Struggling to Find Cause of Tinnitus — Mild Hearing Loss? Allergies? Stress? TMD?

[BB1]

I have had persistent tinnitus for about a month now and I am struggling to find the cause. I know there is limited understanding about what actually causes the condition, but clearly some levels of description exist as this group requires us to list a cause, even if it is - like in my case - unknown. Getting help from my medical provider (Kaiser) has not been terribly successful. I'm hoping group members might have suggestions for how to proceed.

I contacted my doctor about the tinnitus not long after it started and suggested it was due to earwax. I had my ears cleaned but the tinnitus continued. I did a test with the audiologist, who noted mild hearing loss but actually pointed to allergies, stress and TMD as possible causes. My doctor later said that mild hearing loss explained my tinnitus, which kind of seemed to contradict what the audiologist found.

It seems to me the key question is whether the tinnitus is related to a medical condition that can be treated - i.e. an infection related to my chronic allergies - or it is just the result of hearing loss and is something I must learn to live with. Am I framing the question correctly? How should I answer it? What steps do I need to take with my medical provider?

Any thoughts appreciated. This condition is hell. It is interfering with sleep and work.

 

[HalloweenScreamQueen]

Tinnitus sucks, and not in a good way. You may never figure out what caused it or it could disappear next week. I've had tinnitus since puberty (and that happened about 45 years ago!), with no known cause. I didn't go to KISS concerts at twelve, no ototoxic drugs, no loud tv, nothing. And I didn't know I should probably tell someone about this new noise in my head, so no treatment either. But I got used to it and now really only think about it when I'm posting here or am going to be someplace noisy.

If possible, get a referral to an ENT, an allergy doc, and an audiologist who specializes in tinnitus.

Where are you located?

 

[BB1]

Where are you located?

Sacramento. I only see a couple of audiologists listed on the ATA website for this area. Seems like I need to see an ENT to find out if there's a physical cause. IDK.

 

[Michael Leigh]

I have had persistent tinnitus for about a month now and I am struggling to find the cause.

The onset of tinnitus can happen without a cause but this isn't usually the case. Exposure to loud noise is a common cause of tinnitus. An underlying medical condition within the auditory system can be responsible. Stress can bring it on too. A problem with the jaw known as TMJ. It can also be linked to medication.

If you are a regular user of headphones, earbuds or headsets, then you might have been listening to audio at too high volume without realizing it. Or if you work in noisy environment or are exposed to other forms of loud noise. Any of these things could indicate your tinnitus is noise induced. If you are oversensitive to sound, this could be another indication the tinnitus is noise induced.

If loud noise isn't the cause, then look at other things that I have mentioned.

You might find my post in the link below helpful.

All the best,
Michael

New to Tinnitus, What to Do? | Tinnitus Talk Support Forum

 

[HalloweenScreamQueen]

I would see an ENT, especially if you can find one who knows anything about tinnitus.

 

[BB1]

Michael: Do you think I should make a point of seeing an ENT?

My health care provider has said that I should just follow up with the audiologist in a few months. I don't have a history of repeated exposure to loud noise although, like most people, I have worn earbuds some.

The only thing I can think of is my history of chronic allergies. I had a sinus infection recently and I have read those can develop into ear infections and cause tinnitus. On the other hand, if that's true, the condition will likely resolve on its own. We all want to know and solve this problem, but it seems like the risk of going down the rabbit hole is very real and just makes this condition worse than it needs to be.

 

[Michael Leigh]

Michael: Do you think I should make a point of seeing an ENT?

In the early stages of tinnitus the best thing is to wait and see what happens. I assume that you have already talked to your GP. Unless you are experiencing deafness, dizziness, problems with balance, it is too soon to be visiting ENT. A period of at least 4, preferably 6 months should elapse before seeing an ENT doctor, providing you are not experiencing any of the symptoms I have mentioned.

The ear is a delicate organ. Even if you were seen at ENT at this early stage the doctor is likely to tell you to wait and do nothing, assuming nothing untoward is found during tests. The ear will often right itself and for this reason doctors prefer not to intervene too soon.

Please read my post in the link that I have given you as it explains this in more detail. Click on the link below and read my post: Tinnitus, A Personal View. Use low level sound enrichment especially at night, more about this is explained in the posts.

I think it's a good idea not to use any type of headphones even at low volume.

Michael

Tinnitus, A Personal View | Tinnitus Talk Support Forum

 

[BB1]

Thank you. That is very helpful information. This problem would be much easier if doctors just took the time to explain why they are making these decisions, instead of just sending you a link to some article that may not be all that helpful.

 

[mohn]

What method was used to remove the earwax? Have you seen any change (even slight) in your symptoms after the earwax removal?

 

[BB1]

The nurse used what appeared to be soapy water, but I didn't ask. It was a spray bottle. I noticed no change in symptoms. I took acetic acid drops for seven days and that did not help. I had an outer ear infection and perhaps an inner one too. My hope is that when the infections clear, the symptoms will decrease or go away.

 

[BB1]

Update:

I have have had separate visits with an ENT nurse practitioner and an ENT doctor and the cause of my continuing tinnitus remains unclear.

The nurse, who seemed far more knowledgeable about tinnitus than the doctor, said she was hopeful that my unilateral tinnitus will go away when the Eustachian Tube Dysfunction does.

The doctor said he thinks the tinnitus is due to hearing loss. The hearing loss argument makes no sense to me because the tinnitus came at the same time as sinus and ear congestion, almost certainly from chronic allergies. I have hearing loss in both ears but tinnitus in one.

I don't think anyone really knows what is causing this and it is just a guessing game. In a sense, I'm comfortable with the mystery because it gives me some hope this may resolve. I am also preparing myself for the possibility it won't go away.

 

[BB1]

I'm interested in hearing from people who believe TMD caused their tinnitus. How have people figured out that TMD caused their tinnitus? I have had unilateral tinnitus for about four months. I have mild to moderate hearing loss, but I had no significant experience with tinnitus prior to this. I thought it the result of eustachian tube dysfunction and allergies. But two weeks ago, I had ear tubes put in, and the tinnitus is as bad as ever. As worse as it has been. So now I'm wondering if it was caused by TMD.

Here are some reasons why I suspect TMD:

• I have worn a jaw advancing mouthpiece for sleep apnea for six years. It makes my jaw sore
• My jaw feels increasingly tender the last couple of months, as I have dealt with increased stress and arthritis in my neck (this just surfaced)
• My poor posture and stress level makes me a prime candidate for TMD.

Any thoughts appreciated.

 

[Greg Sacramento]

@BB1, I saw that you mentioned Sacramento. I also live in Sacramento. I knew of someone with your name with association to a professional career and the outdoors.

Please forgive my writing skills as I lost most vision and have severe mouth pain.

We have some similar conditions - neck, jaw, posture and tinnitus.

Posted here close to a thousand times on neck, jaw, mouth, facial, ETD and posture with tinnitus.

I would say your problems started with posture which caused neck problems - unnoticeable muscle spasms placing pressure to C-spine and this can later cause neck arthritis and reflect to jaw. With this, it made it easier for your jaw muscles to receive tension from use of your specified mouthpiece. Your sternocleidomastoid muscle of one side may have posture involvement. This muscle can also increase Eustachian Tube Dysfunction and allergies. Trapezius muscles also can have association with posture concerns.

With mentions so far, this can cause or increase Eustachian Tube Dysfunction from allergies. From this, fluid traveled to sore muscles of jaw, neck and especially ears and this may be cause of tinnitus and may resolve in time.

For your jaw/neck to be the only cause of tinnitus, your tinnitus would be somatic - somatic tinnitus. Let me know if your tinnitus is somatic.

If you do have somatic tinnitus, I would consider starting investigation with neck X rays. I would get radiology CBCT of jaw, Eustachian tube, sinuses and neck. This is a single 30-45 second sitting test exam. There are two CBCT exam centers in Sacramento. The lead radiologist is very famous, just like you.

 

[BB1]

@Greg Sacramento, thank you for responding to my message. What you said seems right on point.

I have become increasingly concerned about posture in the last year because I developed sciatica and then neck arthritis. I had been doing daily exercises from a Kaiser physical therapist and they helped neutralize the pain but were not giving me the results I wanted. Through research and trial and error I recently came across the discipline of posture therapy and the work of Pete Egoscue. I don't have the money for private personal trainers so this week I started a program of 1-hour daily online postural exercises through the website ptx.com. I also have made adjustments to my work style so the desk life isn't killing me as much.

I had wondered what role posture my play in my tinnitus. When the neck problems started, it occurred to me that it might be creating stresses that showed up in my jaw and therefore on my ear. Then I started reading about posture therapy and how some people had seen reductions in tinnitus through the practice. I will read some of your posts to see if I can gain more insight.

I don't know if my tinnitus is somatic. That is the big question here. I have mild to moderate hearing loss, all on the high end. But the sudden onset of the tinnitus, and the fact that it came along with a clogged ear and following a sinus infection, suggests that it is at least partially somatic.

That is why what you said about the CBCT scan was most interesting. I will contact that provider to see about getting one. Are you talking about DDI and Dr. David Hatcher? I would like to get such a scan and then take it to the ENT I'm seeing at Kaiser to get the help I need, presuming there is a medical answer. It may be this is something that can only be treated through therapy. And that would be great too. I just am not ready to "just live with it" although I realize some acceptance is needed sooner rather than later.

Thanks again for helping.

 

[BB1]

@Greg Sacramento, I just realized I didn't understand the meaning of somatic tinnitus. Yes, I have that. It can only be heard by me. I doubt there is only one cause of my tinnitus. The evidence right now points to hearing loss, ETD and, like we've been discussing, jaw and neck problems.

 

[Greg Sacramento]

@BB1, X rays are needed to see if your C spine has straightened or has been pressured. This can occur in several ways, but I'm wondering about use of a backpack causing muscle spasms to back, shoulders and neck. More so, if any forward head bending occurred while wearing a backpack. Neck muscle spasms from lifting my head off a dental headrest caused my somatic tinnitus from what is highlighted below.

Any abnormal change(s) to C spine can cause problems and could have led to all your keyword problems.

ETD can cause hearing loss tinnitus with fluid travel to the ears, but with also having neck arthritis and jaw soreness, your sensory nervous, central nervous, skeletal and muscular systems all containing sensory receptor cells probably said lets make this tinnitus somatic. This would be more than just mechanoreceptors auditory hair cells detecting mechanical movement of cells from fluid in the ear.

Until we know more from X rays, it appears that concerning posture aided muscle pressure to C spine causing arthritic issues. Your jaw issues are interdisciplinary - ETD fluids, mouthpiece, C spine can all be players. Jaw may be a limited somatic issue, but your C spine, neck muscles including the sternocleidomastoids. occipital nerves and fusion cells may be more of somatic concerns. I don't think that you have developed cervical radiculopathy.

Until cervical X rays are done, I be careful not to have too much pressure placed to cervical spine and muscles. I would get trapezoid therapy and work on forward head bending posture. I would use just one pillow.

I would also consider a DDI CBCT exam.

Two questions:
Is your neck sore from tight muscles?
Have you ever used communication headphones?

 

[BB1]

@Greg Sacramento, I don't think I fully understand what you are saying about my cervical spine. But I don't think my neck issues are related to pressure from a backpack or anything else. It is from forward head posture, more than anything.

I have had an X-ray on my neck and back. It found osteophytes between C6 and C7.

I am requesting an MRI so I can get more detail, in part because of what also happened with my lower back.

I am going to get a CBCT scan from DDI, looking at the throat, jaw, sinuses and teeth. They don't scan the Eustachian tube, but the person I spoke to there said this is the scan I want and many people want because they want to know if TMD is causing tinnitus.

I'm being careful with my neck but also think a fair amount of movement is what I need most. I am not backpacking these days and it may be a while, sadly.

Yes, I have sore neck muscles. Not unbearable but what might be expected in my situation.

I don't have a lot of experience with headphones.

 

[Greg Sacramento]

@BB1, with your neck X-ray notations, neck can be ruled out as cause of tinnitus, but an abridging osteophyte between C6 and C7 vertebrae can cause obstructive sleep apnea.

Inflamed Eustachian Tube Dysfunction or infection traveling from chronic allergies may be cause of tinnitus, but let's see what the CBCT shows as just having mouth soreness doesn't give us much to work with without joint or mouth pain.

Let me know when you get test results.

 

[BB1]

I am holding off on getting a CBCT scan until I meet with an oral surgeon next month to discuss how to treat TMD. Whether it is TMD or something else, my tinnitus seems highly related to some sort of pain. My pain increases, and so does my tinnitus. It is quieter in the morning when I'm not achy. But as I get tired and sore, the tinnitus starts screaming. It has been like this for the last month, when back and neck pain and TMD have been consistent.

 

[Greg Sacramento]

@BB1, somatic signals that have relation to somatosensory tinnitus are generated from muscle position sensors in the face, neck, head, trunk, tongue, and the temporomandibular joint (TMJ). Somatosensory information from the cervical spine or jaw area can cause or change a patient's tinnitus.

Cervical muscle spasms with often also having a bad back can cause moderate TMD, thus causing somatosensory tinnitus.
This can be caused from forward head posture.
Sinus problems can then be increased. With this, fluid can travel to ears causing hearing loss and/or tinnitus.

For you - multifaceted concerns or just one concern causing somatosensory tinnitus?

There's thousands of case studies with different scenarios that can include more than what I mentioned.

Possible that neck muscle spasms from forward head posture took a limit and is causing quick development of TMD.

For you - Radiologic testing to start with.
A CBCT might be helpful for jaw and to see if sinuses are clear.
Updated C spine X rays.
Then MRA or CTA of cervical and MRI of jaw may be needed.
Oral surgeon may be helpful and or not very helpful.
Interventional radiologists for jaw and cervical spine should be very helpful.

 

[BB1]

@Greg Sacramento, I got the CBCT scan and report. I can't make heads or tails of it. I sent it to my ENT. The only thing that sounds significant is "the possible hyperostotic formation at the superior aspect of the left condyle could indicate articular soft-tissue/discal defect, but this is speculative." Do you know what it means?

Thanks,
Brad

 

[Greg Sacramento]

"the possible hyperostotic formation at the superior aspect of the left condyle could indicate articular soft-tissue/distal defect, but this is speculative." Do you know what it means?

Yes, I know what it means and it's usually considered speculative, but not for you with using a jaw advancing mouthpiece for sleep apnea for six years. Compression from this, could cause somatic tinnitus with more stress happening later into the day.

I won't give you an anatomy lecture, but should explain with this:

The articular disk is made of fibrous connective tissue, which is not supplied by any nerve or blood vessel. The posterior attachment (retrodiscal tissue) is highly vascularized and innervated, and is bordered by retrodiscal lamina, superiorly and inferiorly. The articular disk is attached superiorly and inferiorly to the capsular ligament, which covers the entire TMJ. Anteriorly, the disk is attached to the superior lateral pterygoid muscle fibers, a part of one of the main masticatory muscles. The articular disk functions as a cushion to protect the joint structures by absorbing the stresses and distributing them to a broader area, thereby, providing smooth movement of the condyle.

For you, it's not a nerve or blood vessel causing tinnitus, but either retrodiscal tissue or pterygoid muscle fiber. I'll go with pterygoid muscle fiber.

Treatment: I would speak to your oral surgeon about pterygoid injections. The procedure may cause acoustic discomfort for a few days.

 

[BB1]

What kind of injections? Where exactly would they be made?

 

[Greg Sacramento]

@BB1, in our area, the best oral surgeons for this are located downtown.

Botulinum toxin into the lateral pterygoids, but also maybe into the medial pterygoids. Would like to see your scans of this area.

 

[BB1]

 

[Greg Sacramento]

@BB1, hyperostotic formation at the superior aspect of the left condyle seems to be. Would need to see more scans, but prolonged pressure may have caused very slight non concerning arthritic changes. MRI is best to confirm this.

You may have loose connective tissue attached to the posterior edge of the articular disc. MRI is again needed to view this. Retrodiscal tissue is well innervated by nerves and blood vessels. This condition can cause pain during jaw movements and sometimes a clicking sound is heard when opening mouth.

Unlike the disc itself, the retrodiscal tissue is vascular and highly innervated by nerves and blood vessels. This certainly could cause somatic tinnitus.

Fortunately, in most of the cases, the condition resolves by itself after some time. This is thanks to a process called natural adaption of the retrodiscal tissue, which after a while becomes scar tissue and can functionally replace the disc. Using a jaw advancing mouthpiece could stop recovery.

To help the process is to use a foam toothpaste. I know that Advanced Crest Restore toothpaste used with a very soft brush helps. Toothpaste placed on sides of brush and placed gently around and behind wisdom teeth.

When seeing your oral surgeon bring your scans with you.

 

[BB1]

Thanks. Do you still think Botox injections are a good idea?

 

[Greg Sacramento]

Thanks. Do you still think Botox injections are a good idea?

Not really now, after seeing your scans with notation.

Worked with someone else with your problem and severe tinnitus of two years is completely gone.

I would start using foam toothpaste - mentioned above.

I would avoid using your jaw advancing mouthpiece.

Let me know how your dental appointment goes.

 

[BB1]

I stopped wearing the mouthpiece last week, when the problem became evident. How exactly does the foam toothpaste help this problem? I will definitely try it, but am just curious how it would work.

 

[Greg Sacramento]

I stopped wearing the mouthpiece last week, when the problem became evident. How exactly does the foam toothpaste help this problem? I will definitely try it, but am just curious how it would work.

It pernitrates tissue better, softer and promotes healing. I carefully wet this toothpaste after I cover entire tooth brush with it.