The cause of referred otalgia is usually attributed to temporomandibular pain if the patient shows signs of temporomandibular disease.1,2 A recent study suggests that sleep posture plays a significant role in the etiology of temporomandibular disease.3 Sleeping on one side for several hours can have a traumatic impact on the temporomandibular joint, particularly if the pillow is high. In those cases in which sleep posture is the cause of temporomandibular disease, the commonly accepted explanation for earache may not necessarily be true. Because the outer ear protrudes from the head, it could be traumatized alone or in tandem with the temporomandibular joint. Consequently, earache could either be a coincidental event or be the precursor for temporomandibular pain.
Zenian J. Pillow Otalgia. Arch Otolaryngol Head Neck Surg. 2001;127(10):1288. doi: