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Jaw pain, ear noise may be neuralgia

When I was 8, I had a bicycle wreck, where I landed on my front teeth on a concrete curb. Both front teeth chipped, in addition to the bloody knees and elbows.

Over about three months, my eyes hurt to look any direction but straight ahead. My left ear roared with sounds like ringing, roaring and knocking. My left jaw became touchy and a shooting shock-like pain would go through my lower jaw and teeth. The front teeth were finally able to be fixed when I was in my mid-30s.

The jaw pain I mistook for toothaches, until I have no longer any teeth at all on my lower mouth. Still the shock-type shooting pain persists and I am now in my mid-50s. I have seen my doctor a number of times, four dentists, a neurologist and an ENT.

It extends to my ear also, so that I cannot put any pressure on it, such as a hat, a pillow to sleep, or a washcloth to wash my face. It seems the older I get, the louder the ear noises get.

The nerves that supply sensation and other functions to the face originate in the brainstem and are called cranial nerves (12 in total). The fifth cranial nerve is called the trigeminal nerve, and it supplies sensation to the face through three major divisions, with the third division supplying sensation and muscle movement instructions to the mandible or lower jaw. The seventh cranial nerve is called the facial nerve, and it provides signals for muscle movements to the rest of the face, as well as “sound dampening” muscles in the middle ear. The eighth cranial nerve (the vestibulocochlear nerve) supplies the connection between the hearing and balance centers of the inner ear and brain.

Although trying to pin down how you feel to an event that happened in 1967 is difficult, it sounds like your symptoms of jaw pain and tinnitus (ringing or buzzing in the ear) started when you had that accident. It could be that you had a concussion of the inner ear causing tinnitus, and separately you may have developed a condition called “trigeminal neuralgia” that is causing your lower jaw pain. I’ve known several patients who have had many dental procedures for jaw pain that was thought due to dental problems, when the real problem was that the pain was originating in the trigeminal nerve and not the teeth.

A less likely cause, and this would have been evaluated using an MRI, is that some sort of mass or enlargement of a blood vessel at the base of the brain was pressing on one or more of these cranial nerves at the same time. The reason I say that a mass is unlikely is the duration of your symptoms – masses are expected to enlarge over time, certainly over 50 years, and should cause more progressive symptoms than you have experienced. Ask your primary care doctor or neurologist about the results of your previous testing, and ask if trigeminal neuralgia may be the cause of your pain. There are medications that may help.

Dr. Adam Will practices internal medicine and pediatrics with Parkview Physicians Group. “Ask the Doctor” is a health column by doctors from Parkview Physicians Group. Send questions to Terri Richardson at The Journal Gazette, 600 W. Main St., Fort Wayne, IN 46802, or email trich@jg.net. Please put “Ask the Doctor” for the subject line.

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