There seems to be a consensus that TMJ and Tinnitus are related; not on a massive scale though.
According to a study published in the medical journal Cranio in Oct 2020, the incidence of tinnitus was found to be 11.46% among patients with temporomandibular disorders (TMDs).
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What is Tinnitus?
Tinnitus is a noise in the ear perceived by humans that is not based on the sound that is otherwise perceived. It is described by tinnitus sufferers as an unpleasant, constant, or intermittent ringing, chirping, buzzing, beeping, whistling, or hissing noise. Thus tinnitus is nothing more than an impaired hearing function in humans.
Tinnitus is not referred to as a disease in its own right, but rather as a symptom of other diseases or sometimes as a syndrome. This is because it usually results from other complaints such as dental treatment, stress, middle ear diseases, viral infections, or misaligned jaws. Een medications can cause tinnitus.
When Can Temporomandibular Joint Problems Lead To Tinnitus?
There are many causes. Some are:
- In the case of nocturnal teeth grinding, the teeth are rubbed off, the jaw joints are overloaded and worn out and an internal degeneration (change) develops, and thus a displacement of the jaw joint heads towards the middle ear
- Stress. Stress and mentally unresolved conflicts lead to stress processing through repeated pressing together of the upper and lower jaw. As a result, however, the head of the temporomandibular joint shifts backward and upwards and compresses parts of the temporomandibular joint area, and leads to the introduction of forces into the ear canal, into the skull.
- Dental treatments can trigger acute noises in the ears. This is done by changing the muscle tone of the masticatory muscles
- Misaligned jaws. Incorrect bite (upper jaw and lower jaw are not (no longer) right to one another and cause malfunctions of the temporomandibular joints and possibly ringing in the ears
- Medications that cause tinnitus. The worst is erythromycin (antibiotics), aminoglycosides (antibiotics by infusion, not those in-ear drops), loop diuretics (furosemide), chemotherapy, anti-malarial drugs, NSAIDs (pain killers).
TMJ and Tinnitus relationship
Many people suffer from tinnitus without suspecting a causal connection to the temporomandibular joint or the teeth/dental fillings/dental crowns/dental treatments.
In this context, it is important that the close positional relationship between the temporomandibular joint and the middle ear plays an important role, as does the introduction of forces into the skull that arise during unconscious pressure.
The temporomandibular joint is an important part of the chewing organ and in this context, it is also important for tinnitus. The masticatory muscles, which among other things move the lower jaw in the jaw joints, play a special role.
Our hearing organ consists of the outer ear, the middle ear, and the inner ear. The temporomandibular joint (TMJ), as well as the cervical spine, is in direct proximity to the outer ear.
Picture courtesy of https://mskneurology.com/association-tinnitus-neck-tmj/
There are many nerve tracts here that run directly between the auditory canal or middle ear and the jaw and the cervical spine. A functional disorder of the cervical spine can cause a malalignment of the temporomandibular joints.
If you think of something unpleasant or brood or get upset, you involuntarily press your teeth together and thus cause a displacement of the jaw joint backward and upwards and tension/stress arises in many areas. A higher tension of the masticatory muscles in response to emotional stress, in turn, has an impact on the temporomandibular joints.
If you want, you can feel your jaw joint. It’s right in front of your ear. When opening and closing the mouth you feel the movement of the temporomandibular joint head (condyle) under the finger when you place your finger in front of your ear. You can see that there are close relationships between the movement of the jaw joint and the space available to the ear canal.
Tinnitus patients also observe that the noise in the ear can increase, decrease or change when the mouth is moved.
Depending on what the cause of the tinnitus is, these nerve tracts are then affected and have a corresponding effect on the hearing organ.
What Does Tinnitus Have To Do With CMD?
The masticatory system and the ear are anatomically and muscularly connected to one another. A disturbed occlusion, i.e. a misaligned tooth, exerts more pressure on the masticatory muscles and the temporomandibular joint than is normally the case.
Part of the temporomandibular joint capsule, which is characterized by nerve tracts and blood vessels, is known as the bilaminar zone. If more pressure is now exerted on this zone, as can be the case with a CMD (craniomandibular disorder), an ear noise can arise. Because this zone is very sensitive and is located exactly between the middle ear and the temporomandibular joint.
How is Tinnitus Treated?
If the tinnitus developed due to the CMD, a functional analysis is used to determine what exactly was the cause. As a rule, tinnitus occurs in the context of a CMD when the malalignment of the jaw joint has a lateral component, i.e. when the lower jaw is laterally displaced in relation to the upper jaw.
A CMD is often treated with a special splint that guides the bite back into the correct position and relaxes the jaw joint.
Therapeutic options for positively influencing the function of the TMJ and thus tinnitus include:
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CMD therapy and use of special bite splints
CMD therapy for tinnitus is carried out by the dentist. As part of the dental diagnosis, the doctor first checks whether the patient’s tinnitus can be traced back to a CMD because only then is CMD therapy useful.
As an indication of a connection between CMD and tinnitus, the observation that the severity of the tinnitus changes when the teeth are pressed together or the mouth is opened wide. However, this is not the case for every patient with CMD-related tinnitus.
To initiate CMD therapy, the dentist adjusts an occlusal splint. This usually only has to be worn at night. The entire CMD therapy is sometimes carried out in cooperation with orthopedists, physiotherapists, and osteopaths, as CMD not only causes tinnitus in many patients but also leads to musculoskeletal complaints.
The occlusal splint is worn for a period of two to three months, with weekly dental checks taking place as part of the CMD therapy. The splint treatment may be followed by grinding in or a crown build-up of the teeth.
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Relaxation procedure
Targeted procedures for relaxation with tinnitus can help to relieve stress and tension and to regain greater wellbeing. But how do you practice “relaxation”?
The missed train, the screaming child, exhausting meetings – we encounter stress almost everywhere. Increased stress is one of the causes of tinnitus and can worsen existing tinnitus. Relaxation specifically counteracts these stress factors.
Relaxation methods are an important part of the treatment of tinnitus. In particular, in the case of inpatient tinnitus therapy in a clinic and in tinnitus retraining therapy, learning methods of relaxation is an important part of the treatment concept. Such relaxation methods are also often used in outpatient tinnitus therapy.
Which relaxation technique is the right one?
There is no one way to make everyday life more relaxed. But everyday life can be enriched with valuable moments of conscious silence with the right relaxation method.
There are a number of different methods of relaxation for tinnitus that specifically reduce stress. The relaxation method you choose should suit your situation, needs, and preferences.
A whole range of methods that can provide relaxation for tinnitus is just as popular as they are successful. For example, many patients practice
- Autogenic training: a relaxation technique focusing on promoting feelings of calm and relaxation in your body to help reduce stress and anxieties.
- Progressive muscle relaxation is a method that helps relieve tension.
- Feldenkrais Method is a powerful and revolutionary approach to improving your life that uses gentle, mindful movement to bring new awareness and possibility into every aspect of your life.
- Qigong uses simple poses and breathing patterns to promote a healthy flow and reduce stagnation of qi. Proper flow of qi can help the body engage its own healing processes.
- Tai chi is an art form that embraces the mind, body, and spirit. The ultimate purpose of tai chi is to cultivate the qi or life energy within us to flow smoothly and powerfully throughout the body.
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Physical therapy
The tinnitus treatment with the physiotherapist begins with the diagnosis.
In the case of tinnitus caused by the cervical spine, the physiotherapist’s main focus is on the patient’s cervical spine and, in turn, on the statics, muscles, and mobility. Therapy planning and implementation of the treatment follow the physiotherapeutic findings.
Tinnitus treatment by a physiotherapist can contain both active and passive therapy elements. This means that some of the patients have to participate in the treatment themselves and that other therapy elements are only used by the physiotherapist.
The following physiotherapeutic measures, among others, are helpful for cervical spine-related tinnitus.
- Treatment of soft tissue (muscles, tendons, ligaments, skin, subcutaneous tissue)
- Movement exercises
- Correction of an unfavorable statics
- Prevention of renewed dysfunctions by learning to perform exercises independently
- Advice on sporting activities
- Ice applications to improve blood circulation (which in turn results in relaxation, pain relief, and increased stretching of the muscles)
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Osteopathy
In osteopathy, the skeletal system is specifically treated, among other things, in the case of complaints in the cervical spine that may be related to tinnitus.
Among other things, the osteopath dissolves joint blockages and treats ligaments, muscles, connective tissue, body fluids, and also internal organs with his hands.
An improvement in, for example, movement blocks or muscle tension through the osteopathic treatment can result in an alleviation of tinnitus symptoms. This applies to both acute and chronic noises in the ear.
Careful diagnostics are part of osteopathy for tinnitus. This is also carried out on an osteopathic basis. This means that the osteopath can treat areas of the body that require treatment, such as blocked joints or tense muscles in the cervical spine, felt with his hands. He then connects his findings with the patient’s tinnitus and plans the osteopathic therapy.