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The Link Between Tinnitus & TMJ – What Professionals Need To Know

Author: Donald Tanenbaum DDS MPH - Board-Certified Orofacial Pain Specialist at New York TMJ & Orofacial Pain

Date: September 13, 2023

 

As a TMJ and Orofacial Pain specialist, it is common for patients to arrive at our practice who were referred by an ENT physician. Often, they complain of persistent ear pain, the cause of which could not be uncovered by examination and even CT and MRI scans. Because ear pain can be a symptom of jaw muscle and joint problems associated with TMJ/TMD, we frequently find evidence that their pain is indeed associated with those structures. Treatment strategies usually help reduce or eliminate their pain.

However, some patients referred to us by ENTs do not have ear pain – they have tinnitus.

Tinnitus Is Common

Tinnitus is defined as the perception of a sound that seemingly does not have an external source. According to a systematic review published in JAMA, more than 740 million people worldwide experience tinnitus. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that over 25 million Americans – 10% of the U.S. adult population – suffer from some form of the condition.

Tinnitus sounds are usually described as ringing, buzzing, humming, or roaring. The sounds can be heard in one ear or both and can vary daily. Tinnitus can be disruptive to thinking and the performance of everyday life routines, which causes many people to experience anxiety, sleep disturbances, and even depression.

Most tinnitus patients can recall the exact day and minute it started and came on spontaneously for no apparent reason.

Tinnitus Causes & Brain Interpretation

Research tells us that tinnitus can be caused by the following:

  • Single or ongoing noise exposure, such as concerts or military events
  • Chronic use of medications such as non-steroidal inflammatory and anti-cancer drugs
  • An aggressive ear or sinus infection
  • Head trauma

Some patients believe their tinnitus began when they had Covid or the vaccine. However, most people cannot associate the onset with anything that has occurred in their history. In many ways, their stories are similar to patients who arrive at our practice with facial, jaw, or tooth pain that emerged one day for no apparent reason.

The “I don’t know why story” is why I suspect tinnitus could be related to a brain interpretation disorder. For various reasons, the brain can become overwhelmed by incoming information that it must quickly process and accurately interpret. If the brain can’t do its job efficiently or accurately, pain or tinnitus without evidence of physical injury or pathology can be the result. From my perspective, persistent emotional conflicts, loss of control of daily life, chronic worry, poor sleep, and ongoing medical stressors can be reasons why the brain can make interpretive  mistakes.

Why Tinnitus Can Be Linked To TMJ

At this point, there is no scientific evidence to prove that TMJ problems are associated with tinnitus. In fact, when I look at our typical TMJ/TMD patients, I would say that fewer than 10% report tinnitus. But, for them, it’s important to consider a possible link between their tinnitus and TMJ. Here’s why:

During human growth and development, several structures of the ear and jaw develop from similar embryological tissues. As a result, the Eustachian tube, which helps drain fluid and equalize the air pressure inside the ears, is under the influence of the Tensor Veli Palatini muscle. This muscle receives its nerve supply from the same nerve that serves the TM joint and jaw muscles; the trigeminal nerve.

In addition, the malleolus bone, which transmits vibrations from the eardrum to the inner ear, is connected to the jaw by a small ligament. And, tension across the tympanic membrane is determined by the pull of the tensor tympani muscle, which is innervated by the trigeminal nerve. As a result, persistent jaw problems such as excessive muscle tension, spasms, and inflammation can be responsible for ear symptoms, including tinnitus.

5 Questions To Evaluate Tinnitus

Because tinnitus can be due to a serious medical disorder such as an acoustic neuroma or another intracranial pathology, it’s essential that they first have a medical or ENT evaluation. When a medical disease has been ruled out, and the patient’s tinnitus symptoms and history have been recorded, we ask them these five questions:

  1. Is your tinnitus constant, or does it change?
  2. Does it improve or worsen when you open and close your mouth or move your jaw forward or back?
  3. Does chewing affect your tinnitus?
  4. Does your tinnitus change when you clench your teeth?
  5. Does it change when you move your head?

If the patient answers yes to two or more of the above questions – and if our examination reveals tender jaw and neck muscles, sore TMJ joints, and/or overbuilt jaw muscles – we feel confident to inform them that their tinnitus may be responsive to treatments that we offer.

How TMJ-Related Tinnitus Is Treated

The treatment options we recommend often mirror how we treat more typical TMJ problems. They are one or a combination of the following,

  • Awareness and reduction of daytime jaw overuse behaviors if identified
  • Jaw exercises for stretching and coordination
  • Jaw and neck muscle therapies inclusive of trigger point injections, dry needling, prolotherapy, and neuromodulators such as BOTOX®
  • Referral for physical therapy
  • Utilization of a variety of oral appliances to address bruxism activity
  • Medications to address muscle tension and or nerve excitation.

It should also be understood that these treatments often complement treatments that may already be in place, such as sound therapy or behavioral therapy. New efforts by physicians  to use deep brain stimulation and repetitive transcranial magnetic stimulation also show promise and are being researched extensively.

Conclusion

When a patient suffers from persistent tinnitus, and when medical evaluations and treatment have fallen short the next step is to ask the above five questions. If the patient answers yes to two or more, an assessment by an Orofacial Pain Specialist may be the logical next step.

Feel free to leave your thoughts below.

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