Learning with laughter

Ever had a chronic intermittent ear pain, and over time you develop a chronically stuffy nose or sinusitis (which you think might be an allergy)? Time passes and then another symptom appears …pressure or feeling of fullness/or a “blocked ear” accompanied occasionally by intermittent headaches?

September 24th, 2012

You are advised that The Netipot, decongestants, Ibuprofen, nasal sprays, increased Vitamin “C”, reduce your dairy intake to reduce mucous production, eat more garlic, ginger, and fresh pineapple /a natural decongestant. This may help a little, however they are finally referred to an Ear, Nose and Throat specialist.

“Dentist, along with most doctors, are taught to analyze body systems and body parts separately and taught to change one area at a time, but such approaches frequently ignore the interconnectedness of the systems in the human body.

What does this have in common with ear pain/TMJOINT /neck dysfunction?  I believe that TMD is “A Great Mimic” of the common cold, or allergies.

Here are the facts:

1. Nasal Congestion:

A high percentage of my chronic neck and jaw patients have nasal congestion. I researched what the American Academy of Otolaryngology said about this topic. They have established four main causes of a stuffy nose: They mention infection, structural abnormalities, allergic, and non-allergic (vasomotor) rhinitis.

Therefore the doctor has a challenge to diagnose what is causing the problem. An antibiotic for infection is prescribed sometimes or a decongestant, if they are thought or confirmed to have an allergy. Only when this does not make a significant difference repeatedly, then the patient looks for another explanation.

What are the symptoms and signs of the common cold?

The symptoms of the common cold typically begin two to three days after acquiring the infection (incubation period). Symptoms and signs of the common cold vary depending on the virus responsible for the infection and may include the following

• nasal stuffiness or drainage(with clear nasal discharge, which later may become yellowish or greenish in color);. • sore or scratchy throat• sneezing,• hoarseness,• cough,• watery eyes

• low-grade fever• headache, • body aches and fatigue.( In both TMD and colds the client may feel fatigued. possibly due to a poor O2 / CO2 exchange!)

(More than 200 different types of viruses are known to cause the common cold, with rhinovirus causing approximately 30%-35% of all adult colds. Other commonly implicated viruses include coronavirus, adenovirus, respiratory syncytial virus, and parainfluenza virus. Because so many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem. In fact, children in preschool and elementary school can have six to 12 colds per year while adolescents and adults typically have two to four colds per year. )

The common cold occurs most frequently during the fall and winter months and lasts four to 14 days, with most individuals improving in one week. TM Joint symptoms continue all year on and off …when this happens most clients I find decide they have an allergy!

2. Another reason… “Myofascial syndrome” of the jaw and neck i.e. ‘Stressed out’ muscles from too much clenching. Active and latent trigger points in the clenching muscles (masseter, temporalis, later al &medial pterygoids) can also present with a sore throat and nasal congestion. Therefore “Questions are key to establish whether a cold or TMD.”

An MRI taken shows no abnormality. The internet sources tell you it could be could it be an Allergy or Eustachian Tube dysfunction?  (This is tube connects your throat to the middle ear and opens during swallowing, yawning or eating),

In some cases it takes years/months for someone to realize it could be your jaw and how it is interacts with the upper neck joints.

The TM joint should then be assessed by a dentist and physiotherapist to determine whether it is a dental issue or muscle/nerve issue and /or a postural/structural/or dysfunctional disc problem.

One possible explanation: The tensor veli palatini (TVP) and tensor tympani muscles can become painful from overuse of the clenching muscles: the temporalis, masseter and pterygoid muscles. As everything is connected the pain spread to other divisions of the same neural segment

When this tiny muscle goes into spasm, it closes off the Eustachian tube and produces symptoms that mimic middle-ear problems.

This week I have had a few patients with these symptoms so I decided to write about one of them.

My patient had been suffering from upper back and neck pain for several years which she attributed to a high level of sports activities.  This discomfort became more painful when she started to play tennis, and she tried to manage this with massage and chiropractic treatments to the spine but the pain would never fully go away.  Historically turning to the left was always limited.

Over the last year, her ears developed intermittent pain and clicking. She lived with this until it turned into severe ear and jaw pain following a root canal which required her mouth to be open for a long time. (asking for a neck pillow is a good idea during any long dental appointment ). She went to her GP and told it could be TMJ or Eustachian tube dysfunction but more than likely it was fluid in her ear, which she was prescribed to use a nasal spray to clear out the sinuses and Eustachian tubes.  The nasal spray did not make the ear clicking or jaw pain any better.

Then she was given an upper hard mouth guard because she might be clenching her teeth. This is often prescribed as the first step to manage TM joint symptoms

She corrected her sitting posture at her computer which she was told could be aggravating the problem but this did not help.

Previous medical history:

She had intermittent ear pain, headaches, dizziness and tingling in her fingers. Otherwise healthy.

After the root canal when my patient’s ears plugged, she became very anxious.

MY TREATMENT:

Her ears plugging has been helped by the following treatments

1. Upper cervical (neck) manual therapy to align with bite (Quick test: If you right side bend your neck your teeth should hit on the right side and vice versa. If this does not happen your upper cervical area needs treatment from a physiotherapist

THIS IS IMPORTANT. If your bite is “off” have your neck treated as well as a postural assessment /alignment before your  teeth are filed down to align a bite)

The RIPPLE effect:  Over the years the body tries to adapt to mal alignment of tissues which of eventually shows up as chronic pain and poor posture. IE: The muscles and jaw joints, torque and strain themselves causing other distant parts of the body (cervical, shoulders, pelvis-sacrum and ilium, leg length and foot posture) to mal-align and malfunction.

2. Manual therapy to cranium, upper cervical ,TM Joints

3. Recently I have developed a new technique using the principles of leg length /pelvic and spinal alignment to help teeth align which seems to stop the ripple effect. This is still work in progress.

Notes from Patient:

Before I had treatment from Cathy, my posture was not very good and trying to correct it was always difficult because it actually hurt to be in a correct posture.  I have noticed recently, that my body feels improved because it is better in proper posture. My jaw, neck and spine are in alignment.  It is easier to move my head from side to side whereas before my neck would only go one way and it was always easier to sleep on side than the other.  No matter how much massage I went to for my jaw, the muscles still seemed inflamed and almost felt like they were always working.  Since having treatment, the upper and lower jaw muscles feel less stressed.

There are many suggestions in the literature why fullness in the ear happens. According to Clayton Chan, a dentist from Los Angelos:

1. Fullness of the ears and subjective hearing loss can occur when there is dysfunction of the tensor veli palatini and medial pterygoid muscles. 

(Of note, patients with intermittent allergic edema of the eustachian tube reflexly initiate bruxism in order to open the orifices so that normal pressures on both sides of the ear drum are restored. However Nocturnal bruxism often persists throughout adult life from allergy, habit, or malfunction of the eustachian tubes.)

Dr. James F. Garry, DDS Perspective on Bruxism

Bruxism is a subconscious reaction to a malocclusion and/or Eustachian tube dysfunction. It is usually the result of hypertrophied lymphoid tissue blockage or partial blockage of the orifice of the Eustachian tube in children. When a child bruxes, the medial pterygoid muscle affects the function of the tensor veli palatini (TVPM) due to their approximation. Since the TVPM dilates the Eustachian tube, contraction opens the Eustachian tube equalizing middle and outer ear pressure. The TVPM descends vertically between the medial pterygoid plate and pterygoid muscle. The Eustachian tube is often partially obstructed by hypertrophied adenoid tissue and the TVPM cannot open the Eustachian tube adequately. Contraction of the medial pterygoid muscle in bruxism assists the TVPM in partially opening the Eustachian tube to equalize middle and outer ear pressure.

 Many dentists have noted that children stop bruxing within 3 months following an adenotonsillectomy!

To understand possible causes one must understand that everything is connected in the body therefore over the years can have a ripple effect, affecting other tissues to adapt.

THIS IS WHY MY PATIENTS HAVE SEEN MANY SPECIALISTS BEFORE THEY REACH ME! ENT / ALLERGISTS / OPTHALMOLOGIST/ had surgery for chronic sinusitis/ Health professional for aches and pains….look at trigeminal nerve branches.

If it is a “hard wiring” or nerve supply problem to this area it will likely be

Cranial Nerve V/ Trigeminal Nerve which has a sensory and motor portion.

1. Sensory: The sensory portion of the trigeminal supplies touch–pain–temperature to the face. The nerve has three divisions:

•           The Ophthalmic- The innervation includes the cornea and conjunctiva of the eye. Result could be Dry eyes!

•           Maxillary, and mandibular nerves supplying the mucosa of the sinuses, nasal and oral cavities; (This is why patients often are referred to the Ear Nose and Throat specialist;)  and dura of the middle, anterior, and part of the posterior cranial fossae.

Of note an “Anatomic relation between the rectus capitus posterior minor and the dura mater”, discovered a previously unknown ligament directly attaching the posterior arch of the atlas to the dura mater of the brainstem and cerebellum. This attachment has become known as the myodural bridge

Everything is connected and when things don’t make sense I look to the anatomy

2. Motor portion is the mandibular division which conveys proprioceptive impulses from the temporomandibular joint. These patients when I request they move their jaw left and right cannot do it, and often cannot feel if their teeth come together in certain neck positions.

(There is a connection between the teeth coming together and side bending the neck .See previous newsletter).

It is also the nerve supply to the muscles of mastication: masseter, temporal, pterygoids, mylohyoid, and digastric. These muscles produce elevation, depression, protrusion, retraction, and the side-to-side movements of the mandible. The motor division also supplies the tensor tympani and tensor palati muscles.

Therefore one possible explanation: The tensor veli palatini (TVP) and tensor tympani muscles can become painful from overuse of the clenching muscles: the temporalis, masseter and pterygoid muscles. As everything is connected the pain spread to other divisions of the same neural segment

When this tiny muscle goes into spasm, it closes off the Eustachian tube and produces symptoms that mimic middle-ear problems.

More in depth info:

During eating the TVP assists another muscle to elevate the palate to occlude and prevent entry of food going into the nasopharynx during swallowing. The tensed palate consequently provides a stable platform for elevation of the pharynx during swallowing by the pharyngeal muscles. Since it is also attached to the auditory tube, it assists in its opening during swallowing or yawning to allow air pressure to equalize between the tympanic cavity and the outside air. Equalization of air pressure in the tympanic cavity is essential for preventing damage to the tympanic membrane and a resulting loss of hearing acuity. We are familiar with candies being handed out during an air craft landing

The spasm of the lateral pterygoid can displace the disc medially towards the Eustachian tube and the muscle spasm or disc, partially block it.

I often wonder if there could be a percentage of seniors who lose their hearing acuity when they lose posterior teeth and have mandibular /maxilla bone mass changes.

My own Mum had terrible issues with her sinuses and hearing when she lost her posterior teeth on one side and did not have any dental implants or bridges

Home help: To relax the Lateral pterygoid “massage in the deep pocket back beyond your upper molars and cheek  with the index finger inside the mouth. This can be excruciatingly painful. “The fingertip should push both inward and upward using tiny short strokes.

The common cold is the most frequently occurring illness in the world, and it is a leading cause of doctor visits and missed days from school and work. It is estimated that individuals in the United States suffer 1 billion colds per year, with approximately 22 million days of school absences recorded annually.

“Dentist, along with most doctors, are taught to analyze body systems and body parts separately. We are taught to change one area at a time, but such approaches frequently ignore the interconnectedness of the systems in the human body. If it is accepted that normal cranial motion and structure are necessary for the optimal functioning of the individual

 

 

 

 

Comments are closed.