Ear, Nose & Throat Community

As you may know, the Interent poses some significant barriers when it comes to making or even narrowing down diagnoses. Since I do not know the medical details of your case, your complete medical history, or have any way of examining you first-hand, it is next to impossible to ascertain any patient-specific "ideas" as to what may be going on.

Yes, you have considered TMJ - this can cause clicking. Eustachian tube dysfunction and even chronic sinusitis can cause odd, difficult-to-locate symptoms. Just because one Japanese ENT has not been able to find the answer, does not mean an answer cannot be found. Of course, not all things in medicine can be diagnosed at all. Unfortunately, this is not something that I can blindly determine over the Internet.

What treatments have you tried?

Dear Dr. Moser,

Thank you again for providing your input.

I have actually tried several different ENT doctors in Japan, but all of them attempt to correct the problem by shooting air through the Eustachian tube, which, as I said, does nothing to alleviate the symptoms. Do you have any advice for me about things I could maybe propose to them? Would an X-ray be something worth trying? Anything else you can think of?

I haven't tried any other treatments because I don't know what kind of treatments are appropriate or available, and my doctors have not been much help. Do you think I should see an oral surgeon about TMJ? I was under the impression, though, that TMJ would be persistent - not only when I talk, but when I eat or otherwise move my jaw - and painful, too, which my condition isn't.

If I were to continue seeing the ENT about this problem, is there anything else that they can do to "look inside" and see what's going on in the area? Just knowing the root or precise location of the sound would be an immense help.

Finally, does the fact that I don't experience any clicking when I'm laying down indicate anything to you?

Thanks for your help.

Your unusual symptoms really have me stumped. Basically, it is going to take a persistent clinician to keep searching for a source; a task that can be unbelievably difficult, I might add. Any chance that you can go to a large, university-based clinic in Japan? The large institutions may offer you collaborative efforts of several clinicians of different medical disciplines. I wish that I could be more helpful to you, but your case is one that I would refer to others, since it is well beyond my primary care expertise.

I don't know if a CT or MRI would be diagnostically helpful, but imaging studies may be in your future. This is really the only way to look inside, as you mentioned. As you know, you can't "see" clicks.

Hi tmkain,

I know that you posted this three years ago.

I am also a 27 year old male. Last year I woke up in the morning with this: clicking and noise when I talk. Since then it has gotten so bad I can barely talk anymore without debilitating discomfort and pain as well. This is affecting me badly as well as my relationship with my family and friends since I find it so hard to communicate with them.

I have seen many experts in the TMJ, ENT, Dental, Orthodontia, and even Homeopathic and Kinesiology fields. None has been able to help me. They all seem to try to wedge their profession into my problem without listening and understanding the issue.

After an exhaustive search on the internet I have only found your post describing the exact same symptoms I experience. I literally feel your pain because this is the most debilitating thing I have ever experienced. Like you described, it only happens when I'm vertical and after 'hard' consonants, not nasal words like 'Mommy'.

I know it has nothing to do with my Eustachian tubes as they were tested and found to be totally clear and I'm pretty sure it's not my TM joint because it doesn't happen when I say nasal words or when I chew or move my mouth.

Please tell me that after four years you have found a solution to this problem. I am going absolutely bonkers.

Thank you

Yes_Please,

First of all, I'm just glad to know that that three-year-old post I made helped somebody out. When I first realized the clicking was happening, not being able to find ANYTHING on the Internet remotely close to what I was experiencing was really depressing.

I'm happy to report that my clicking is no longer constant - it flares up every once in a while (seasonally, maybe (?)), but only for maybe two weeks at a time. Like you, I saw pretty much every "specialist" imaginable but couldn't get anyone to do anything but throw their hands up and point in another direction.

After a few months of that, I pretty much threw in the towel. As my symptoms started to fade in and out, though, I did a little self-diagnosis: what could be making the symptoms go away? What might be behind the relapse when they start again? I came up with two theories. First, I thought the clicking might be caused by some sort of seasonal or environmental trigger. You know how some people can "feel" rain coming in their knees/other joints due to changes in air pressure? Maybe, I thought, something in the air or the temperature was just shifting something around in my facial bone/cartilage arrangement that made two parts snap against each other when I said hard consonants. To me, it's as feasible a conclusion as I can come to - the only problem is that I could never figure out exactly what the triggers were.

The other hypothesis I came up with was pretty simple: stress and stress-related habits that involve my jaw. Maybe the continuous pain and frustration was all the product of a vicious stress cycle: something stressful set off the clicking; thinking about the problem created more stress, which led to more stress-induced clicking, and so on. I noticed that if I just gave up trying to fix it, it would eventually go away - but that's easier said than done. You have to have reached a certain level of exasperation first (but I think you might be there). If you assume that no doctor is going to be able to figure it out and you're not going to be able to fix it yourself, you actually have less to stress about. Compounding the problem by devoting every waking moment to thinking about it (like I did) does more damage than good, I think.

For good measure, I also said goodbye to my years and years of nail biting, which I just assumed had a negative impact on my jaw placement. If you're a nail biter, it's probably time to give it up - even if it's not tied to the clicking problem.

The only difference between my case and yours is that you say your pain is "debilitating," whereas mine was just annoying. My main problem was the mental anguish - that dreadful feeling of a click coming on, that lack of any control over the situation.

Sorry I couldn't be of more practical help. If you can live with the pain, I'd recommend just accepting it as a fact of life and trying to focus on something else. Keep talking with your family even if the clicking continues - they'll likely be a source of relief in a sea of stress.

Good luck!

Tmkain,

Thank you so much for replying. I did not have too much hope that after all these years you would reply to my post.

Im really happy for you that the clicking is mostly gone. How long did it take before it was no longer constant? I have had it for about seven months with no break although some days it is worse than others.

On bad days it feels debilitating because every sentence I say is accompanied by multiple loud clicks which are very distracting. I think though that you are correct that when I forget about it, it bothers me less.

I have been combing the Internet all this time and you are the only person to have described the exact same symptoms as me. Can you elaborate on the things that you do which helps the problem? Which climate do you live in? Have you moved since it started? Do you have/had any other illness that may have started it? TMJ for example?

Any information would be really appreciated. Perhaps here is a way I can send you a personal message to communicate about this?

Strangely enough it also started in my left ear but also occasionally pops up in my right ear as well. It gets worse the longer I talk, so a long conversation really is hard on me.

Thanks

Also, after going to several doctors, and realizing that they were having a hard time hearing the noise, I actually recorded the sound by pressing my phone to my cheek and recording as I blew air out of my mouth. (clicking happens when I blow too) I then listened to the recording with the volume cranked up. It's very audible and sounds like someone clicking a Snapple cap. That's my doctors words not mine..

Another thing- how is your posture? I slouch a lot and when I straighten up the clicking gets a bit better. Do you have a similar experience? Any info like this is very very helpful.

Thanks in advance!

Dear Yes_Please,

Don't you think it would be better to keep our discussion on this board just so other sufferers will have a better chance of finding help? If you'd really rather make our conversation private, let me know.

I can't really say how long it took for the symptoms to subside - considering that my first post here was three years ago and I probably turned to the website after several months of problems, I'd say it's now been four years or so since I actually started experiencing the clicking/snapping/sensations. By my best estimation, my symptoms probably went away "for good" (knock on wood) about 3.5 years after initial onset, with periods of good and bad in between.

What alleviates the problem?
1. Accepting that it will happen most of the time
2. Thinking about something else/not trying to determine the source/cause of the problem when the clicking is bad
3. Eliminating unnecessary sources of stress
4. Making yourself horizontal when the problem is unbearable
5. Relaxing your shoulders
6. Not putting any unnecessary pressure on your jaw (nail-biting, grinding, etc.)
7. Trying different environments (dry/moist, hot/cool, etc.)
8. Getting a lot of sleep
That's all I can think of right now, but I'll let you know if I remember anything else.

I live in Japan, actually, where the weather is pretty humid in the spring, summer, and fall and quite dry in the winter. The temperature rarely gets below freezing. For me, the clicking seemed to be most pronounced in the winter, but it's not like the humidity ever seemed to make it go away. I've lived in the same place since the symptoms started, so location doesn't seem to have that much of an effect.

What you say about posture is intriguing. I have pretty bad posture, too - people tell me my head is always kind of jutting forward. As I said, my symptoms kind of disappeared without me doing anything specific (like adjusting my posture), but if going horizontal makes the symptoms go away, you could easily say that making your neck and back as straight as possible might produce similar results. Makes sense to me. If good posture makes a considerable difference, I would recommend making a conscious effort to correct your posture and invest in chairs that force you to sit up (if there is such a thing).

My medical history is pretty boring: no broken bones, no TMJ, no sleep disorders, no depression... nothing except for type I (juvenile) diabetes, which I got when I was 21. I doubt that triggered the problem, though. The only thing with a potentially direct influence on the area is my nail-biting habit.

I'm 100% positive that I had the same condition that's currently driving you crazy. Honestly, it drove me crazy too. There were times when I got so mad at it, so reluctant to talk for fear of making the click happen, and so frustrated that no one could understand what the heck I was going through that I just had to cry. That aggravation went on until I just gave in and said, "OK. If this isn't going away, I'm going to learn to live with it." Then it just evaporated one day.

I wish I could tell you that there's something you can do to make it go away, but I just can't. Maybe the posture thing is the key. But for me, it was more about acceptance than an actual remedy. That sure made life easier to live.

Best of luck!