Response furnished by Robert M. Mason, DMD, CCC/SLP, ASHA Fellow I am treating a 23 yr old who exhibits the typical characteristics of an anterior tongue thrust with TMD issues. She also complains of her ‘ears popping upon swallowing’. This is the first case of ‘ear popping’ I have come across in my practice, therefore I went to the library to research this. Nothing. Could you explain the mechanics to me? Are the TM Joints pressing against her Eustachian tube? She has stated that the ear popping is decreasing as she moves through the program. However, if this comes up again I’d like to be able to explain it – thus – really understand it myself. Thanks in advance!
As to your question, the patient report of popping of ears during swallowing indicates negative pressure in the middle ear. As a result, there is popping when the muscles around the Eustachian tubes contract during the swallowing (specifically the salpingopharyngeus and the levator veli palatini). The TM joints are not pressing against the Eustachian tubes. That would be impossible, but I’m glad you asked the question. The reason why your patient reports that she is doing better with a reduction of ear popping in therapy is that during swallows, especially those which are exaggerated during therapy, the Eustachian tubes are being milked open and closed, and this helps to aerate the middle ear cavity. Your patient should be seen by an ENT specialist to evaluate this situation. In your referral, you can state that the patient complains of ear popping which indicates to you that there may be some dysfunction of the Eustachian tubes that may have created some negative pressure in the middle ears. FYI, an antibiotic may clear up the problem, although ear wax or some problem in the middle ear (crud) could be involved. You report that your patient has some TMJ issues. I have completed a memo that is long and detailed, but this is necessary since the implications of treating patients with TMDs are many. As you will see, the memo includes a tutorial about several concepts related to the TMJs and remind SLPs that ASHA forbids SLPs to work with such problems. I try to save our course participants from any legal actions against them, and I feel that this document should be read carefully and remembered. https://orofacialmyology.com/wp-content/uploads/2017/10/orofacial-myology-policy_toward_tmd.pdf