Expert: Harriet B Jacobster, Au.D. - 1/30/2009

Question
QUESTION: Hi,
After two root canals in 11/08, I developed facial muscle spasms.  They have since resolved with soft diet and Flexeril but I developed heavy buzzing/hissing/ringing overnight beginning two weeks ago.  (I had very low ringing in the ears before onset that was not bothersome to me).  This has been escalated to constant popping/crackling/clicking (occasionally) when I swallow or yawn.  I had an MRI of the TMJ and it showed that meniscus and joint are in perfect condition.  My ears feel full, especially the left, and even slight touch of the facial skin would make me feel "something runny" inside my left ear.  

I had vestibular, hearing test, and MBR and they were all normal, except for loss of one frequency of hearing in one ear.  I am 24 years old.  
Should I go back to see my ENT?  Will this resolve with time? Could you recommend treatment?  I heard that steroid injections can treat the noises in 30 days with Prednisone.

I stopped taking the Flexeril after a week because I read that it causes ringing in the ears.  Is the bilateral clicking related to the joint (although they are normal in MRI)?
The ringing is constant and loud and impedes my sleep.  

Thank you.

ANSWER: Hi Linda,
Usually the symptoms you describe are associated with either a dysfunction of the Eustachian Tube or TMJ disorder.  Apparently it seems that these were ruled out.  The only other thing that I can think of is the symptoms are being caused by a muscle spasm in one of the middle ear muscles, or by a neuralgia, specifically geniculate neuralgia or glossopharyngeal neuralgia.  These will not show up on routine examinations.  You may try consulting a neurologist.  Another choice is to find an audiologist near you that specializes in tinnitus treatment.  Here is a website that can help: www.ata.org.  If the nerves or muscles are inflamed, steroids may reduce swelling, but that is a treatment option you should discuss with your physician.
Hope this helps.
Harriet B. Jacobster AuD
Board Certified in Audiology

---------- FOLLOW-UP ----------

QUESTION: Hi,
Thank you for your response.  These ear symptoms started only after my root canals.  I did go to an oral surgeon and he did say I had a muscular problem.  When I swallow, I do hear clicks in my ear and then I can feel a sharp shooting pain.  My MRI stated that I had hyperintense parotid glands which could be lymph nodes.  When I touch the inside of my ear, I can feel a vibration and crackling.  It feels muffled/full.  I went to my GP today and he could not find any ear symptoms.

The ringing I'v ehad before but not audible or bothersome at all.  Then when when I had facial muscle spasms, it was so loud and occured overnight.  When I chew, I could also hear popping (not sure if from joints or ears).

Do the muscle spasms in the ear resolve by themselves over time?  What tests should be ran to diagnose the ear muscle spasms?

I'm confused as to whether these are real ear symptoms or just referred pain from muscular TMJ.  

I heard about the intratympanic steroid injection that could eliminate tinnitus within onset of 30 days, does this work?

Thank you.

Answer
Dear Linda,
The spasms may or may not resolve over time.  It all depends on their cause.  A neurologist would know which tests to run to determine if it is indeed a neuralgia.  As to whether they are real or referred, again, you would need to consult a neurologist to find this out. Many times, diagnoses is based upon history of symptoms and response to therapy.  As for the steroid injection, that is something you should discuss with your ENT.  Research has shown that IT treatment with steroids have helped reduce tinnitus but will not eliminate it.  Again, this is a treatment option best discussed with your ENT.
Hope this helps.
Harriet Jacobster, AuD
Board Certified in Audiology