New Theory: TMD the Cause of Tinnitus

[donotringatme]

Since the neck has been thoroughly examined and treated, to no avail, there is no implication. Plus, one eventually discovers that the jaw not only is responsible for neck discomfort but also is responsible for pretty much everything else. Here are some random text from articles to begin with, before sharing my story:

Condyle presses against nerve endings and strains aligaments by the ear, and this causes the tinnitus.

MR-Neurography imaging noted that there was facial nerve irritation as it exits the stylomastoid formen and passes inferior to the external auditory canal which would be consistent with a focal entrapment or irritative syndrome.

Treatment commonly employs painless procedures which help stimulate muscles and joints to function normally, decrease spasm, remove toxic waste products, and increase blood flow and nutrition to the affected areas.

Therapies such as low current electrical stimulation to reduce muscle spasm and stimulate healing, ultrasound for deep tissue heating, hydrocollator for moist heat, and cryotherapy (cold therapy) are used with a variety of removable orthopedic appliances aimed to correct the position of the condyle, or "ball", of the lower jaw within its socket. In addition, joint mobilization procedures, physical manipulation, and other procedures might be employed.

The TMJ and muscles are innervated by the same nerves that innervate the ear.

The closeness of the ear to the temporomandibular joint makes the overlap of symptoms natural. In fact, the temporal bone, part of the joint, actually houses the delicate structures of the inner ear. When the joint experiences pressure, that pressure could manifest in ear symptoms. Jaw clenching and ear fullness seem a natural combination. The clenched jaw puts pressure on the ear, creating a sensation of fullness. And the jaw and ear are connected by tiny ligaments. Plus, nerves running from the ear have to go past the joint and interweave with jaw muscles. This means that any type of jaw disorder or displacement could pressure those nerves, leading to long-term or transient symptoms.

 

[donotringatme]

So the story goes, I was a mouth breather. That can be detrimental to one's face. I already had nail biting and clenching to my arsenal of bad deeds but frankly I was cleared by all doctors and was told my bite and teeth are fine. It's true they are, but I wanted to somehow improve my facial structure. Low and behold, came across mewing. And something tells me... a lot more people in this board did.

Mewing is resting your tongue up to the roof of the mouth all the way to the soft palate which of course is impossible at first, especially for a mouth breather. Since you can't do it, you have to push to make room for the tongue, as instructed by the author. And here I think lies the problem.

Long story short, mewing provides you with bone remodeling in favorable manner, as my deep cheek lines were gone, my cheekbone became prominent, my lower jaw also did, becoming more square too, in other words it did come out of my turkey neck. So far so good.

The problem started when I noticed my temporalis and masseter muscles were sort of way too strong. Then, my temporalis started bulging, this happened months ago. Now I learn this is because of a bad bite.

There are two big masticatory muscles that are attached to the mandible: the temporalii and the masseters. The first one brings the jaw up and back, the second one up and forward:

When you are using the temporalis too much, you may end up dragging the teeth and the palate towards your temples, which would make the bite feel tense. Then, as the mandibular joint pushes against the ears, this could very well cause tinnitus.

Apparently TMD does not just cause tinnitus. It causes a variety of tinnitus, pain, ear ache, ear fullness, ETD and it is a bit more complicated than a splint it seems. Any bite irregularities or anatomical ones lead to tinnitus, a tinnitus that may become worse or kickstart hyperacusis and of course completely mess up the neck.

Anyone with "somatic" tinnitus should definitely have a CBCT and MRI on their jaw. I just tried one-two things on my jaw and got a lovely new tone for ten seconds after discomfort and fullness right at the joint area. This area is affected when doing strenuous activity, lying down, eating, chewing, yawning and of course... talking.

I always had a feeling the back of my head was being sort of dragged down to my neck. I suppose tongue posture led to the maxilla going up by millimeters, the upper palate expanding by millimeters and the lower jaw not actually following as it should have, or following and dragging the back of my skull twisting it by a few degrees (?) leading to neck stiffness. I don't believe I can actually "push" the entire joint to the ear canal, that's just not possible. I do believe it's a muscle issue. I think one can understand if it's getting better or worse by ear itchiness to be honest as mine completely went away as soon as I stopped doing it. Tinnitus remains but has a 25% actual reduction since day 1 (no habituation BS) and ETD is also slightly better. The aural fullness never felt normal anyway, it's as if something is pressing on the bone that hosts the middle ear. Back when I was doing the tongue thing, I could tell I started bulging a bit under my zygomatic arch, there was tension. That's where the joint was.

I have no idea how a splint can correct this other than basically relaxing the muscles but I don't know how you can reprogram a "correct" bite when this whole thing is out of place.

Boys, we're going in.

 

[donotringatme]

Alright, here are images of 2017 and 2020 x-rays. 2017 is long before I started mewing or clenching hard, 2020 one I took after tinnitus onset so it's fresh. Also took a cephalometric one that same day. Both X-rays same facility, machine, posture and bite to the machine to take the X-ray.

2017 one, condyles look good and in position. 2020 one, condyles look changed. Right one out of place, left one also off compared to 2017. Also, in my cephalometric, am I blind or do I see an elongated styloid process? I remember @Greg Sacramento mentioning this and a relevant thread here somewhere. I googled Eagles syndrome to view such images and some of them have the same styloid process length as mine. Is this maybe why 2 days prior to tinnitus I had this weird deep sensation in my SCM, feeling was deeper than muscle.

I think this is it really. Either it's just TMD creating aural fullness and tinnitus. Or both. I don't think an elongated styloid process causes aural fullness, does it? Is this why I lie down in the pillow I have tinnitus change? And lying on the side gives me temporarily a pulsatile feeling in the ear but it goes away tbh.

How do I fix this mess lol.

 

[donotringatme]

Okay. It comes down to one thing. TMD.

X-rays don't lie. Tongue posture probably worked as an appliance and messed my upper palate up, creating an improper bite, forces created cranial misalignments, accompanied by muscle tension, tension to the ligaments too and tinnitus eventually snapped. I assume many more suffer from this without doing the stupid tongue posture or applying forces. I caused this. Others had no choice to it. But the treatment choice is pretty much laid out. Guard, splint, muscle manual therapy, X-rays and CBCT falling under the category of diagnosis and monitoring, cranial manipulation and of course patience.

Reversing mewing is the only option to silence. I keep my tongue rested down as it always was before. Muscle tension, bulging temples and forehead, everything seems to be slowly coming down. The joint area is still under pressure. The ears are still under pressure. The mild static tinnitus is always present. The high pitch mild tinnitus appears itself during sleep sometimes or under strenuous activity during which tension is created to the sternocleidomastoid, masseters, temporalis and occipital from habit, therefore leading to more pressure which results to more tinnitus.

I sincerely wish everyone a speedy recovery or habituation regardless of the cause. This forum helped me identify the problem and rule out other problems. I learned a lot. My most dearest thanks to @Greg Sacramento who has been a catalyst.

I found many links about TMD affecting the tympani too, causing hyperacusis and a variety of tunes, I mention it for user @weab00 who I think also caused his tinnitus from mewing and not trauma.

I hope one day I will come back to post in success stories. Take care.

 

[kamil1364]

I suffer from mild static tinnitus and dysacusis/reactive tinnitus.

I am worried it was brought by too loud headphone use and lawnmowing without proper ear protection.
But I always had problems with bite - it's bilateral. Always heard and felt that popping noise when chewing, lately it got so much worse.

I already visited TMJD specialist, and so far he has made molding of my teeth, I'll keep you up to date guys.

My hearing turned out to be normal in standard audiogram, on the upper frequencies I have slightly better hearing than most of my friends who played in bands with me, so I hope it might all get resolved with proper dental treatment, although I am going to stay away from headphones/loud noise for a while for sure.

 

[Aaron91]

I've been doing a lot of reading the last few days about the neck and TMJ disorder. It's interesting to me that although I got my H during lockdown following a loud motorbike passing by me on the road, it was also during lockdown that I started to notice noticeable pain and discomfort in my neck, jaw and shoulders from looking down at my phone/laptop all day long as I had nothing else better to do. I was also under immense stress from losing my Dad around that time and I know I grind my teeth at night.

A few weeks after I developed H, I had an X-ray to check for any teeth issues. My doctor didn't make any comment on the state of my jaw, even though I know I've had issues with it for years (clicks, pops, inflammation etc.), but I'd be interested if anyone can make any sense of my scan. My hyperacusis has improved considerably in my left ear but it's still quite bad in my right ear.

 

[donotringatme]

Your X-ray looks fine to me as far as the TMJ is concerned.

I believe that masticatory muscles can change the mandible and therefore the bite, which creates anatomical changes that can affect the ear directly, muscle hyperactivity and tension that can affect the CNS. Check last 2 posts there.

I'm still trying to figure out some things because the guy who treats me now is an annoying poser who doesn't like explaining much but next week I will force him. He is manipulating my temporal area, c1 and c2 and they can see if something is sort of "out of place" or has become "dysmorphic". It is stated that hyperactivity in the temporal area, bulging and some other nearby clues that I miss, are the preliminary factors for depression.

Like I said, dude is not being entirely transparent and he's pissing me off but next week I'll update with hopefully something of value.

The one thing I can say is that the way those X-rays are taken, usually force our head and bite in a weird position which can actually not be very indicative of TMD. A CBCT scan would be better.

 

[linearb]

In my experience it's often a significant contributing factor but rarely a cause -- that is, there seem to be a LOT of people who (like me) feel that treating their TMD symptoms makes their tinnitus less bad, but doesn't make it go away. In 20 years of reading tinnitus anecdotes online I have read maybe 3-4 where people claimed complete resolution from TMJD treatment, compared to hundreds of anecdotes reporting either partial relief or no change.

If we consider the current theory on the neurogenesis of tinnitus then this makes a great deal of sense: tinnitus arises from a miswiring at the DCN level which causes touch-sensing neuronal data to be heard as "sound".

So, in this model, it makes a lot of sense that TMJD causing inflammation, irritation and compression of the structures around the TMJ would make tinnitus worse, and if you treat the TMJD you will improve the tinnitus. However, you won't fix the fundamental problem (which is some amount of hearing loss combined with a DCN miswiring) just through TMJD manipulations.

 

[donotringatme]

I tried to make a somewhat small useful post of those somatic tinnitus articles we link, maybe someone can go to his physiotherapist more prepared or self-diagnose to an extent. Anyway.

//Questions

• Do they have or priorly had neck or jaw pain or stiffness?
• Clicking in the jaw, indicating that the TMJ disc is displacing?
• Are there signs of fullness of the ears or aural clicking, indicating eustachian tube dysfunction?
• Is there a history of migraines, either present or priorly?
• Does the patient have vertigo or headaches?
• Does their external jugular vein distend as they sit or lie supine, indicative of increased secondary venous drainage, and potential IJV compression?
• Do they hinge at the neck or have significant forward head posture or thoracic kyphosis?
• Is there underdevelopment of the maxilla?
• History of trigeminal neuralgia or similar neurologic disorder?
• Is there a dropped hyoid bone?
• Is the mandible maximally retracted in resting position?
• Is there atlas torsion?
• Are they clenching the hyoidal musculature in posture or during neck loading?

//Tests

• Find movements that modulate pitch. Periodic stretch of suspected muscles or squeeze thumb for ten seconds to indicate pain, pain indicates weakness, weakness indicates dysfunction. Strengthen suspected muscles for one week and if no pitch alteration then exclude them as a root cause.
• The cervical plexuscan be grossly tested by pulling the chin down to the sternum for a good 30 seconds. Does the pitch change?
• For the trigeminal nerve,forward or backward movement of the jaw, as well as manual pressure into the auriculotemporal nerve between the ear and mandible, or into the lateral pterygoids.
• For the vagus nerve and brachial plexus, perform ipsilateral rotation and dorsal cervical movement to pull the ipsilateral ear toward the spine (as in the DeKleyn's test as shown below), once again for thirty seconds.
• For the sympathetic cervical plexus, have the patient pull the head back toward the dorsum (spine) with a nasty cervical hinge, leave it for thirty seconds. In the latter, you are looking for both pitch changes as well as a feeling of intracranial hypertension, as the jugular vein most likely compresses against the atlas.
• For vascular testing, these are once again similar to the DeKleyn's test for the vertebral artery and posterior cervical hinging to see if intracranial hypertension occurs (simply ask the patient if they feel pressure building up fast). Generally, because vascular symptoms tend to show up after higher demand of cardiovascular activity, these tests may seem negative unless the patient has severe dysfunction, and may be done right after a short jog or similar. Evaluating the patient's posture, musculature and history (migraines etc) are usually greater indicators of possible dysfunction than just doing these tests. Thus, just because a test is negative, this doesn't necessarily mean that no relevant musculoskeletal dysfunction is present.

//More issues and treatment

• Patient start to clench the hyoidal muscles to make up for poor function of the deep neck flexors. It will often cause the mandible to jam into the TMJ socket.
• A dropped scapula and/or excessive kyphosis of the thoracic spine will promote cervical hinging, which once again causes utter inhibition of the deep neck flexors, scalenes, sternocleidomastoid and more.
• Spinal integrity (alignment) is necessary for these muscles to work properly and reflexively.
• Learning to maintain 'long neck' posture, with proper cervical, thoracic and scapular positioning, and without clenching the hyoidal musculature, is the first and most important step to stop things from getting worse, and setting the foundation for proper rehabilitation.
• Once proper posture has been achieved, rehabilitation of the musculature that has been found related to nerve entrapment or similar, must be rehabilitated, which basically means carefully strengthened.
• For the various nerve entrapment syndromes we have been discussing, strengthening the pterygoids, trapezius, longus colli, longus capitis, scalenes, sternocleidomastoid and suboccipital muscles will be a good start, presuming the adequate postural correctives have been implemented already.
• This will, once the muscles are once again strong and healthy, cause the vagal and trigeminal nerves along with the brachial, cervical and cervical sympathetic plexuses to un-entrap.
• This approach will also decompress the internal jugular vein and vertebral arteries. Although this may seem simple, maybe even too simple to be true, you will see that implementing all of these correctives after (often) a lifetime of dysfunction is extremely hard work.

// Articles that help

• The true cause and solution for temporomandibular dysfunction (TMD)
• Atlas joint instability: Causes, consequences and solutions
• Resolve migraine headaches by addressing the atlas and thoracic outlet
• How to truly identify and treat thoracic outlet syndrome (TOS)
• Spiral CT Scan Image
• Atypical Earache Otomandibular Symptoms
• Jaw and ear ligaments connection for tinnitus

I read every article line by line and now realize why tinnitus is so complex, even for those who are excluded from the common ear disorders. It's laughable that I thought Eustachian tube dysfunction is the only cause and that I would treat it. @Greg Sacramento was absolutely right and I tried hard to rationalize and deny the complexity of the matter of tinnitus but to no avail.

I suppose all one can do is get scans after scans after scans and fix things one by one, trying to find cure through the classic process of elimination. Unfortunately, that's tinnitus.

 

[NikoD]

This is a fascinating thread. I'm deep-diving into a publication I read about the connection between temporomandibular disorders and hearing/balance issues. To summarize, it suggests TMJ dysfunction may impact the cochlear through various mechanisms because of its proximity - such as sudden changes in blood flow, physical trauma or pressure changes to the inner ear. Mostly my speculation, bone remodeling could cascade through chemical signalling to surrounding areas or inflammation, which in turn can compromise the cochlear/hearing. The cochlear is 'bone remodeling privileged,' in which very little bone remodeling should occur here compared to the rest of the body; cells in the cochlear produce a special chemical signal, OPG, to prevent remodeling from occurring. I do wonder if TMJ disorder pushes the OPG/RANKL ratio to remodel. Again speculation.

Oddly, there isn't any literature apart from a single publication/case study, so I could be chasing my tail.