. she hears the “wind” sounds.
Patient’s right jaw no pain for 7 days.
9. 5/24/19 Patient’s left ear and jaw is less tender to touch. She had radiating pain from left ear to cheek 1 time in the last 4 days. She continues to have hearing loss in the left ear. she hears the “wind” sounds.
Patient’s right jaw no pain for 11 days.
10. 5/31/19 NO MORE PAIN IN BOTH EARS. No more hearing loss on left side but jumped to right side hearing loss accompanied with pain in the inner ear with pressure. On 5/29/19 shooting pains inside the ear, but less intense than previously.
11. 6/3/14 Tinnitus in Right ear has increased. 15 minutes on Saturday and currently has tinnitus that is high pitched. Also hears “wind” sounds in both ears. Tinnitus started May 27th week, comes and goes but now more constant.
12. 6/14/19 RS tinnitus 3-4/10, wind , daily comes comes and goes. 6/10 previously. no pain and no more hearing loss when sleeping at night.
LS tinnitus- 0/10,
13. 6/21/19 RS ear slightly sore to touch. 2 weeks no pain, until yesterday soreness with touch
2 days after last tx, no more ringing in either ear. “Wind” sounds continue daily, couple times through the day, lasts 1 hour. Hearing loss has improved. Always right side. Jaw and neck range of motion is good.
14. 7/1/19 Right ear pain has lessened. Full hearing. Still has “wind sound”- 2/10. No ringing. Left ear is full function, no wind sound.
15. 7/10/19 NO MORE RINGING IN EARS
16. 7/19/19 Some remaining “wind sounds” in right ear.
17. 7/26/19 I’m happy to report: PAIN-FREE, TINNITUS-FREE, no more ringing or “wind sound”
Written by Zen Tuan, Licensed Balance Method Acupuncturist and Herbalist at Healing with Zen