TMJ the Cause of ETD?

[Suzerman]

I've been walking around with jaw problems and ear problems for a solid good 3 months now. My left ear started hissing 3 months ago, and the doctor confirmed back then that my ear was inverted. Most likely cause for this is a blocked eustachian tube. After a flight to Milan it got worse, my ears became severely inverted, they have cleared up quite a bit since then but the sounds have remained the same. So I've been on countless nasal sprays without much effect. I do produce a lot of mucous, but I do think the blocking of my eustachian tube is actually caused by something else.

I have tried to do a bit of self diagnosing and I have the following theory.

I am seeing a jaw therapist, and am also wearing a splint. Whenever I massage my jaw. neck and shoulders, the sound seems to be getting less. Also, my ear starts making slight popping noises whenever I do this, almost like some tension is released from my ear. So here's my theory. When my tinnitus started I was going through a lot of stress, may I mention I also had other health problems (epstein barr, extreme fatigue, candida in the mouth etc.) which were giving me a lot of stress, along with a lot of personal problems. It is around this time that the noise started.

If the noise is indeed from my inverted ear due to a blocked eustachian tube, I am convinced that I started to clench and pressure my jaw around this stressful period. This tensing of my muscles has led to them putting pressure on my eustachian tube and pressing it shut.

Anyone who thinks this might be a possibility or has the same suspicions about their tinnitus and its cause?

 

[Greg Sacramento]

@Suzerman An invented ear drum can cause Eustachian tube problems. http://www.dizziness-and-balance.com/disorders/unilat/etd.htm

You also mention "whenever I massage my jaw, neck and shoulders, the sound seems to be getting less." You also mention "I do think the blocking is caused by something else". Maybe so.

http://www.natural-solutions-for-muscle-pain.com/sternocleidomastoid-muscle.html

Caution needs to be shown and examined by a physical therapy first. One sided ringing could be made worse by mastoid pressure or by the mastoid emissary vein with modulation of the dorsal cochlear nucleus.

http://budokan.wcart.net/JuJitsu/popup_mastoid.htm

I would continue PT for your jaw and would consider some PT neck therapy as well. I would relax your trapezius and temporalis muscles with home massage.

Wishing you the best.

 

[Dana]

Anyone who thinks this might be a possibility or has the same suspicions about their tinnitus and its cause?

This is definitely a possibility. I think more than that, in the sense that this is not only a possibility, but what happened. Your putting pressure with the jaw may have shut down the Eustachian tubes.

And i think that the same thing led to my tinnitus, that is why i put on your post a "helpful" rating. I think that is the answer.

When my t spikes, i always feel increased pressure in the ear, but i was never sure if that increased pressure that i feel is in the middle, or the inner ear. (just like middle ear, the pressure in inner ear may change and cause tinnitus, but this is definitely not a problem that you have, only a problem that i suspect(ed) that i have).

I also resorted to massages and one day, the follwing morning after a massage, i had no pressure and tinnitus.

I take clonazepam, and for me it works. It lowers the tinnitus and pressure. For a long time i thought that clonazepam works beacuse it is an anti-epileptic and i have hyperactivity (seizure) in the auditory cortex, and clonazepam works because it stops the seizure, but now i am starting to think that clonazepam (Rivotril made by Roche, other brands were bad for me) works because cloanzepam is also a muscle relaxer.
So now i am thinking that clonazepam relaxes the tense jaw, neck, and muscle around the temporo-mandibular joint, the Eustachian tubes is reliefed from pressure and it can start doing its function, the pressure in the middle ear gets close to normal, and tinnitus lowers a lot and sometimes dissappears. But in times of stress i must take clonazepam every evening.
When i was relaxed in a vacation my symptoms almost disappeared. I think it was the relaxation during swimming.

So "yes", i think your theory is correct, so, like Greg says, continue PT for jaw, neck, trapezius, and temporalis muscles.

Do you feel pressure in the ears as well?
I started to feel pressure in the ears only after a while after my tinnitus emerged.

Do you have ringing in one or both ears?

 

[Suzerman]

@Suzerman An invented ear drum can cause Eustachian tube problems. http://www.dizziness-and-balance.com/disorders/unilat/etd.htm

You also mention "whenever I massage my jaw, neck and shoulders, the sound seems to be getting less." You also mention "I do think the blocking is caused by something else". Maybe so.

http://www.natural-solutions-for-muscle-pain.com/sternocleidomastoid-muscle.html

Caution needs to be shown and examined by a physical therapy first. One sided ringing could be made worse by mastoid pressure or by the mastoid emissary vein with modulation of the dorsal cochlear nucleus.

http://budokan.wcart.net/JuJitsu/popup_mastoid.htm

I would continue PT for your jaw and would consider some PT neck therapy as well. I would relax your trapezius and temporalis muscles with home massage.

Wishing you the best.

I will continue with the physio therapy definitely! I have another appointment in less than two weeks. I will be a bit more careful then with the self massaging, don't want to cause myself any more harm. I am also seeing an ENT in two weeks, hopefully he can shed a bit more light on this situation. Thank you for all your advice!

This is definitely a possibility. I think more than that, in the sense that this is not only a possibility, but what happened. Your putting pressure with the jaw may have shut down the Eustachian tubes.

And i think that the same thing led to my tinnitus, that is why i put on your post a "helpful" rating. I think that is the answer.

When my t spikes, i always feel increased pressure in the ear, but i was never sure if that increased pressure that i feel is in the middle, or the inner ear. (just like middle ear, the pressure in inner ear may change and cause tinnitus, but this is definitely not a problem that you have, only a problem that i suspect(ed) that i have).

I also resorted to massages and one day, the follwing morning after a massage, i had no pressure and tinnitus.

I take clonazepam, and for me it works. It lowers the tinnitus and pressure. For a long time i thought that clonazepam works beacuse it is an anti-epileptic and i have hyperactivity (seizure) in the auditory cortex, and clonazepam works because it stops the seizure, but now i am starting to think that clonazepam (Rivotril made by Roche, other brands were bad for me) works because cloanzepam is also a muscle relaxer.
So now i am thinking that clonazepam relaxes the tense jaw, neck, and muscle around the temporo-mandibular joint, the Eustachian tubes is reliefed from pressure and it can start doing its function, the pressure in the middle ear gets close to normal, and tinnitus lowers a lot and sometimes dissappears. But in times of stress i must take clonazepam every evening.
When i was relaxed in a vacation my symptoms almost disappeared. I think it was the relaxation during swimming.

So "yes", i think your theory is correct, so, like Greg says, continue PT for jaw, neck, trapezius, and temporalis muscles.

Do you feel pressure in the ears as well?
I started to feel pressure in the ears only after a while after my tinnitus emerged.

Do you have ringing in one or both ears?

Yes! I also feel pressure in the ears almost all the time when I smile or put tension on my jaw in some way or another. The ringing is in both ears I think but the left one is definitely dominant, the right ear has some kind of sound like im in a car or plane sometimes, very low windy noise, barely bothers me. The left ear has a bit of static/hiss/electric noise, which is a lot more intrusive. I notice the difference in ears when I sleep, left ear makes a lot of noise when I put it on the pillow, right ear barely does. I also get a lot of fleeting tinnitus, and I also think its related to the jaw. Ive been writing down my episodes, how long they last, their intensity and when I have them. I had 4 days in between episodes this time and it was a lot less intense than previous times, definitely think its jaw related! Good to know that im not too far off with my self diagnosis, and Im hoping it can help more people to figure out whats causing their tinnitus!

 

[Carlyi]

Yes! TMJ causes ETD. When i started to get extreme muscle tension in my jaw my Eustachiuan tubes became affected and my eardrums were inverted. My ears pop and crackle when i slightly move my jaw. I still have this issue 9 months later but it is very slowly getting better. I must say that i have an extreme cause of muscle tension where it was almost impossible to talk and to smile.. Now i'm able to do this again, but it took a while.

 

[Shera]

Totally TMJ related. I had an accident that messed with my neck and jaw out only gave me mild T. Until it popped out again and my jaw muscles went crazy. Pressure issues, elevations, popping and what not. It's only recently been easing up enough. The ear fullness and pain being a big change. Be careful what kind of PT you do and not to over do it. That can keep the muscles inflamed and bad for a while.

For me the biggest help is a massage therapist I found one that really knows what she's been doing. She does my back, neck, and TMJ related muscles. The noise and ear fullness back off.

 

[Suzerman]

Yes! TMJ causes ETD. When i started to get extreme muscle tension in my jaw my Eustachiuan tubes became affected and my eardrums were inverted. My ears pop and crackle when i slightly move my jaw. I still have this issue 9 months later but it is very slowly getting better. I must say that i have an extreme cause of muscle tension where it was almost impossible to talk and to smile.. Now i'm able to do this again, but it took a while.

Thank you so much for this message! This truly makes me believe Im on to something with this. Seriously, Ive been using nasal sprays like no tomorrow and none of them have helped and to me now its obvious why, because it is not related to fluid, but to muscle tension! This past christmas Ive been truly trying to ignore the tinnitus by getting as much distraction as possible and giving my brain a chance to forget the sound by stopping to listen for it all the time, and truly relax over the holidays, and I think as a result there was less tension in my jaw. I have also stopped with the nasal sprays because I no longer believe it to have any effect on me. Yesterday I had a huuuge break through with my left ear, it just started popping like crazy and making all kinds of sounds like it was opening up every time I swallowed. Unfortunately I have a bad cold now which made it close off again, but going from an ear that barely made any popping sounds unless I did an extreme yawn of some sorts, to one that feels like its almost opening up out of its own is a huge deal! Ive been making a conscious effort to relax my jaw and I do feel like some change is already happening. Not in the noise yet, but definitely in the opening of my eustachian tube.

Totally TMJ related. I had an accident that messed with my neck and jaw out only gave me mild T. Until it popped out again and my jaw muscles went crazy. Pressure issues, elevations, popping and what not. It's only recently been easing up enough. The ear fullness and pain being a big change. Be careful what kind of PT you do and not to over do it. That can keep the muscles inflamed and bad for a while.

For me the biggest help is a massage therapist I found one that really knows what she's been doing. She does my back, neck, and TMJ related muscles. The noise and ear fullness back off.

Thank you! Sad to hear about an accident giving you this horrible tinnitus, it truly is a terrible affliction. I do have ear fullness as well, a lot of fleeting tinnitus attacks, and definitely a lot of tension in my jaw, back and neck. I see my physio therapist once a week and I try to gently massage my neck shoulders and jaw, but try not to overdo it.

 

[Shera]

Hope all this can help you make progress! Good luck.

 

[Seawater7]

Could be the only cause ues. I have known people who it went away with after their tmj went away.

 

[Suzerman]

Just wondering if anyone has experience. My ear is constantly feeling like a balloon that's inflating every time I swallow. The crackling seems to have gotten louder cause it feels closer to my ear. Is this a sign of my eustachian tube clearing up slowly?

 

[Suzerman]

It also feels like its sooo close to popping but just can't quite get there lol

 

[Shera]

Just wondering if anyone has experience. My ear is constantly feeling like a balloon that's inflating every time I swallow. The crackling seems to have gotten louder cause it feels closer to my ear. Is this a sign of my eustachian tube clearing up slowly?

Yep. That balloon thing when you swallow is very accurate. When it was super bad it was constantly do that. When I breathed even triggered it.

Now that I have my jaw in place, and more importantly the muscles and cartilage calmed down it has helped.

The sad reality is TMJ stuff takes awhile to get under control and heal. Even when it seems better you need to pay attention to it.

 

[David G]

I've had these ear problems for 9 months now. Ears pop or crackle when I either scratch my face, chew or when there's certain loud noises as It's mostly in my left ear. This only happens indoors.

Also almost this past week I've had the flu and my nose has been partly blocked on top of that. I dreaded that a bug might make me notice the tinnitus more but it wasn't as scary as I thought it would be.

If it is a neck muscle problem, do chiropractors help with this sort of issue?

 

[Suzerman]

Yep. That balloon thing when you swallow is very accurate. When it was super bad it was constantly do that. When I breathed even triggered it.

Now that I have my jaw in place, and more importantly the muscles and cartilage calmed down it has helped.

The sad reality is TMJ stuff takes awhile to get under control and heal. Even when it seems better you need to pay attention to it.

I do feel like the more I feel the sensation of a balloon inflating, the closer it is to popping. Do you agree? I have noticed it does three things. Sometimes there is a ripping/ squishy sound when I swallow, and it feels like its opening up a big part of the eustachian tube. Then there is this opening up sensation, where it feels like my ear drum is slightly moving forward, and then there are proper popping noises, that come with an inflated eardrum feeling. It is very frustrating though, every time I feel like they might be popping open, they seem to be deflating again.

I've had these ear problems for 9 months now. Ears pop or crackle when I either scratch my face, chew or when there's certain loud noises as It's mostly in my left ear. This only happens indoors.

Also almost this past week I've had the flu and my nose has been partly blocked on top of that. I dreaded that a bug might make me notice the tinnitus more but it wasn't as scary as I thought it would be.

If it is a neck muscle problem, do chiropractors help with this sort of issue?

Do you also have problems with your jaw? Otherwise it might be the muscles and ligaments pressing your eustachian tube shut. It could also be fluid in the ear. Does it also make your ears more sensitive to sounds? I personally cannot handle a lot of sounds anymore, like dishes clanking, plastic bags being opened etc. If it is related to your jaw, I do think wearing a mouth guard and seeing a physio therapist might help. Im not saying my problem is solved, far from it. But I definitely feel a lot more activity and ear popping in my ear than I did a few weeks ago, so Im seeing that as a good sign for now.

 

[Shera]

@Suzerman Yeah to a degree that all sounds familiar. One of my issues is my ears just can't adjust on their own anymore. I live in the mountains so it really sucks. Even if it's the smallest change--though that has gotten not so severe--but when I have a couple 1,000ft elevation change my ears occasionally loudly pop. But I still find I have to swallow to get them to even think about equalizing. It sucks cause it just used to happen and I never noticed. Something got messed up in my eustachian tube or something. I feel like what ever it is my ears want to adjust, but just can't. Soaking in a tube used to help with earaches I remember. I'm wondering if going swimming might help them or make it worse.

@David G Be careful with chiropractors. I think going to mine helped in some ways, but it doesn't do anything for your muscles. If you find a therapist or massage therapist who knows what they're doing they will calm your muscles down and can put your neck and jaw back in place without forcefully popping things. The more my chiropractor jerked my neck and jaw around, not to mention the exercises, I kept getting more ear issues. I'd approach it cautiously and interview the people.

Now the further I've gone with out a chiro treatment a lot of my more hellacious noises have eased up. The massage is the thing that has eased my ear pressure issues the most.

 

[David G]

I think it might be a stress related muscle issue, because in the first month of getting tinnitus I stressed like hell, which I started having ear pain that went along the side of my neck down to my arm, and then the eusthacian tubes issues began.

I didn't have any colds before or during the 9 months of having T until recently, so I don't think there's any fluid in my middle ear.

 

[Suzerman]

Just a quick update everyone. I went to the ENT today, and apparently, my ears are open? My ear drums are in their normal position. I was very confused as to how this is possible, seeing how I do hear popping, crackling, inflated balloon sensations etc. She said that it could be that my eustachian tube is still slightly clogged despite my ears being open. My hissing ear has nothing to do with an inverted ear drum then I am afraid, however, it could still be a mucous build up in my eustachian tube or my jaw. She told me to keep using the fluconase nasal spray, and Im getting a hearing test in a few weeks from now to see if it isnt hearing damage.

 

[just1morething]

@Suzerman, It could be your TMJD affecting your tiny ear muscles and/or eustachian tubes. I'm looking at that currently. I have a crunchy left TMJ and hissing.

https://managebackpain.com/tmj-pain/tmj-tinnitus

 

[Shera]

Just a quick update everyone. I went to the ENT today, and apparently, my ears are open? My ear drums are in their normal position. I was very confused as to how this is possible, seeing how I do hear popping, crackling, inflated balloon sensations etc. She said that it could be that my eustachian tube is still slightly clogged despite my ears being open. My hissing ear has nothing to do with an inverted ear drum then I am afraid, however, it could still be a mucous build up in my eustachian tube or my jaw. She told me to keep using the fluconase nasal spray, and Im getting a hearing test in a few weeks from now to see if it isnt hearing damage.

Last time I had a hearing test they said my ears looked great and that my ear drums were fine. Though the pressure test hurt. They had no explanation for why suddenly my ears were having those issues. There was no medical reason. Though I do know that my TMJ has a big influence on it and that is what pushed it all over the edge. It's speculation if I have mucus or something in there. Or if it's all just TMJ muscles.

Actually the doc tried to convince me it was my vegas nerve.

 

[Suzerman]

Last time I had a hearing test they said my ears looked great and that my ear drums were fine. Though the pressure test hurt. They had no explanation for why suddenly my ears were having those issues. There was no medical reason. Though I do know that my TMJ has a big influence on it and that is what pushed it all over the edge. It's speculation if I have mucus or something in there. Or if it's all just TMJ muscles.

Actually the doc tried to convince me it was my vegas nerve.

I think its the TMJ too! The ENT told me to keep using fluticasone nasal spray, because my eustachian tube is probably out of whack, but seriously after using it again for a few days my ears feel a lot worse! The hissing seems to be slightly more high pitched, and Ive also had two fleeting tinnitus episodes in 3 days, after not having one for almost 12 days!!! When I did not use the nasal spray, my ears felt less clogged, and I did not have fleeting tinnitus episodes! Im considering to stop using the nasal spray, but dont know what to do seeing how the ENT told me not to.

 

[Shera]

I think its the TMJ too! The ENT told me to keep using fluticasone nasal spray, because my eustachian tube is probably out of whack, but seriously after using it again for a few days my ears feel a lot worse! The hissing seems to be slightly more high pitched, and Ive also had two fleeting tinnitus episodes in 3 days, after not having one for almost 12 days!!! When I did not use the nasal spray, my ears felt less clogged, and I did not have fleeting tinnitus episodes! Im considering to stop using the nasal spray, but dont know what to do seeing how the ENT told me not to.

I was advised to use the spray too. I did. I then thought it was giving me some new screaming T. I quit. Then the doc advised I should use it longer. I did. (This was the same one that advised me to sleep with the ill fated heat packs.) My nose got ticked, my ears felt worse and the same noise came back. I stuck with it and then once I quit that particular noise went away. My T started from hitting my head/jaw, and it got worse when my jaw popped out and the muscles went crazy. So I didn't worry to much about quitting it.

Though it's up to you.

I know right now I use a saline spray to keep things clean in my nasal passages and it doesn't seem to irritate anything. Besides now that my muscles and jaw are healing better things are getting better. So I know I'm on the right track.

 

[Suzerman]

I was advised to use the spray too. I did. I then thought it was giving me some new screaming T. I quit. Then the doc advised I should use it longer. I did. (This was the same one that advised me to sleep with the ill fated heat packs.) My nose got ticked, my ears felt worse and the same noise came back. I stuck with it and then once I quit that particular noise went away. My T started from hitting my head/jaw, and it got worse when my jaw popped out and the muscles went crazy. So I didn't worry to much about quitting it.

Though it's up to you.

I know right now I use a saline spray to keep things clean in my nasal passages and it doesn't seem to irritate anything. Besides now that my muscles and jaw are healing better things are getting better. So I know I'm on the right track.

Very interesting! I personally think it has nothing to do with mucous in the eustachian tube like the ENTS think, but rather the jaw just pressing it shut. I asked my jaw physio therapist today if he knew anything about that but unfortunately he didn't. I am considering to just quit the nasal spray like I did a week or two ago. Since using the nasal spray again, I do think my sensitivity to noise has also increased drastically. I cannot do my job anymore because they use powertools on occassion and I jus cant tolerate the noise. Is this also common with ETD and TMJ?

 

[Shera]

Very interesting! I personally think it has nothing to do with mucous in the eustachian tube like the ENTS think, but rather the jaw just pressing it shut. I asked my jaw physio therapist today if he knew anything about that but unfortunately he didn't. I am considering to just quit the nasal spray like I did a week or two ago. Since using the nasal spray again, I do think my sensitivity to noise has also increased drastically. I cannot do my job anymore because they use powertools on occassion and I jus cant tolerate the noise. Is this also common with ETD and TMJ?

I think you might be experiencing Hyperacusi. I lightly had this with my T for a bit, but it went away so fast I had forgotten that a base from another car had bothered my ears. Then when my jaw popped out I had it again mildly, with it I noticed it warped sounds. Turning other sounds into T as well. Maybe look up Hyperacusi and if it's getting worse bring it up with your doctors.

Like T I think H can be unpredictable, but from other threads of TMJ some have it and others don't. https://www.tinnitustalk.com/#hyperacusis-ear-pain.75

 

[Suzerman]

Decided to give a little update again. I went to the ENT again for a hearing test, and it turns out I have above average hearing, its basically perfect. The results even showed that my hearing was the best in my tinnitus ear, so that was pretty surprising. Well, whatever is causing my tinnitus, it is not due to hearing loss. They also performed a test on my eustachian tube, and everything was functioning properly according to the doctor. They did an air pressure test, and the results came out fine. I have to say that either habituation kicked in or the tinnitus actually got significantly lower, because I am noticing it a lot less than in the beginning. It seems to depend on my position however. When my tinnitus is loud in the morning I can sometimes lower it by changing my position and relaxing my jaw. So it seems to be related to my neck, jaw and posture. I still get the fleeting tinnitus attacks, sometimes worse than other times, and they are still terrifying me everytime until they pass.

I have also done a few blood tests, there is no sign of the epstein barr virus or candida anymore in my system, so that is also not likely to be the culprit anymore. I do, however, have a B12 vitamin deficiency, which might also be a factor in my problems. I will continue to see my jaw therapist, and work on my posture, sleeping position etc. and see if it helps. I will keep everyone updated on how im doing so that I might help people with similar problems.

 

[Shera]

Good luck. Glad you're getting some improvement.

 

[paganismos]

Hi everyone, sorry to bump this post but it's the one I found most useful.

I've had cracking and popping in my ears for about a week and have had T for six weeks. I believe my ETD is related to the problems with my jaw since i've been under a lot of stress and anxiety (thanks to t) and my jaw this past week has been hell. I can't talk or smile because it hurts, let's not talk about eating food... ten times worse. I can't even fit three fingers inside my mouth without effort and pain.
I found a way of swallowing without the cracking and my ears have been popping less...

Did yours finally resolved? @Suzerman

Have you got any good news ETD related? @Carlyi

 

[paganismos]

Decided to give a little update again. I went to the ENT again for a hearing test, and it turns out I have above average hearing, its basically perfect. The results even showed that my hearing was the best in my tinnitus ear, so that was pretty surprising. Well, whatever is causing my tinnitus, it is not due to hearing loss. They also performed a test on my eustachian tube, and everything was functioning properly according to the doctor. They did an air pressure test, and the results came out fine. I have to say that either habituation kicked in or the tinnitus actually got significantly lower, because I am noticing it a lot less than in the beginning. It seems to depend on my position however. When my tinnitus is loud in the morning I can sometimes lower it by changing my position and relaxing my jaw. So it seems to be related to my neck, jaw and posture. I still get the fleeting tinnitus attacks, sometimes worse than other times, and they are still terrifying me everytime until they pass.

I have also done a few blood tests, there is no sign of the epstein barr virus or candida anymore in my system, so that is also not likely to be the culprit anymore. I do, however, have a B12 vitamin deficiency, which might also be a factor in my problems. I will continue to see my jaw therapist, and work on my posture, sleeping position etc. and see if it helps. I will keep everyone updated on how im doing so that I might help people with similar problems.

Any updates? I'm waiting for my splint and

 

[Suzerman]

Any updates? I'm waiting for my splint and

So far not that much improvement in my tmj I'm afraid. I'm wearing a splint everyday and seeing a jaw therapist once a week, but my jaw opening is still really limited, and my tinnitus still the same. There are better days and worse days though. Last night was hell again, my head was vibrating and humming. Kept waking up. My face sometimes feel tingly too and I'm really scared it has something to do with my tmj

 

[Shera]

So far not that much improvement in my tmj I'm afraid. I'm wearing a splint everyday and seeing a jaw therapist once a week, but my jaw opening is still really limited, and my tinnitus still the same. There are better days and worse days though. Last night was hell again, my head was vibrating and humming. Kept waking up. My face sometimes feel tingly too and I'm really scared it has something to do with my tmj

Facial tingly, twitching, and stiffening is something you can get. Even vision issues. Have they completely checked to make sure you're jaw isn't out of position? Though that really hurts so you should be able to tell, and they made you a splint.

 

[dayma]

So far not that much improvement in my tmj I'm afraid. I'm wearing a splint everyday and seeing a jaw therapist once a week, but my jaw opening is still really limited, and my tinnitus still the same. There are better days and worse days though. Last night was hell again, my head was vibrating and humming. Kept waking up. My face sometimes feel tingly too and I'm really scared it has something to do with my tmj

I have my appliance and have been using it for 4 days so far

My dentist told me that it can take months to really show improvement.