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Practice 10-Minute Consultation

Eustachian tube dysfunction in adults

BMJ 2014; 348 doi: (Published 11 March 2014) Cite this as: BMJ 2014;348:g1647

Rapid Response:

Re: Eustachian tube dysfunction in adults

The recently published 10 minute consultation on Eustachian tube dysfunction1 gave a good overview of the condition but missed a common differential diagnosis of a feeling of fullness in the ears: Temporomandibular joint dysfunction (TMJD).

Although unilateral facial pain is the most common symptom, TMJD can often present with single sided or bilateral aural fullness without significant hearing loss. A population study in Finland demonstrated that between 5% and 9% of patients with TMJD complained of aural fullness. Additional symptoms included tinnitus (12-17%) and otalgia (12-16%). These symptoms can also occur in Eustachian tube dysfunction2.

TMJD can affect the temporomandibular joints, muscles of mastication, and associated structures. Causes affecting the intra-articular biomechanics can be either congenital, or acquired, with trauma, muscular disorders, and degenerative joint disorders among the most common. The prevalence of TMJD is highest in middle-aged adults and is more common in females by at least 3:1. Up to a third of the general population complain of at least one symptom of TMJD, but of those, only 5-10% will require treatment and up to 40% resolve spontaneously. Reassurance, rest, heat therapy and non-steroidal anti-inflammatory medications form the mainstay of treatment, and intraoral jaw appliances can be used to alter joint mechanics if conservative measures fail. Surgical treatment is only considered if there is substantial pain and interference with activities of daily living3.

Comparison of audiometry and tympanometry between patients with TMJD and controls has shown no significant difference4, indicating that the symptoms of TMJD are not related to any concomitant Eustachian tube dysfunction.

1. Sproat R, Burgess C, Lancaster T, Martinez-Devesa P. Eustachian tube dysfunction in adults. BMJ 2014;348: 36-37
2. Kuttila S, Kuttila M, Le Bell Y, Alanen P, Jouko S. Aural symptoms and signs of temporomandibular disorder in association with treatment need and visits to a physician. Laryngoscope 1999;109 (10) 1669- 1673
3. Scrivani S, Keith D, Kaban L. Temporomandibular Disorders. N Engl J Med. 2008 Dec 18;359(25):2693-705
4. Toller M, Juniper R. Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J.Craniomaxillofac Surg 1993; 21(1); 2-8

Competing interests: No competing interests

20 May 2014
Alison Carter
Core Surgical Trainee
Theo Joseph, Consultant ENT Surgeon
Royal National Throat, Nose and Ear Hospital
330 Gray's Inn Road, London, WC1X 8DA