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Clinical Problem Solving
September 2014

Unilateral Ear and Temporomandibular Joint Discomfort

Author Affiliations
  • 1San Antonio Military Medical Center, San Antonio, Texas
  • 2Department of Otolaryngology–Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
  • 3Department of Otolaryngology–Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. 2014;140(9):873-874. doi:10.1001/jamaoto.2014.1472

A woman in her 30s presented with right-sided otalgia, otorrhea, decreased hearing, and worsening right temporomandibular joint (TMJ) pain. Her medical history was unremarkable. Physical examination revealed bilateral TMJ tenderness with crepitus on the right. Examination of the right ear revealed a polyp and granulation tissue in the anterior-superior external auditory canal (EAC) that was mobile with jaw movement and a normal-appearing tympanic membrane. An audiogram showed normal hearing. Computed tomographic (CT) imaging revealed dehiscence of the right glenoid fossa, erosion of the anterior EAC, TMJ, and middle cranial fossa (Figure, A). Magnetic resonance imaging (MRI) revealed a heterogeneous 8.5 × 7-mm mass based in the air cells at the root of zygoma, posterior to the right TMJ, with extension into the osseous external canal. The lesion displayed intermediate signal intensity on T1- and T2-weighting and enhanced with gadolinium administration (Figure, B). Positron emission tomographic (PET)-CT imaging ruled out distant metastases.

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