I was recently performing an evaluation on a 27-year old male s/p car accident. He presented with classic whiplash signs and symptoms- neck pain, tenderness to palpation and hypomobility of the upper cervical spine, cervical joint restrictions, and high fear avoidance to movement. Additionally, he was having near constant headaches with reports of tinnitus and earaches. In this post I want to cover how and why ear symptoms can be related to both upper cervical and TMJ Dysfunction
Cervical nerves 1-3 and cranial nerves V, VII, IX, X, and XI all meet at the trigeminocervical nucleus. These nerves are in very close proximity to one another. When dysfunction occurs in one of the nerves, the other nerves can receive abnormal inputs as well. The TMJ is innervated by the mandibular division of the Trigeminal Nerve (cranial nerve V) and is therefore at risk. The mandibular division further branches into the deep temporal nerve, masseteric, and auriculotemporal nerves. Since the auriculotemporal nerve is responsible for innervating the tempanic membrance and the external auditory meatus, dysfunction of the TMJ can cause ear symptoms. On the same note, the upper cervical nerves exit around the suboccipital triangle, giving the possibility of a cervical patient to have ear symptoms.
In my car accident patient described above, I have been focusing heavily on patient education, proper body mechanics, relaxation techniques, and upper cervical joint mobility. By improving upper cervical mobility, the upper cervical nerves can be taken off tension. Therefore the trigeminocervical nucleus will stop receiving poor inputs and indirectly stop affecting the auriculotemporal nerve.
Within 3 visits, he continues to have headaches, but his ear symptoms have subsided!