The Connection Between Tinnitus and TMJ Problems

Patients that are sent to my office with TMD problems have at times, (about 15% of the time), tinnitus as one of their symptoms. At other times, patients are sent for consultation with a primary complaint of tinnitus and lesser concerns about their jaw. I am, therefore, often asked whether there is a clear-cut relationship between tinnitus and jaw dysfunction and whether there are predictable ways to determine who can be helped.

Before we get into a discussion of the connection between tinnitus and TMJ, let’s look at the definition and causes of tinnitus.

Tinnitus Definition: The annoying sensation of hearing a sound when no external sound is present. Patients describe these sounds with words such as ringing, humming,?buzzing, roaring, clicking and hissing. This sensation is constant for some people and intermittent for others, and it can be in one or both ears. For some sufferers, the intensity of the sounds can vary from day to day while for others it is without fluctuation in intensity.

Tinnitus Causes: There are many known causes of tinnitus that include identifiable damage to the inner ear hair cells, age-related hearing loss, exposure to loud noises, earwax blockage, and changes in the health of the bones in the middle ear. Less commonly tinnitus can be associated with Meniere’s disease, trauma to the head and neck region, and/or TMJ disorders. For some people, however, the cause is never discovered.

When tinnitus is persistent it can greatly impact the quality of a person’s life and prompt ongoing consultations and treatments, though many of which have no consistent track record of producing benefit.

Tinnitus and TMJ problems

TMJ problems are essentially orthopedic in nature and are associated with jaw malfunction/dysfunction. The common symptoms of TMJ are many and can include pain in the jaw muscles or specifically in the jaw joints, limited jaw motion, jaw muscle tension and tightness, jaw joint clicking, popping and or locking, headache pain in the temples, and/or a bite that doesn’t feel normal. Tinnitus is a less common symptom.

When TMJ problems affect the ear, symptoms can be pain, stuffiness, and/or tinnitus.

The onset of these symptoms may be due to underlying medical disorders, emotional stress which drives muscle tension, traumatic events, periods of sustained jaw opening due to dental/surgical procedures, sleep bruxism, postural strain, and/or daily jaw overuse behaviors which can result in joint sprains, muscle strains, muscle spasm and /or inflammation. Less common origins include malocclusions and structural asymmetries.

Reasons why TMJ problems can lead to tinnitus (or make it worse)

1. The nerves (third division of the trigeminal) that serve the jaw muscles and jaw joint are also responsible for the function and tone of muscles that determine the size of the Eustachian tube and tone of the tympanic membrane. Alterations in the function of these two structures can be responsible for tinnitus. If the trigeminal nerve is lit up by a jaw problem that persists, the tensor veli palati (determines diameter of the Eustachian tube) and the tensor tympani (controls the tension across the tympanic membrane) can be adversely influenced.

2. There is one specific ligament connecting a middle ear bone (the malleus) to the jawbone. It is called the malleo-mandibular ligament or Pintos ligament. When a TMJ problem changes the position of the lower jaw, the malleus can be altered in its function due to ligamentous traction and that can lead to tinnitus.

3. The main nerve supply (the trigeminal nerve) from the TM joint has been shown to have connections to parts of the brain involved with hearing and the interpretation of sound. If TMJ problems alter the function of this nerve it’s quite possible that the brain will interpret normal sounds as abnormal (hence the ringing perception). In this scenario, all medical testing is unremarkable and patients are often made to feel as if they are making up the symptoms.

Worth mentioning: because TMJ problems are often associated with neck problems, evaluations of the neck must be also part of an overall assessment. There is evidence that nerve endings in the neck make connections to the hearing centers of the brain. Ear symptoms, therefore, have been shown to emerge as a result of long-standing neck problems or those created by acute trauma.

Determining if a TMJ problem is driving tinnitus symptoms

When patients report that jaw motions, postures, influence their tinnitus symptoms and/or during chewing, there is an increased likelihood that a relationship may exist. On the other hand, when tinnitus symptoms are constant and never change with jaw use, an association is less likely.

The same thinking should be applied to head motions. If the reported tinnitus symptoms change as neck muscles are activated, then an association can be considered with a degree of confidence.

If the tinnitus is related to the jaw or neck improvements can be anticipated as the TMJ/neck problems are helped or resolved. Treatment options can include daytime strategies to diminish muscle fatigue from overuse behaviors and or postures,?exercises, home TENS therapy, muscle injections or dry needling techniques, Botox, dental appliances to support the jaw joints and jaw muscles, physical therapy, medications, and multiple forms of mindfulness training and diaphragmatic breathing instruction. I don’t recall an instance where changing a patient’s bite or jaw posture as a?stand-alone therapy led to a resolution of their tinnitus.

Treatments that seem to be helpful may require several weeks or months to achieve maximal benefit.

Summary?

Tinnitus problems continue to be a challenge to those that are suffering. Once formal medical testing is unremarkable, assessment of the jaw and neck structures would be an important part of the evaluation process.

I welcome your thoughts.