to the editor: Headache, sinus pain, and ear pain are common chief complaints in the primary care setting. In 17 years of working in a community urgent care practice, I routinely encountered patients who reported a history of recurrent ear infections, sinus infections, or migraine headaches; yet, the history and physical examination did not correspond with the chronic recurrent diagnoses they reported. In many cases, examination of the jaw revealed they were most likely experiencing temporomandibular disorder (TMD).
TMD affects as many as 10% to 15% of adults (peak ages 20 to 40 years) and presents with symptoms that include facial pain, ear discomfort, headache, and jaw pain.1 Physical examination findings include tenderness over the temporomandibular joint, restricted jaw movement, and crepitus or clicking with opening the mandible.1,2 TMD is often comorbid with primary headache disorders and is found to be a contributing cause of “sinus headaches” in otolaryngology practice.3,4
In my experience, most patients feel much better with short-term use of nonsteroidal anti-inflammatory drugs; symptoms typically resolve within about two weeks. Some patients also may need muscle relaxants, anxiolytics, or referral to an oral surgeon for an occlusive splint.1
Of particular concern, many patients I saw over the years in community urgent care reported repeated treatment with antibiotics for presumptive ear and sinus infections. Some were skeptical of the new diagnosis and thought they did not need to take antibiotics. During the past year, I have worked in a university student health center where I have seen several undergraduate and graduate students with chronic recurrent headaches that, at least in part, could be attributed to TMD.
Physicians should consider TMD in the differential diagnosis when a patient presents with headache, sinus pain, or ear pain and no other diagnosis that readily explains the symptom. Accurately diagnosing TMD can not only lead to more appropriate treatment to relieve the patient's pain but also reduce unnecessary antibiotic prescriptions.