Theory: ETD the Root Cause of Somatic Tinnitus

[donotringatme]

https://goodhealthcentre.co.uk/tinnitus-temporomandibular-joint/

THEORIES OF TMJ INVOLVEMENT IN TINNITUS

1. The chewing muscles' approximation to the inner ear can impact on hearing if the muscles become too tense. (Temporalis, Masseter, Pterygoid). By the muscles becoming tense it may alter the size of the Eustachian tube and tympanic membrane.
2. There is a ligament attaching from the jaw to a bone on the middle ear called the malleus. If this ligament becomes overstrained, sprained or inflamed it can impact on tinnitus.
3. The nerve supply to the TMJ has connections with the area of the brain that interprets sound, an alteration to the TMJ's function may inhibit the nerve function.
4. There is also a significant link between TMJ problems and acute or chronic neck problems.

Of course, those are again generalized statements.

This article is interesting: https://www.tmdheadacheoregon.com/assets/docs/32.pdf

It's obvious that people can have such dysfunctions without doing stupid things like mewing. Those dysfunctional patterns can go on for years and then tinnitus starts. Those patterns don't get fixed, tinnitus worsens. TMJ dysfunctions described as muscle hyperactivity (can be any of the things mentioned before) can either damage the ear, cause tinnitus from minor reversible damage to parts of the ear or around the ear and/or lead to Eustachian tube dysfunction of an anatomical / mechanical manner, which explains why ETD is present on people with "clean" tubes or why people get Patulous tubes in their late twenties or thirties out of the blue (which is just dumb, considering literature lists PET as something one would have from birth.

Still not a "cure" but at least one has clues to move forward with it. Muscle hyperactivity, improper bite, improper muscle function to the maxilla and jaw (read posts up), nerve irritation, bones pushing against the ear (I've no idea if this is actually feasible), Eustachian tube hypertrophy, dysfunction and failure to equalize properly, tympanic membrane alterations (meh), and bone remodeling that can lead to cranial dysfunction(?) that stretches to the neck, shoulders and then we end up massaging our feet to relieve tinnitus.

I truly truly believe it IS the jaw (the most fascinating joint is the TMJ after all) and as a result of THAT dysfunction, ETD, which can produce tinnitus by itself.

Interesting.

 

[donotringatme]

Supposedly the mechanism of evil causing it all. To be continued.

 

[donotringatme]

Tympanometry printed results give some decent information. Other tests are LDV, ECR and wideband tympanometry for checking ossicular disruption / discontinuity, flaccid ear drum etc. There can be ETD without blatant tympanometry results or fluid.

Other tests are ET test on ENT machine, it literally measures equalization ability. After that, endoscopy can be done.

Trigeminal nerve is a possible suspect.

Occiput is a possible suspect (it provides with blood the inner ear etc).

Unfortunately the ear drum itself can be the suspect too so one must have an ENT check carefully as it has many parts and some are innervated...

However, as far as ETD goes, one can definitely get detailed results for its function to rule it out. It is not as vague as i thought before.

TMD is awfully vague and unless the condyle is displaced, I doubt it is a cause. Muscular tension though or the clenching effect to the CNS could be it, so relieving tension will definitely improve tinnitus or completely remove it.

If I had to make a list it would be:
ETD
Blood flow
TMJ condyle

A CBCT for condyle, MRI and MRA for neck and head, spiral CT for atlas, the previously mentioned tests for ETD, MRN for inner ear vestibular check.

It would be convenient if a sole cause was present for every somatic tinnitus case but unfortunately...

 

[Mathew Gould]

I have a theory regarding somatic tinnitus in people with no hearing loss and it may include some with hearing loss.

The root cause is ETD. What causes ETD is what we must address.

ETD increases middle ear pressure. More pressure causes the ear drum to be stiffer. Stiffness of the ear drum causes the bones responsible for transmitting sound waves to malfunction, which causes tinnitus. The malfunction meaning eardrum stiffness and not anything severe or irreversible. The stiffness of the eardrum has a direct relation to pitch. The more stiff an eardrum is, it influences the part of cochlea responsible for high Hz. On the contrary, an eardrum moving too much influences low Hz.

This can explain why we have a static - in my opinion caused purely by increased middle ear pressure - and a high pitch that may or may not alternate.

Why it alternates I think depends on three things: middle ear pressure changes, outer ear pressure changes and muscles and those can change a dozen times per day which can explain why some experience frequent pitch changes.

If middle ear pressure worsens, the tinnitus worsens. If outer ear pressure increases, I bet you your tinnitus will improve for a minute as the pressure comes closer to equalizing but the aural fullness remains so the sensation is going to be bad. Muscles affect the ear and movements can pull on it, affecting the eardrum, thus affecting the bones, thus affecting the tinnitus, muscles such as the SCM. Literature states also that the back of our ear plays a supporting role at helping the eardrum endure ear pressure differences.

Other muscles that may affect this are face muscles, directly influenced by the jaw. Imbalances are created by the mouth IMO, not a severely messed up jaw. One however must address the jaw because it's all related. Muscles, ligaments, glands, it can create an absolute mess that FYI is the root cause of the ETD in the first place. Inflammation or anatomical changes that need to be addressed. This is why steroid medications help as they reduce inflammation and ETD is also reduced. Others are completely cured by addressing sinus infection, ETD resolves, eardrum returns to normal function, bones too, tinnitus is gone.

Neck also plays a role because it directly affects the ear and also the SCM and the muscles of the face and the posture, posture affects our face, even contributes to bone altering position and fascia (not augmentation as this is impossible).

So, inflammation and strain in such conditions is certain. It develops slowly, it leads to ETD, ETD is not understood immediately especially in cases of no sinus infection or fluid presence (aka mechanical issue) so pressure builds up, eventually tiring the eardrum to the point that it starts to act up, since the bones behind it malfunction.

This also explains why PET hear a completely different low Hz pitch, since the pressure and eardrum are the exact opposite.

Neck then has nerves that can modulate the ear so if you go and irritate that nerve, your tinnitus will increase momentarily. In that sense, it contributes to the issue but I don't think it's the main problem.

The funny part now is how to address ETD, because you can't really directly address it. You have to do this backwards by addressing everything else, as everything else contributes to its development. That means addressing your pelvis, core, upper back and neck (as neck issues stem from below), then focusing on your face, knowing that everything below the head no longer contributes negatively. Of course this takes time, effort, money and someone who knows what they do.

Now, you can focus on the face which is an absolute mess so an MRI has to be done, there are some that allow you to also do various jaw movements to monitor ET function. Since most - if not all - can detect ETD in one or all movements of its function (swallowing, chewing, yawning), it's obviously a jaw and mouth mechanical issue. Myofascial release and medication help but to permanently alter something, one must address the mouth and consequently the teeth and tongue. From malocclusion to improper tongue posture or forces applied. An MRI and CT will hopefully show what's going on and one can start addressing everything slowly and see whether there is improvement or not. So, I don't think it's a nerve being pinched (especially if you have discomfort only and no severe pain) or something hitting the ear canal etc.

During the past few days I tried things. I tried dietary changes, tried ACV, tried tiring myself etc. Those, including cold showers, avoiding caffeine, calming the nervous system down, ALL help modulate tinnitus. However, it remains the same. What do I mean? It changes from better to worse based ONLY on my ETD. ETD worsens with certain movements or positions, tinnitus increases. ETD improves, tinnitus decreases. The ONLY thing that considerably helped was a week of cortisone, because it greatly reduced the inflammation, thus improving ETD, but not addressing the root cause. I doubt blood pressure and relaxation techniques do anything more than addressing muscle tension.

So, if you have somatic tinnitus, do a test to measure your middle ear pressure, have the ENT closely monitor your eardrum condition, take a close look at the ET using a camera through the nose and also monitor any hearing loss once per month.

If this theory is correct then tinnitus should be eliminated completely once one fixes ETD, perhaps not instantly, But if the conditions for an ear to heal are present and nothing intervenes anymore, it should heal in quick time and THAT is the point where I do believe nerve healing protocols can indeed help.

Before my tinnitus I had to pull on my left ear a little to crack it from time to time, I was fine then... After my tinnitus started from forward head posture which caused neck and jaw issues, now I have to pull on my right ear to crack it for relieve. It's like everything shifted in my head.

 

[Greenkeep]

Great thread! I wanted to comment on somatic tinnitus which I totally agree is related to posture from the ground up. I am a long time sufferer of low back pain and have worked very hard fixing my issues. Recently I had a breakthrough in my pain working with my new pt. Soon after I woke up with tinnitus and a month later jaw pain. This happened because after reducing my back pain my quadratus lumborum let go slightly which then released the impingement in my left shoulder. This then resulted in scapular instability which then put more stress on my neck. I am currently addressing this instability and am confident this will end my tinnitus. Years of poor posture and alignment led me down this road. The thing that gives me hope is that the body is capable of healing with the right stimulus. I have had close to 20 years of back pain only to be greeted to my new friend tinnitus. I see this as the "right of passage" to healing.

The earlier posts are quite daunting when looking for causes as there are many but I will try to simplify things a bit. I believe somatic tinnitus is caused by weakness and instability. You can stretch till the cow comes home but nothing will improve. If something is tight then there is a reason. Release can you temporary access to musculature out of reach so that the joint in optimal position to fire. The good news is the body is always trying to heal and anyone can build muscle and endurance at any age.

For me it is always strengthening my core, hip strength and mobility. Thoracic mobility and scapular/shoulder stability. Finally cervicle stability. Don't worry about asymmetry, we are all crooked. The body is always looking for stability and will pull it wherever it needs it even if it causes tinnitus to hold your neck up or stabilize your shoulder etc. I can trace my tinnitus back to my back issues. I have postural distortion but never had tinnitus in my life until I started to fix myself. This is because when you are in dysfunction, it happens so slowly that you don't realize what is happening to you because the changes are subtle and the body finds stability over the course of time. When you correct something like I did, the changes come quick and are dramatic just like the tinnitus that came shortly after. It opened up a can of worms for sure.

 

[AliasM]

Great thread. Late at night here so I skimmed through a lot but I will return tomorrow to clarify a few things for myself. I am particularly interested your posts about sleeping position and tinnitus sounds. It is random what sounds I get from one day to the next. I usually know by midnight when I wake (always do) if I am going to have a good or bad day next day. Pure tone high pitched ring, bad day. Cricket like hissing, better day. Ultra high pitch glass crackling sensation in my brain, really bad day. I have never documented sleeping position with sound.

Any updates?

 

[Jebbis]

So much of this matches my case, @donotringatme. My tinnitus is unilateral. I also have headaches on that side, odd ocular pressure, itchiness in the ear, and an ability to greatly reduce/eliminate my sound when I plug my ears pretty hard. I have a clicking jaw on the side of the tinnitus, as well as a muscle knot at the base of my skull on the side of the tinnitus.

 

[JamesAtMvertigo]

@donotringatme, I had to register just to respond and thank you for the quality of your thread, especially the OP.

I run an online community to support people with Vestibular Disorders (mvertigo). Invariably these conditions include tinnitus. I don't usually like to compare suffering, but for those suffering "only" tinnitus (which can be initially very disturbing, granted), be thankful you don't have a slew of other symptoms in addition to that including but not limited to brain fog, disassociation, crippling migraines, nausea, imbalance, dizziness, vertigo, anxiety and depression!

Anyway, back to ETD specifically.

My journey to tinnitus started with minor ear trauma when pointing a shower at low pressure and moderate temperature into my ear one day, to try and DIY some wax removal. Oh how foolish! It was not painful, but the minor discomfort made me stop almost immediately. I barely did it for a second or two, but this was enough to set me on a journey of total life collapse (and ultimately one I rebuilt).

I initially had 5 weeks of severe imbalance and nausea, but this completely cleared up and I thought I'd dodged a bullet.

Unfortunately, a sensation of fluid build up in my ear overnight (which would drain away when I got up out of bed) did not go away, and something very strange started 5 months later: I started to get tinnitus and then a tsunami of vestibular and neurological problems hit me.

I would suffer from chronic imbalance (and varying levels of everything else) for over 3 years.

I ended up on a long journey of going from doctor to doctor and had several diagnoses, but not once could any of them explain my symptoms fully, from a logical perspective. Nearly all denied the trauma was involved and this made no sense to me at all. Finally I met a doctor who suggested that I had probably had a Perilymph Fistula and this had led to Secondary Hydrops.

However, I knew about ETD and had done some reading on it, confirming your opinion it can cause many symptoms.

Reading your post further encourages me to think that I might have physically traumatised my ear in some way which has lead to an increase in mucosa output ("fluid"), which has since subsided, but in the meantime has left chronic inflammation and a lack of 'homeostasis' - that is the ET is pinching too much when closed which as you say decreases the lower powered movements of the oval window (i.e. the high frequencies).

For a long time, periodically my ET would appear stuck shut as if with some kind of glue and I could free it with a 'crack' or 'crackle' with suitable jaw of neck movements.

I suffer from some high frequency loss and an issue with bass sounds when loud (which leads me to think the middle ear condition has altered the resonant frequency of my ear).

In any case things have improved dramatically for me over the ~ 6 years of suffering this. My vestibular and neurological issues are all but gone and I don't need to take medication anymore.

However, the fluctuating hissy tinnitus, the somatic tinnitus (clenching jaw, eating, leaning head to side), a feeling of slight ET "glueyness" and occasional pulsatile tinnitus and dull ear pain continue.

I look forward to further improvement because I feel as that's been my trajectory, it's likely to continue.

I live in hope that eventually the rest of the inflammation will subside and I'll be roughly back to normal. Just hope the apparatus of my middle ear has not been permanently affected by the inflammation. Given my lack of tinnitus and hearing loss for the initial 5 months, I can only surmise that it was the other issues were secondary and caused by the immune response.

@donotringatme, I hope you are improving and thank you again for your post!

James

 

[Lukee]

My journey to tinnitus started with minor ear trauma when pointing a shower at low pressure and moderate temperature into my ear one day, to try and DIY some wax removal. Oh how foolish! It was not painful, but the minor discomfort made me stop almost immediately. I barely did it for a second or two, but this was enough to set me on a journey of total life collapse (and ultimately one I rebuilt).

I initially had 5 weeks of severe imbalance and nausea, but this completely cleared up and I thought I'd dodged a bullet.

Unfortunately, a sensation of fluid build up in my ear overnight (which would drain away when I got up out of bed) did not go away, and something very strange started 5 months later: I started to get tinnitus and then a tsunami of vestibular and neurological problems hit me.

I would suffer from chronic imbalance (and varying levels of everything else) for over 3 years.

I ended up on a long journey of going from doctor to doctor and had several diagnoses, but not once could any of them explain my symptoms fully, from a logical perspective. Nearly all denied the trauma was involved and this made no sense to me at all. Finally I met a doctor who suggested that I had probably had a Perilymph Fistula and this had led to Secondary Hydrops.

However, I knew about ETD and had done some reading on it, confirming your opinion it can cause many symptoms.

Reading your post further encourages me to think that I might have physically traumatised my ear in some way which has lead to an increase in mucosa output ("fluid"), which has since subsided, but in the meantime has left chronic inflammation and a lack of 'homeostasis' - that is the ET is pinching too much when closed which as you say decreases the lower powered movements of the oval window (i.e. the high frequencies).

For a long time, periodically my ET would appear stuck shut as if with some kind of glue and I could free it with a 'crack' or 'crackle' with suitable jaw of neck movements.

I suffer from some high frequency loss and an issue with bass sounds when loud (which leads me to think the middle ear condition has altered the resonant frequency of my ear).

In any case things have improved dramatically for me over the ~ 6 years of suffering this. My vestibular and neurological issues are all but gone and I don't need to take medication anymore.

However, the fluctuating hissy tinnitus, the somatic tinnitus (clenching jaw, eating, leaning head to side), a feeling of slight ET "glueyness" and occasional pulsatile tinnitus and dull ear pain continue.

I look forward to further improvement because I feel as that's been my trajectory, it's likely to continue.

I live in hope that eventually the rest of the inflammation will subside and I'll be roughly back to normal. Just hope the apparatus of my middle ear has not been permanently affected by the inflammation. Given my lack of tinnitus and hearing loss for the initial 5 months, I can only surmise that it was the other issues were secondary and caused by the immune response.

@donotringatme, I hope you are improving and thank you again for your post!

James

James,

You are lucky that an ENT was even capable enough to mention hydrops or PLF as most don't venture down that path. Strangely, many people who get tinnitus end up with these symptoms of fullness, crackling and pressure in the ear. I myself have similar symptoms that came a few months after getting my initial tinnitus.

One theory I have is that I may have given myself TMJD from the stress of the initial tinnitus, even subconsciously grinding more than I normally would. I know I used to grind and clench under stressful situations and especially at night but after tinnitus my anxiety sent me into a downwards spiral where I had never been so stressed in my life.

If you look up the symptoms for TMJD, hyperacusis, fullness, crackling and glue ear type feeling are all possible (including tinnitus and migraines).

Do you think it's possible that you developed a TMJ issue?

 

[JamesAtMvertigo]

Hi Luke!

Do you think it's possible that you developed a TMJ issue?

No, definitely not. I had had zero issues with my jaw up to and including the onset of MAV symptoms (incl. tinnitus).

However, full disclosure: if you look at my diary (on my support site) you will note that I did develop TMJ subsequently as a result of muscle tensing 'relaxation' exercises my psychotherapist prescribed (Never clench your jaw unless you are eating food!). The TMJ subsequently cleared up spontaneously (almost completely) after avoiding para-functional use over a period of 2 years!

I'd say given the amount of anxiety created by these symptoms, TMJ could be an outcome of the condition too, but don't believe it's a driver. I doubt TMJ can be so bad as to cause inflammation in the ET?

I'm _certain_ I'm dealing with inflammation as a (chronic) secondary condition after the initial acute trauma.

One of my doctor friends told me that some tissues in the body can have a significant autoimmune reaction if exposed to blood. He gave the example of the knee joint soft tissues.

 

[Lukee]

Hi Luke!

No, definitely not. I had had zero issues with my jaw up to and including the onset of MAV symptoms (incl. tinnitus).

However, full disclosure: if you look at my diary (on my support site) you will note that I did develop TMJ subsequently as a result of muscle tensing 'relaxation' exercises my psychotherapist prescribed (Never clench your jaw unless you are eating food!). The TMJ subsequently cleared up spontaneously (almost completely) after avoiding para-functional use over a period of 2 years!

I'd say given the amount of anxiety created by these symptoms, TMJ could be an outcome of the condition too, but don't believe it's a driver. I doubt TMJ can be so bad as to cause inflammation in the ET?

I'm _certain_ I'm dealing with inflammation as a (chronic) secondary condition after the initial acute trauma.

One of my doctor friends told me that some tissues in the body can have a significant autoimmune reaction if exposed to blood. He gave the example of the knee joint soft tissues.

Ok. So if it's an issue with inflammation then do steroids clear up your issues? Have you ever tried LDN?

 

[JamesAtMvertigo]

Ok. So if it's an issue with inflammation then do steroids clear up your issues? Have you ever tried LDN?

I heard that long-term, steroids are not an effective treatment for ETD, but tempted to pop to an ENT to re-verify that?

What's LDN?

 

[Lukee]

What's LDN?

Low-dose Naltrexone.

 

[JamesAtMvertigo]

Hey @Lukee et al, I've had some further thoughts on this.

I wonder if during attempted irrigation of my ear, I leant my head over and accidentally let some stomach fluids into my ET?

I recall the feeling of dizziness coming on some minutes later (not immediately after application of water). In fact it was at least 15-20 minutes later. I'm wondering if this was the inflammatory reaction in my middle ear building up?

I raise this because of this research:

Reflux Revisited: Advancing the Role of Pepsin

You might imagine this is a risk for anyone, especially those with GERD or a bad bout of Gastritis.

One more point about your suggestion of TMJ being at fault: what if it was the other way around? If your ET became puffed up with inflammation and less flexible, I suspect it might cause a change in the amount of force needed to move the jaw, even very slightly, meaning that existing neurological learned patterns of muscle tension would have to be relearnt in order to realign everything as a habit.

 

[Lukee]

Hey @Lukee et al, I've had some further thoughts on this.

I wonder if during attempted irrigation of my ear, I leant my head over and accidentally let some stomach fluids into my ET?

I recall the feeling of dizziness coming on some minutes later (not immediately after application of water). In fact it was at least 15-20 minutes later. I'm wondering if this was the inflammatory reaction in my middle ear building up?

I raise this because of this research:

Reflux Revisited: Advancing the Role of Pepsin

You might imagine this is a risk for anyone, especially those with GERD or a bad bout of Gastritis.

One more point about your suggestion of TMJ being at fault: what if it was the other way around? If your ET became puffed up with inflammation and less flexible, I suspect it might cause a change in the amount of force needed to move the jaw, even very slightly, meaning that existing neurological learned patterns of muscle tension would have to be relearnt in order to realign everything as a habit.

I'm not going to say it's far fetched but anything is really possible. There is something called LPR or silent reflux which can cause ETD and middle ear issues without the common GERD symptoms. If you have GERD you could start from there by treating it and see how everything else reacts.

 

[JamesAtMvertigo]

I suppose this paper might have been cited elsewhere, but it is nothing short of fascinating:

Bell (2017).pdf (anu.edu.au)

People suffering from tinnitus should read this, despite it focussing on Meniere's.

It is laying the 'blame' for a lot of symptoms on Middle Ear dysfunction, a stark contrast to the opinion of many medics.

I've read a lot of different theories that try to explain audiovestibular dysfunction.

The theories seem to come and go with fashion.

PLF, "migraine", ETD, depression, stress, TMJ, salt poisoning...

I've not read many extremely convincing theories as this one.

In my humble opinion a lot of symptoms like tinnitus, vertigo and conditions like Meniere's might be a continuum of escalating symptoms.

As such, focussing on just one class of patients (tinnitus only) puts the blinkers on for what might be a common pathophysiology but at different levels of severity between sets of patients.

I for one sit at a more severe level that the tinnitus patients, but far less severe than a Meniere's sufferer.

That doesn't mean we don't all have a lot in common.

 

[JamesAtMvertigo]

@Lukee,

Sorry, sometimes it's tempting to give strong responses based on a set of pre-held assumptions.

How about this thought:

ET inflammation or over production of mucosa might actually cause TMJ as it might very subtly change the amount of muscle tension required to line up the jaw.

So my bet is that ETD might cause TMJ.

(btw, one question, possibly an aside, I've lost the thread: was it you or another poster who reported on an engineer who had tinnitus for 10 years which then completely resolved? Where is that post?)

 

[JamesAtMvertigo]

Avoidances:
No alcohol
No coffee
No candy, sweets, sugar
No breads at all
No cheese at all
No extra salt
No milk

Curious, but this is almost identical to the so called "6C's diet" prescribed to people diagnosed with Migraine Associated Vertigo and Vestibular Migraine! Cross-over, much?!

 

[Slambonie]

I've experienced tinnitus since the night I got the Pfizer COVID-19 vaccine. I notice that when I yawn or otherwise flex my jaw really hard, all the pressure build up seems to strain my tinnitus so it exacerbates while I am yawning/flexing my jaw then goes back to how it was when I release. Is this somatic tinnitus? What kind of doctor would be best to look at underlying issue that could be causing this? ENT or a neurologist?

I've been to an ENT for this and he gave me Prednisone which did nothing, he also said I don't have ETD. He seemed to figure that out almost immediately from just looking in my ears.