I. A syndrome of Ear and Sinus Symptoms Dependent upon Disturbed function of the Temporomandibular Joint

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Abstract
Headache and ear symptoms directly dependent upon disturbed function of the mandibular joint frequently occur in cases showing sufficient pathology about the sinuses to otherwise account for them. There are so many medical, rhinologic and ophthalmologic reasons for headache distributed about the ears, vertex and occiput; and there are so many nasal changes to account for eustachian tube obstruction, that evulsion of the condyle of the mandible from overbite is not considered. Hearing tests show a mild type of catarrhal otitis with eustachian tube involvement, usually simple obstruction. This is due to pressure on its anterior membranous wall, transmitted through soft tissue from the relaxation of pterygoid muscles and associated sphenomandibular ligaments during overbite. The promptness with which the ears improve seems to controvert the idea that the ear condition is due to trauma or concussion of the labyrinth or tympanic structures from the condyle of the mandible. Cases of shock to the labyrinth from a blow on the chin are not within the scope of this paper. Attacks of dizziness in these cases are obviously due to changes in intratympanic pressure affecting the labyrinth. The effect is transient and recurrent, relieved by inflation of the eustachian tube, and not the picture seen in toxic labyrinthitis. The areas involved in the headache cases are typical of headache of posterior sinus origin and are easily taken for such. Persistence of the headache after indicated sinus surgery is sometimes due to mandibular joint pathology. The symptoms arise as a result of overaction of the joint at first, and later adds the regional effect of a loose, pathologic joint, produced by absorption of the meniscus, condyles and surrounding bone. The prognosis in a given case depends on these factors: (a) the accuracy with which refitted dentures relieve abnormal pressure on the joint; (b) the extent of injury to the tube and to the condyle, the meniscus, and the joint capsule. The mechanics of occlusion and dental problems are not included here. Only sufficient reference to the anatomy of the mandible and joint is made to clarify the ear or sinus diagnosis. Anatomic reasons are advanced to account for abnormal conditions of the eustachian tube, and for the distribution of pain toward the vertex, occiput, pharynx and tongue. It is barely possible that mandibular joint pathology may be an etiologic factor in glossopharyngeal neuralgia, the association of chorda tympani and auriculotemporal nerves with the ninth occurring via sensory connections to the otic ganglion.

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