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Treated for vascular headache. Cranial doppler showed suboptimal blood flow in ear. TMJ disorder?

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ENT Specialist
Practicing since : 1991
Answered : 2538 Questions
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Dear Doctor,
I want to know whether a TMJ is a dreadful disease?
I initially went to t ENT specialst for sinus infection and then treated for vascular headache.
My symptoms i had are as follows:
1. Vague dizziness
2. Imbalance problems
3. Irritability
4. Inability to concentrate
5. When i lie on one side, i get pain in my eye and areas near ears.
6. When i lift weight also , i get the same pain as above
My ENT specialst ordered the following tests:
1. MRI brain
2. MRA & Venogram of Brain
3. Trans cranial doppler scan
4. Thyroid test
5. Complete blood test (HBA1c. lipid profile, sugar, Liver and kidney)
6. VEMP test
7. BSER test
8. BP
All the reports came normal.
However, the Trans cranial doppler showed that i have suboptimal blood flow in my left side ear. The ENT specialist initially treated me forvestibular problem, however after i told symptoms like pain in my ear and eye, he suspected that it should be a TMJ disoder.

i went through net and found that there are symptoms which are simlar

1. A clicking sound in my left side jaw when i open my mouth, though there is no pain.
2. Grinding of my teeth often

I have a medical history of Health anxiety for which i took Nexito for 1.5 years and my doctor stopped the treatment
Currently my ENT specialists stopped medicines for Migraine and vestibular problmes and he has asked to take OPG xray to see the extent of TMJ.
HE asked me to take vertin 8 mg if i develop dizziness and a nasal spray for sinus.
Hence kindly advise on the following:
1. Whether TMJ is a dreadful disease?
2. WHether my imbalance and vague dizziness are due that ?
I am really worried and it has impacted my social life.
Please help

Posted Thu, 14 Feb 2013 in TMJ
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your query.

1. TMD (Temporo Mandibular Joint Disorder) is not a dreadful disease. Since most of your investigations are normal, it has to be a mild form of TMJ problems.

2. Vague dizziness and imbalance is a known symptoms of TMD syndrome.

3. The clicking sound from the left TMJ is also known as Costen's Syndrome. The sound is caused by the articular disc of the joint moving forwards with respect to the glenoid fossa or condyle of the mandible. There is no pain as this is a mild movement. the central part of the articular disc has no sensation. Hence there is no pain.

4. Frequent grinding of the teeth is known as Bruxism. This may be stress or habit related. Bruxism worsens TMD.

5. The TMJ is a complex joint with no support. the two sides rotate the mouth open and close, the jaw can move forward and backward and side to side as in chewing. This delicate balance between the two TMJ's can be disturbed by joint problems or dentition or 'bite' problems.

6. Treatment is based on identifying the exact cause. Your OPG will demonstrate the health of the joints. The jaw may be relaxed by getting a silicone splint or dental tray initially to be used in the night. This also prevents Bruxism.

7. Sinus problems should ideally be ruled out on a CT Scan of the Para Nasal Sinuses (PNS Scan), however the MRI should suffice. Get a review of your MRI for sinus related issues or upload the images here (not the report).

8. You may continue to take Vertin 8 mg for the time being if it is reducing your dizziness and imbalance. This is because you have a trans cranial doppler study showing blood supply problems to your left ear.

9. Discuss this with your doctors and also that other common conditions to be ruled out in addition are Trigeminal Neuralgia and Temporal Arteritis.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Treated for vascular headache. Cranial doppler showed suboptimal blood flow in ear. TMJ disorder? 53 minutes later
Thanks doctor

I already took a ct pns and I have been diagnose with sinus

I just want to know if there is a CT scan available to diagnose tmj disorder

If available.then what specification should I tell to my scan technician and what are the areas to scan?

Do I need to take a ct temporal bone to rule out problems with my inner ear?

If you prescribe me the appropriate scans.i can get it done and scan it to you the results
 
 
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for writing back.

1. You may combine an HRCT (High Resolution CT) of the Tremporal Bones and the TMJ. Along with the MRI, this will help in evaluating the structure of the TMJs.

2. For functional problems with the TMJ you may insist on a few images with the jaw held open and rely also on direct examination by a specialist. The OPG will also help. A Dental examination and opinion is required.

3. CT and MRI are complementary imaging techniques and should be done together for a complete understanding of the bone and soft tissue.

4. You may share your CT PNS, HRCT Temporal Bones & TMJ along with your MRI images for further treatment options.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Treated for vascular headache. Cranial doppler showed suboptimal blood flow in ear. TMJ disorder? 17 hours later
Dear doctor.

I have done the tests prescribed by you and
The results of the same are as below,

CT TEMPORAL BONE

No significant abnormality in temporal bones

SCREENING OF PNS

1. DNS to right 2. Bilateral inferior turbinate hypertrophy 3. Paradoxical curvature of both middle turbinate 4. Mucosal thickening of both maxillary sinus with right OMC block

SCREENING OF TMJ

Subchondral erosions in mandibular articular surface of left TM joint wit. Maintained joint space

I checked with dentist and they conducted opg xray and they told me that I have a mild erosion which is just only a wear and tear of my joints.

I am yet to get the mri reports and once when it comes I will scan and send it to you


Kindly advise
 
 
Answered by Dr. Sumit Bhatti 15 minutes later
Hi,

Thank you for writing back.

1. It is good to hear that your CT Temporal bones is within normal limits. This means that the dizziness and imbalance is probably due to the TMD.

2.The CT PNS findings are very common. If the mucosal thickening in the maxillary sinuses is mild,medication will suffice. Radio-frequency ablation of the inferior turbinates and Balloon Sinuplasty are option to Septoplasty and Sinus Surgery.

3. The TMJ Screening shows mild stage one degeneration. The measures outlined above will help prevent further damage. Since the age of onset is early, ask your physician to screen the blood and other joints for any arthritis.

4. Awaiting your MRI report.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Treated for vascular headache. Cranial doppler showed suboptimal blood flow in ear. TMJ disorder? 1 hour later
Thank you doctor

My ent specialist has prescribed me the following

For sinus

She hah prescribed me fluticone nasal spray along with deslor 5mg

For my giddiness and imbalance.since my CT temporal bone and other vestibular tests came normal. She suggested that I am in the beginning stage of migraine and she prescribed sibilieum 5 mg at night
:
For tmj. I have consulted a dentist today and she has suggested to keep splint to avoid grinding of teeth

And if pain is there. She has asked me to take pain killer and a topical gel

Kindly advise if I am on the right medication
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for writing back.

1.Your current medication is good.

2. I recommend that you discuss with your ENT Specialist to add an anti-leukotriene such as montelukast.

3. Migraine is a possibility but as mentioned above, Trigeminal Neuralgia, Temporal Arteritis and the various types of Arthritis.

4. Initially the dental splint is given for wearing at night. If it is still not effective a daytime prosthesis is also used.

5. Costen's syndrome (TMD) is also treated with a short course of steroids in addition to painkillers and local pain relieving gels. Get an anxiolytic prescribed, if stress is high.

6. Diet modification is suggested and avoid chewing only on one side. Have you ever had any orthodontic work (dental wires or braces) done in the past?

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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