Ringing in left ear and pressure traducida,noise cancelling ear damage,ringing in ears pituitary tumor vision - Plans Download

26.09.2014
Ear infection occurs mostly in summer months when people indulge in water related activities. The purpose of this case report is to describe the chiropractic and dental comanagement of a patient with temporomandibular dysfunction, headaches, and myalgia. A 38-year-old black female patient presented for chiropractic care with a chief concern of jaw pain, tinnitus, headaches, and neck and shoulder soreness of 8 months’ duration. The patient demonstrated increased mouth opening, decreased pain rating, improved Kinnie-Funt visual index, and an increased cervical lateral flexion range of motion after 3 weeks of a combination of chiropractic and dental care. A patient with TMD may have multiple conditions that may be related and managed separately. At present, there are few reports of collaborative approaches between dentists and doctors of chiropractic for the comanagement of TMD.
A 38-year-old black female patient presented for chiropractic treatment with a chief concern of TMD, headaches, and neck and shoulder pain with a duration of 8 months. The patient had a history of a head-on collision 16 years prior in which she hit her face on the steering wheel. History revealed that her jaw pain was on the left side with clicking and popping with jaw range of motion. The patient filled out the Kinnie-Funt Chief Complaint Visual Index for Head, Neck, and Facial Pain and TMJ Dysfunction to list and prioritize her complaints (Fig 1).
This patient was evaluated initially with the joint vibration analysis (Biopak from Bio-Research Associates, Inc, Brown Deer, WI).
Chiropractic treatment included spinal manipulative therapy of the pelvis and the cervical and thoracic spine with Activator technique according to Activator protocol. Dental comanagement consisted of an initial, temporary anterior repositioning splint made out of heated beads directly molded in the patient’s mouth. Outcomes measured included the Kinnie-Funt chief complaint visual index initially and then the follow-up Kinnie-Funt, numeric pain rating, MMO, and cervical range of motion.
Research has shown central sensitization in some patients with TMD.8,23 This may explain the resolution of the patient’s numerous complaints in the head and neck region in addition to the TMD.
One of the limitations of this case report is that we did not complete a long-term follow-up.
This case report described how collaboration between a dentist and a doctor of chiropractic may help to provide quick resolution for patients with TMD, headaches, and myalgia.
This case report is submitted as partial fulfillment of the requirements for the Master of Science in Advanced Clinical Practice in the Lincoln College of Post-professional, Graduate, and Continuing Education at the National University of Health Sciences.
The most common causes are extreme cold conditions, excessive exposure to water through activities like swimming, scuba diving etc.
In the case of infants, during bottle feeding sometimes allows fluid to collect in the throat near the Eustachian tube which connects the ear and the throat. When children are forced to drink milk it can enter the middle and external ear canal and cause inflammation. When children suffer from sinusitis, cold or cough the infection travels to the ear as the microorganisms multiply and spread across the inner ear. Avoid exposure to cold and chill conditions such as rain and sudden change in temperature etc. Consume liberal amounts of ginger, garlic and onion both internally and externally to get relief from ear ache. Chiropractic care consisted of Activator treatment to the pelvis and the thoracic and cervical spine. Therefore, the purpose of this study is to describe the collaborative treatment of a patient with TMD, headaches, and myalgia. The results showed the mandible deflecting 8 mm to the left at the maximal mouth opening (MMO) of 42 mm.


Impressions were then taken to make a custom-made splint that is inserted on the mandible and a maxillary splint for nighttime both used for mandibular advancement. At 1 week after treatment, the patient reported less of all her symptoms except bruxism on the follow-up Kinnie-Funt (Fig 4). The patient in this study responded well to the combined short course of care (6 treatments in 3 weeks) for TMD, headaches, and myalgia. The tensor veli palatini and tensor tympani muscles are innervated by the medial pterygoid nerve, a branch of the mandibular nerve, which is a branch of the trigeminal nerve.5 This may be the connection showing why the patient’s tinnitus resolved with treatment and why many patients with TMD also complain of otic symptomology.
Checking the patient’s Kinnie-Funt visual index at 6 months and 1 year after the end of treatment would have given more data on the long-term effects.
With 25% of the population having some form of TMD and taking into account the neurological and biomechanical connection to the cervical spine, dentists and chiropractors have the potential to help patients improve symptoms through comanagement.
A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol.
Sleep bruxism increases the risk for painful temporomandibular disorders, depression, and non-specific physical symptoms.
Effect of treatment of temporomandibular disorders in patients with cervicogenic headache: a single-blind, randomized controlled study. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department.
Wavelet transforms of TM joint vibrations: a feature extraction tool for detecting reducing displaced disks. Characteristics of temporomandibular joint vibrations in anterior disk displacement with reduction in adults. The effect of cervical spine manual therapy on normal mouth opening in asymptomatic subjects.
The dental-chiropractic cotreatment of structural disorders of the jaw and temporomandibular joint dysfunction. A manual therapy and exercise approach to meralgia paresthetica in pregnancy: a case report. Use of post-isometric relaxation in the chiropractic management of a 55-year-old man with cervical radiculopathy. Intra-oral myofascial therapy for chronic myogenous temporomandibular disorders: a randomized, controlled pilot study. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial.
Orthodontic treatment for the temporomandibular joint patient following splint therapy to stabilize a displaced disk(s): a systemized approach. Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders.
Referred pain from muscle trigger points in the masticatory and neck-shoulder musculature in women with temporomandibular disorders. The patient had a maximum mouth opening of 42 mm, graphed evidence of disk displacement, loss of translation on opening of the right temporomandibular joint viewed on the lateral radiograph, and numerous areas of point tenderness on the Kinnie-Funt Chief Complaint Visual Index.
Manual manipulation of the temporomandibular joint was performed along with a soft tissue technique intraorally on the lateral pterygoid.
Continued measurement of the MMO was performed with the TheraBite ruler (Atos Medical, Horby, Sweden).
This was done by placing the thumb on the left lower molars intraorally and the index finger hooking on to the inferior aspect of the mandible on that side. Anterior repositioning splints have been shown in the research to be good at reducing not only joint pain but also joint sounds in patients with TMD.21 Anterior repositioning splints are used to stretch the muscles, recapture the disk, and unload the joint.


This patient had multiple tender muscles and trigger points in her head, neck, and face with local and referred pain patterns.
Not only is holistically treating the stomatognathic system important, but it is important to address the associated complaints in the head and neck region to desensitize the nervous system by facilitating inhibitory pathways such as the descending inhibitory pathway after stimulation of areas such as the periaqueductal gray area through the propriospinal tract. There also were several methods and targeted tissues in the manual therapy, including adjustments, postisometric relaxation, and other myofascial release techniques. Prior to her visit, the patient was diagnosed with TMD by an otorhinolaryngologist who also gave a preliminary diagnosis of fibromyalgia and therefore referred her to a dentist. This method has been used in the research to measure MMO.12 There were vibration and increased friction found on the left side showing a small-amplitude vibration indicative of a posterior disk derangement that reduces. Then the wrist was ulnar deviated to distract the joint; and while in distraction, the mandible was moved in such a manner that the mandibular condyle moved medial and lateral attempting to recapture the disk. Splints can be used in phase I treatment, which is a reversible procedure before more permanent treatment is done. After 3 weeks and the conclusion of chiropractic treatment, the patient reported no longer having any of her symptoms on the follow-up Kinnie-Funt (Fig 4) except for bruxism.
A study showed that the local and referred pain elicited from active trigger points in these regions shared similar pain patterns as spontaneous TMD, which supports the concept of peripheral and central sensitization mechanisms in myofascial TMD.24 This sensitization may be why the patient had so many tender points and why the otorhinolaryngologist gave a preliminary suggestion of fibromyalgia. This makes it difficult to determine what was the effective treatment or if it was necessary to perform a combination of all therapies. Furthermore, postisometric relaxation was performed on the trapezius, suboccipital, and masseter muscles. Phase I treatment could also include other treatments such as trigger point injections, myofascial release, medications such as muscle relaxers, electric stimulation, or meditation. Posttreatment diagnostics would have been beneficial to see the increase in translation of the TMJ, and a follow-up joint vibrational analysis could have shown a reduction or absence in the vibration on the left.
Lateral radiographs of the TMJ were done bilaterally to show the translation of the joints (Fig 3). This technique is commonly used and has been shown to be effective in other case reports.17,18 Myofascial release was performed on the lateral pterygoid by having the patient open slightly and sliding the index finger along the gingiva to the lateral pterygoid and then having the patient turn her head away from the side of contact. There are different causes of TMD including but not limited to disk derangement, osteoarthritis, and myofascial pain sources. The right TMJ had less translation as compared with the left correlating with palpation of the TMJ, which showed a reduction in motion on the right.
The opposite hand was then placed flat on the temporal bone, and light compressions were done; as the lateral index slid back, the lateral pterygoid relaxed. The patient followed up for final evaluation at 6 weeks after her initial visit for delivery of her permanent splint and reported no recurrence of TMD, headaches, and myalgia. As this is just one case report, the effects of the comanagement should not be generalized to other patients with TMD. Muscles in the head, neck, and facial region were found to have moderate to severe tenderness including the temporalis, masseter, medial and lateral pterygoids, buccinator, lateral TMJ capsule, posterior TMJ space, trapezius, sternocleidomastoid, splenius capitus, and suboccipitals. A study using a similar technique for a pterygoid release intraorally found improvement in MMO and in jaw pain at rest and upon opening in patients with TMD.19,20 This treatment was performed twice a week for 3 weeks for a total of 6 visits.
Cervical range of motion was found to be reduced during active range of motion with right lateral flexion at 25 and left lateral flexion at 35.
Further research and other case studies should be done with a specific category of TMD, like an articular disk displacement, and fewer manual therapies with the dental splint to isolate the better method.



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