I’ve an issue with ache in my ear once I chew or grind my tooth. However is that this a tooth drawback?
John Grint MBE, Stoke-on-Trent.
Ache on consuming can’t be a lot enjoyable and it’s vital to get to the basis of the problem.
The signs you describe are attribute of temporomandibular dysfunction. The temporomandibular joint connects the decrease jaw bone with the higher jaw and the remainder of the top — it acts like a hinge, angling up and down. The joint also can slide forwards, permitting the mouth to open wider.
It’s managed by the masseter and pterygoid muscle mass, and the nerves that management these muscle mass are additionally linked to the muscle mass of the center ear.
This hyperlink signifies that when the joint dysfunctions, it may be felt as earache. Some sufferers may expertise tinnitus (a ringing noise within the ears), restricted skill to maneuver the jaw, and clicking or locking within the joint.
The temporomandibular joint connects the decrease jaw bone with the higher jaw and the remainder of the top — it acts like a hinge, angling up and down
Sometimes it’s attributable to clenching the jaw or grinding the tooth at night time (often known as bruxism), so the secret is to cease that taking place. The primary therapy is to put on a chew guard, which might resolve the issue in a variety of weeks.
This analysis could be finest confirmed by your dentist, who may refer you to a maxillofacial advisor.
It’s possible you’ll be given just a few weeks of treatment to assist with the ache and scale back irritation — probably a day by day non-steroidal anti-inflammatory (e.g. naproxen). Hopefully this brings some aid.
I’ve been identified with polymyalgia. What precisely is it, are steroids the one possibility, and can it ever go away?
Mairwen Jewitt, Wolverhampton.
A typical however distressing inflammatory situation, polymyalgia rheumatica (PMR) largely impacts these of their 70s or older — it is rather uncommon in these beneath 50 — and two to a few occasions as many ladies as males.
The primary signs, as you’re solely too conscious, are ache and stiffness within the muscle mass across the shoulders, neck, hips and pelvis. Sometimes, that is worst very first thing within the morning and after a interval of inactivity.
These aches and different signs, comparable to a normal feeling of not being effectively (malaise), fatigue, weight reduction and delicate fever, are as a result of immune system misfiring and attacking the physique’s tissues.
The causes aren’t identified, however genes might improve your susceptibility, as might publicity to viruses and different environmental triggers.
There’s no particular PMR check — analysis relies on signs, medical historical past and blood assessments to verify irritation ranges.
The primary signs, as you’re solely too conscious, are ache and stiffness within the muscle mass across the shoulders, neck, hips and pelvis
Glucocorticoids (steroids) comprise cortisone, which eases signs by dampening the immune response and decreasing irritation. I want to reassure you that that is essentially the most applicable therapy.
Sufferers often begin on 15 mg of prednisolone a day. This dose might be lowered each one to 2 months as signs enhance.
Corticosteroids are invaluable remedies however they’ll have widespread undesirable results comparable to osteoporosis, sort 2 diabetes, hypertension, glaucoma and cataracts. These happen as a result of steroids can have an effect on the intestine (and nutrient absorption) and trigger weight achieve. The hypertension and eye situations could also be associated to fluid retention. That is why nice efforts are made to maintain the dose as minimal as attainable.
Whereas I perceive your reluctance to take steroids long-term, the alternate options actually aren’t passable. Ibuprofen and different non-steroidal anti-inflammatory medication (NSAIDs) generally used to alleviate ache and swelling are ineffective right here, and physiotherapy is of no worth initially — the ache and stiffness are too extreme.
Different immunosuppressants, comparable to methotrexate and tocilizumab, are extra poisonous, much less effectively researched for PMR, and should not really helpful as stand-alone remedies nowadays.
Tapering the steroid dose helps guarantee you’re stored on the bottom attainable dose to suppress your signs and scale back the long-term danger of side-effects.
Your observe nurse will see you usually to observe you and perform blood assessments, to regulate your prescription as essential. (Sufferers are sometimes suggested to take day by day calcium and vitamin D tablets to assist shield in opposition to osteoporosis.)
The excellent news is that PMR often responds quickly to therapy, with sufferers experiencing a considerable enchancment of their signs inside days. What’s extra, the situation usually burns itself out inside one or two years, after which the steroids might be stopped — though relapses can happen.
A be aware of warning for all sufferers with PMR: an intensely painful headache, scalp and jaw ache and sight issues might be indicators of a extra severe type of the situation, referred to as large cell arteritis (GCA), which might harm sight if not handled instantly with greater doses of the steroid.
So search medical assist urgently should you expertise unexplained signs comparable to these.
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