TMJ and Tinnitus

There is a close relationship between certain problems with the jaw joint (temporo-mandibular joint or TMJ) and tinnitus.

 

The prevalence of frequent headaches and fatigue, or even tension in jaw muscles, was higher in tinnitus patients

Background

There is a close relationship between certain problems with the jaw joint (temporo-mandibular joint or TMJ) and tinnitus. Scientific studies have shown that people with TMJ problems are more likely to suffer from tinnitus. Similarly, some individuals who have sustained an injury to their neck may also suffer from tinnitus. Some people with either TMJ problems or neck problems are able to alter the intensity of their tinnitus by moving their mouth, jaw, face and neck. Successful treatment of the underlying problem can be associated with an improvement of tinnitus symptoms.

Tinnitus Defined

"Tinnitus can be defined as the conscious experience of a sound that originates in the head of its owner." Everyone has experienced sounds that did not originate from their outside world, at one time or another. But the true tinnitus victim suffers from a constant ringing, hissing, or buzzing sound that in some instances can drive the patient almost insane. They also suffer from many of the complaints described above.

Multiple Symptoms of Tinnitus

The mechanism by which tinnitus occurs is not clear to many professionals; however the current medical theory is that the majority of cases of tinnitus have no detectable acoustic basis! Tinnitus can be a symptom of some ear disease such as otitis externa, chronic otitis media, otosclerosis, or Meniere's disease.

But even in the presence of obvious middle ear disease, such as otosclerosis or chronic otitis media, the actual site of the lesion which causes tinnitus remains obscure. Because tinnitus can be a symptom of serious ear disease, such as an acoustic neuroma, it is recommended that an ENT or neurological evaluation be performed prior to initiating TMJ/TMD evaluation and dental treatments.

A relatively recent book, entitled Tinnitus and Craniomandibular Disorders: Is There A Link, took a hard look at this problem and came up with some interesting observations.

Several of the findings indicated a relatively strong relationship between craniomandibular disorders, tinnitus, and subjective hearing loss. The prevalence of frequent headaches and fatigue, or even tension in jaw muscles, was higher in tinnitus patients than would have been expected even if these conditions were unrelated. Approximately one-third of the individuals suffering from tinnitus reported an influence on tinnitus by jaw movements, or pressure on the TM Joint.

What is the temporo-mandibular joint (TMJ)?

The TMJ is a complex joint as it has to allow for side-to-side and front to back movements that take place during chewing. The muscles that make the jaw move are some of the most powerful in the body. This means that quite large forces have to act through the TMJ. As a result, the joint is at risk of damage just as much as any other weight-bearing joint in the body.

TMJ problems can be due to trauma, such as a ‘pulled muscle’ or a dislocation to the fibrous disc that sits in the hinge joint. Other TMJ problems may be due to longer-term problems such as arthritis within the joint. 

What are the symptoms of TMJ problems?

The usual symptoms of TMJ problems are TMJ pain, which may be felt as earache, clunking of the jaw, or limitation of movement, causing difficulty in opening the mouth. Other symptoms that may arise are swelling of the joint, headaches, neck pain and tinnitus. Some people notice that when stressed, they grind their teeth - particularly at night - and this can put pressure on the TMJ.

Sensitive or Ringing Ears

How come YOUR ears feel so weird, yet your doctor has never found a problem? Put your little finger in your ear while opening and closing your mouth. Now move your jaw from side to side. You can feel a lot of action in there!

 

The over-activity of your jaw can make your ear canal sensitive. The ear has two important muscles:

The tensor tympani -(it attaches to the ear drum, and stabilizes it from the excess vibration caused by loud sounds) and 

The tensor levi palatini - (it attaches to the Eustachian tube, and helps to open and close the tube, thereby equalizing pressure within the inner ear...it is what "unplugs" your ears as you chew gum in an airplane).

 

How does the TMJ affect tinnitus?

There are three main theories behind why problems with the TMJ may cause tinnitus, or make it worse.

Firstly, the chewing muscles are near to some of the muscles that insert into the middle ear and so may have an effect on hearing, and so may promote tinnitus.

Secondly, there can be a direct connection between the ligaments that attach to the jaw and one of the hearing bones that sits in the middle ear.

Thirdly, the nerve supply from the TMJ has been shown to have connections with the parts of the brain that are involved with both hearing and the interpretation of sound. The general discomfort associated with TMJ problems can also aggravate any pre-existing tinnitus.

How can neck problems affect tinnitus?

Long-term pain and discomfort from conditions in the neck can also aggravate tinnitus in the same way TMJ problems do. Studies have shown that patients who have suffered an injury to the head and neck region, such as from a car accident, or who have neck pain or stiffness for other reasons, such as arthritis, are more likely to experience tinnitus.

Furthermore, there is some scientific evidence to support how the nerve endings in the neck make connections in the hearing centres of the brain, explaining how neck problems may affect tinnitus. Quite often the tinnitus associated with neck injuries may be more severe, and can be combined with other symptoms such as headache, depression, and problems with memory and concentration.

Treatment generally depends on the cause of the neck problem, but the results from treating the underlying neck problem are often good. Treatment options can be discussed with your family doctor, who in some cases will recommend simple measures such as the use of painkillers and physiotherapy. Some people are able to modify their tinnitus by moving their neck. Recently, it has been suggested that in a minority of these individuals, TENS (Transcutaneous Electrical Nerve Stimulation) can help them with their tinnitus 

Tinnitus and TMJ Symptom Sharing

Over activity of these muscles can sometimes cause a ringing sensation, called tinnitus. It is not unusual for the patient with TMJ/TMD to complain of ringing in their ears, or vertigo. The tensor tympani and tensor levi palatini are tensed whenever the jaw-closing muscles are tensed, i.e., when ever the jaw is clenched. The reason is that the same nerve (the trigeminal) feeds all of the muscles of mastication as well as these two important ear muscles.

Many of the patients that we see at our office present with tinnitus (ringing in the ears) as a primary or secondary complaint. Tinnitus may occur alone, or in concert with other symptoms.

The most common pattern of complaints with most patients is as follows:

  • head, neck and back pain
  • dizziness (vertigo)
  • otalgia (ear pain)
  • impaired hearing
  • stuffy sensations in the ears
  • double and blurred vision
  • various jaw joint noises
  • sinus pain
  • frequent sore throats
  • migraines, headaches

Patients with tinnitus usually present to our office desperately looking for a solution for their multiple problems. The effect on the individual can vary from mild awareness to reduced work capacity, lack of concentration, total disability, and in some cases suicide.

How can TMJ problems be diagnosed?

We can often diagnose TMJ problems on clinical examination. If necessary, we will refer you for further tests. Disorders of the TMJ may be investigated with Magnetic Resonance Imaging (MRI) scans and even, on occasion, by arthroscopy, which is a small procedure where a tiny camera is inserted into the joint.

Tinnitus Treatment

Prior to initiating the dental assessment for TMJ/TMD, a thorough medical evaluation is necessary. Appropriate medical and neurological referrals should be made. A number of symptoms and signs can be found in association with tinnitus. These include:

  • worn down teeth
  • tenderness of the muscles of mastication
  • pain in or around the TM Joint (with or without noises)
  • otalgia (ear pain) aggravated by mandibular movement
  • neck pain
  • poorly fitting dental work or dentures
  • bruxism (tooth grinding)
  • dizziness and disequilibrium
  • stuffiness in the ears

Clinical observations have found that tinnitus is present in approximately one-third of the patients who present with ear pain, fullness, hearing loss, etc. After proper dental therapy is performed, tinnitus is generally relieved.

A variety of treatments are available to treat TMJ disorders. If your tinnitus is related to your TMJ problem, the tinnitus may improve as the TMJ problems get resolved.

There are some simple measures that can help TMJ problems, such as a change to a soft diet, jaw muscle exercises or the use of anti-inflammatory medicines and painkillers. For people who grind their teeth or clench their jaw, a bite-appliance may be made which corrects the way in which the jaw works and reduces the stresses and loads on it. This can be disposed of when normal function is restored. In exceptional cases a specialist dentist, known as a maxillo-facial surgeon, may be required to perform surgery on the TMJ.

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