Trucker MD
Jaws jacked up? Nose won’t work?

By John McElligott, MD

Some conditions have unusual symptoms. Google might help you self-diagnose the problem, but eventually you’ll need a doctor to pinpoint the trouble and explore treatment options.

When I talk or eat, there’s a weird clicking and my face hurts a little. During the winter, it’s worse. When it’s really cold, I can’t even open my mouth very wide, so a Big Mac is out. I have frequent ear noise, like ringing and even some aching. What is happening here? Should I see a doctor or dentist?

Your symptoms in the face and noises in the ear are from what they call “TMJ disease.” Excuse the alphabet soup name, but the technical name is a mouthful (no pun intended).

The temporomandibular joint, or TMJ, is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. The joints are flexible and let the jaw easily move up and down and side to side.

It’s amazing all the things this joint can do. Think about it: talking, chewing, yawning, etc. Muscles attached to and surrounding the jaw joint control the position and movement of the jaw.

Temporomandibular disorders, or TMD, occur as a result of problems with the jaw, jaw joint and those surrounding facial muscles. These disorders are often incorrectly called TMJ but it’s really TMD. Those problems could be caused by an injury to the jaw, the joint, or muscles of the head and neck.

Have you suffered whiplash? Head injury? That could be the cause, or if you have a habit of grinding your teeth or clenching them, that could cause the problem. It could also be arthritis in the temporomandibular joint.

Because of the symptoms you describe, I advise you to see a TMJ dentist or an oral surgeon.

In the spring I had a really bad sinus infection. Since then, my sense of smell has been screwed up. Some food stinks, even though it’s fresh and cooked just the way my wife always fixes it. Sometimes I smell a bad odor, but there does not appear to be anything to cause it. What is up with this, and what can I do?

The sinus infection may be related and may be just coincidental.

I researched this with my friends at Medscape. My workup is somewhat different from the one these folks do. I start with a CT scan of the head with a special look at the sinuses. If this is absolutely normal, then I proceed with a referral to a specialist that can do all the exotic tests. If the CT scan is abnormal, then I proceed with an MRI of the brain.

Disorders of taste and smell generally have been difficult to diagnose and treat, often because of a lack of knowledge and understanding of these senses and their disease states. An alteration in taste or smell may be a secondary process in various disease states, or it may be the primary symptom.

In an article titled “Disorders of Taste and Smell,” Dr. Donald Leopold mentions a 1994 survey. It revealed that 2.7 million American adults have an olfactory (smell) problem, and 1.1 million report a gustatory (taste) problem. An earlier study found that 66 percent of people are aware of a period in their life in which they had decreased smell acuity. Although often discounted and overlooked in the basic examination, deficiencies in taste and smell can cause anxiety, depression and even nutritional deficiencies due to decreased enjoyment of food.

Loss of smell and/or taste may be life threatening, impairing the detection of smoke in a fire or the ability to identify spoiled food. For truckers, this is critical.

Let’s talk a little terminology. The disorders of smell are classified as “-osmias” and those of taste as “-geusias.” There are a number of these. Anosmia, for instance, is the inability to detect odors. Parosmia is when you perceive the odor differently than you used to, mostly unpleasant. You said you smell an odor when there’s nothing there? There’s a name for that and it’s phantosmia.

Have you had problems tasting? Anything different with your taste buds?

According to Medscape, the first step in diagnosing any deficit of taste and smell is obtaining a thorough history and physical examination. Your physician will give attention to previous nasal or sinus pathology, history of trauma, other medical problems and medications taken.

Your doctor will likely order sinus CT scans if the history and examination are not consistent with a common pattern. If that does not reveal a cause, many other tests are available to evaluate for allergy, diabetes mellitus, thyroid functions, renal and liver function, endocrine function, and nutritional deficiencies.

All this clinical testing can be time-consuming, but some commercially available tests out there can evaluate the extent of odor detection. There’s even one called Sniffin’ Sticks.

Anything you can do while you are waiting to see the doctor? Sure. For starters, my first treatment of choice is a “neti pot.” That’s a teapot kind of vessel that can be used to wash out the nasal passage. Is using tap water OK? It’s debatable, depending on where you live. Saline is good; you can get saline packets at a pharmacy. Or you can put a half-teaspoon of salt in a small bottle of water (400-500 cc) and shake it up.

Lavage (which means irrigate) the nasal cavity every day for two weeks while you wait to see the doctor.

This will save you two weeks as this is probably the first thing your physician will ask you to do. LL

John McElligott is an MD, Fellow of the American College of Physicians, and medical director of the St. Christopher Trucker Development and Relief Fund. Jeff Heinrich, who serves as the column’s medical editor, has a Doctor of Education degree and is Physician Assistant Certified.