Differential Diagnosis for Intermittent Pain with Chewing and Tension around the Ear
Single Most Likely Diagnosis
- Temporomandibular Joint (TMJ) Disorder: Given the patient's history of TMJ and symptoms of intermittent pain with chewing along with tension around the front of her ear, this diagnosis is the most likely. TMJ disorders are known to cause pain in the jaw, face, and around the ears, especially during activities like chewing.
Other Likely Diagnoses
- Myofascial Pain Syndrome: This condition involves pain and inflammation in the muscles that control jaw function, which could explain the pain and tension experienced by the patient. It's often associated with TMJ disorders.
- Dental Problems (e.g., Tooth Abscess, Cracked Tooth): Dental issues can cause pain that radiates to the ear and jaw area, especially during chewing. Given the proximity of the teeth to the TMJ and the ear, dental problems should be considered.
- Ear Infection or Otalgia: Although the primary complaint is related to chewing, ear infections can cause referred pain to the jaw and face area. The patient's history of tension around the front of her ear suggests this possibility.
Do Not Miss Diagnoses
- Trigeminal Neuralgia: A condition characterized by intense pain in the face, typically on one side, which can be triggered by activities like chewing. Although less common, missing this diagnosis could lead to significant morbidity due to the severe pain it causes.
- Giant Cell Arteritis: An inflammatory condition affecting the blood vessels, which can cause jaw claudication (pain in the jaw when chewing) among other symptoms. It's crucial to consider this in older adults due to its potential to lead to blindness if not treated promptly.
Rare Diagnoses
- Ramsay Hunt Syndrome: A condition caused by the varicella-zoster virus, leading to facial paralysis and ear pain. While it's less likely, the combination of ear tension and potential facial involvement warrants its consideration.
- Osteonecrosis of the Jaw: A rare condition characterized by the death of jawbone tissue, often associated with bisphosphonate use or radiation therapy. It could cause pain in the jaw that might be exacerbated by chewing.