Dear Doctors: The left side of my jaw used to click when I chewed. It was odd, but it didn't bother me. Then one day last year, I couldn't fully open my mouth. I got diagnosed with TMJ and got treatment. It fixed my jaw, but now I have tinnitus in my left ear. Is this connected? How can I know?

Dear Reader: Let’s begin with your jaw, which is where the sequence of events you described began. The temporomandibular joint, commonly called TMJ, connects the jaw to the skull. This joint, which is found on either side of the jaw, works as a sliding hinge. It is cushioned by a soft disc of cartilage known as the articular disc. This keeps the various surfaces of the jawbone from coming into contact with each other and allows the joint to move smoothly as your mouth opens and closes.

When illness, injury or a mechanical problem causes the jaw to become misaligned or inflamed, that disc of cartilage can become damaged. This, in turn, interferes with the smooth working of the jaw. This type of malfunction is known as temporomandibular disorder, or TMD. The clicking sound that you noticed is a common symptom of TMD. Some people report hearing the joint grind or pop. Additional symptoms include pain in the region of the jaw, temple or ear; headache; difficulty opening the mouth; and episodes in which the jaw locks shut.

Due to the proximity of the TMJ to the interior structures of the ear, it is possible for a TMD to adversely affect hearing. The jaw and the middle ear share muscles, ligaments and nerve pathways, and any existing irritation or dysfunction in the shared anatomy can alter how sound is perceived. Someone living with TMD may experience ear pain, muffled hearing and tinnitus, the condition you are asking about. This occurs when someone perceives a sound that does not have an external source. The phantom sounds of tinnitus can range from faint to very loud, and can include buzzing, hissing, ringing, whistling or squealing.

Unfortunately, there is no single test that can identify whether TMD has led to tinnitus. Instead, a doctor will use your medical history, existing symptoms and a physical examination of the jaw and ear to help uncover a possible cause. This exam includes checking for ear infection and signs of physical jaw dysfunction. The clinician may palpate the jaw to assess for tenderness, measure the maximum width of the mouth opening and watch for lateral deviation as the jaw opens and closes. In some cases, hearing or imaging tests may be suggested.

Signs that TMD may play a role in tinnitus include persistent jaw dysfunction; a sensation of fullness in the ear without evidence of infection; and tinnitus that changes with jaw movement, such as chewing, clenching or yawning. In your own case, the fact that the tinnitus appeared in tandem with the TMD repair you underwent suggests a possible connection. It would be wise to discuss the situation with your ENT, and if needed, seek a second opinion.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Kansas City, MO 64106; 816-581-7500

Dear Doctors: I had to take antibiotics recently, and I want to help my gut microbiome recover. My doctor said instead of taking probiotics, I should eat a lot of high-fiber foods. I was surprised when she said using herbs and spices can also help gut diversity. I would like to know more about this.

Dear Reader: Antibiotics are often an effective treatment for clearing up a bacterial infection. Unfortunately, because they are broad-spectrum medications, they can kill or inhibit the trillions of beneficial bacteria that make their homes in our gut. Research shows that, depending on the specific drugs used and the length of treatment, the gut flora can be disrupted for a few weeks to several months after treatment.

Not surprisingly, as awareness of the importance of the gut microbiome has grown, patients taking antibiotics are actively seeking approaches to speed the healing process. Taking probiotics can seem like a good idea, but research has shown that they can actually delay recovery.

The gut microbiome is a complex ecosystem. When antibiotics significantly reduce the diversity there, introducing a small number of probiotic strains can disrupt the natural balance within the gut, particularly when those organisms are not native to an individual’s own microbiome. The end result is a disruption of the natural recovery process.

Your doctor is recommending that you repair your gut the old-fashioned way. That is, by providing it with the nutrients microbes need to recover their numbers. High-fiber foods that sail through the stomach and small intestine largely unscathed reach the large intestine intact. There, through the act of fermentation, the mighty microbes of the gut turn them into food for themselves, as well as a variety of short-chain fatty acids and other biologically active compounds that support gut and overall health.

That brings us to the foods themselves. In addition to leafy greens, vegetables, fruit, grains, beans and legumes, which fall into the high-fiber category, it’s a good idea to include fermented foods in a gut-recovery diet. These foods -- such as yogurt, kefir, tofu, pickles, tempeh and kimchi -- contain a range of beneficial live cultures. Research also shows that herbs and spices can give a meaningful boost to the gut. These flavor enhancers, such as garlic, cinnamon, turmeric and oregano, turn out to be rich in polyphenols, a category of organic compounds that act as antioxidants. Polyphenols in a post-antibiotic diet have been shown to selectively feed beneficial microbes, discourage the growth of harmful ones and support the overall conditions the microbiome needs as it rebuilds and repairs.

We hope you will consider the food-based recovery route your doctor has prescribed. Probiotic supplements, while easy to use, contain high numbers of a limited range of microbes. Plant-based and fermented foods, by contrast, introduce microbes and microbial fuel at a gradual and measured pace. This gives existing gut bacteria the time and room to recover and helps avoid disrupting the natural process of recolonization.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: If it's true that, according to a 2024 study, there are some 200,000 deaths (amazingly!) each year from medical errors in the United States, might AI be used to reduce them? I've read it can help with ventilator mishandling, patient instruction omissions and detecting diagnostic oversights.

Dear Reader: Your question about artificial intelligence broaches a topic that is generating both cautious enthusiasm and widespread concern. It may seem like an emerging debate, but the idea of AI as a medical tool dates back to the mid-20th century. What started as a largely theoretical idea in 1950 had, by the turn of the century, evolved into a range of algorithms and pattern-recognition models. These were designed to assist with imaging analysis, diagnosis and even some aspects of clinical care. It wasn't until a significant leap in data and computing resources in the 2010s that modern deep-learning approaches would be able to turn theory into practice.

Before we look at how AI may be useful in medical care, we should clarify the statistics you cited. Despite a widespread desire for an authoritative number, estimates of deaths due to medical error vary widely, depending on how those errors are defined. Some studies stick solely to point-of-care mistakes. Others include system-level failures, such as a lack of coordinated care, a lack of access to appropriate care, medical insurance practices, faulty or incomplete safety nets and inadequate follow-up care. The analysis associated with that 200,000 figure takes this broader view and does not reflect only point-of-care mistakes.

Proponents of AI believe these tools can be harnessed to improve medical care. Pattern-recognition models, in particular, have already proven effective at analyzing medical imaging scans, often with gains in both speed and accuracy. A study done here at UCLA found that AI models were able to identify pancreatic tumors in CT scans months, and sometimes years, before the human eye could see them. Another real-world use is screening for diabetic retinopathy, a complication of diabetes in which high blood sugar levels damage blood vessels in the retina. AI systems have also shown promise as early warning tools for sepsis, in detecting heart arrhythmias in ECGs and for reading mammograms in breast cancer screenings.

While acknowledging the possible benefits of these powerful tools, many clinicians and researchers advise a measured approach to adopting them. Medicine is, at its core, a deeply personal science, and context matters. For that reason, most experts emphasize that artificial intelligence should be used as an aid, not treated as an authority.

When incorporated thoughtfully and with proper oversight, AI systems have the potential to improve medical care. They can scan large amounts of data quickly and identify patterns associated with early-stage diseases or conditions that might otherwise go unnoticed. They can improve accuracy in imaging review, detect early signs that a patient’s vital signs are signaling future problems, identify gaps in follow-up care and reveal breakdowns in coordination before they lead to harm. As AI tools evolve, keeping humans firmly in the equation will be key not only to their success but to their eventual acceptance.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)