Trigeminal Nerve Damage (Dental?) Affecting the Dorsal Cochlear Nucleus (DCN) and Causing Tinnitus?

[JimChicago]

Searching TinnitusTalk shows that this has come up in the past but may be not quite like this.
If true, I wonder if trigeminal nerve damage can repair itself.

My short version question/hypothesis:
Dental work damage to nerves can cause T because both the auditory and facial (gum) nerves share a common nerve relay (the DNC).

Long version:
I had dental work done (upper molar crown) and then a week later got loud tinnitus.
At first I was thinking it was the dentist's loud drill and the fact that he didn't follow the ATA recommendation of 5 seconds on, 10 seconds off. But I now learned that my hearing is all in the normal range up to 8khz (tinnitus is at 12 khz). For 5 days after the dental work (and before tinnitus), I had massive radiating pain across my upper gum and slight numbness on my upper lip. Then that went away and I got T around day 8. Perhaps nerve damage from the anesthetic needle?

So today "Dr. Google" exposed me to the fact that the trigeminal nerve (which has 3 branches including gums and face) shares a relay (the DCN) which integrates nerve signals from both the trigeminal nerve and the vestibulocochear nerve (auditory nerve).

This document makes the link and suggests that facial nerves can impact a middle ear nerve and T.

Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=10609479
RESULTS: Some patients with tinnitus, but no other hearing complaints, share several clinical features including (1) an associated somatic disorder of the head or upper neck, (2) localization of the tinnitus to the ear ipsilateral to the somatic disorder, (3) no vestibular complaints, and (4) no abnormalities on neurological examination. Pure tone and speech audiometry of the 2 ears is always symmetric and usually within normal limits. Based on these clinical features, it is proposed that somatic (craniocervical) tinnitus, like otic tinnitus, is caused by disinhibition of the ipsilateral dorsal cochlear nucleus. Nerve fibers whose cell bodies lie in the ipsilateral medullary somatosensory nuclei mediate this effect. These neurons receive inputs from nearby spinal trigeminal tract, fasciculus cuneatus, and facial, vagal, and glossopharyngeal nerve fibers innervating the middle and external ear.

CONCLUSIONS: Somatic (craniocervical) modulation of the dorsal cochlear nucleus may account for many previously poorly understood aspects of tinnitus and suggests novel tinnitus treatments.

And in this document, the reverse linkage is described: how middle ear nerve damage can affect the face! (in guinea pigs at least):

Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614620/
Abstract: Multisensory neurons in the dorsal cochlear nucleus (DCN) achieve their bimodal response properties [Shore (2005) Eur. J. Neurosci., 21, 3334–3348] by integrating auditory input via VIIIth nerve fibers with somatosensory input via the axons of cochlear nucleus granule cells [Shore et al. (2000) J. Comp. Neurol., 419, 271–285; Zhou & Shore (2004) J. Neurosci. Res., 78, 901–907]. A unique feature of multisensory neurons is their propensity for receiving cross-modal compensation following sensory deprivation. Thus, we investigated the possibility that reduction of VIIIth nerve input to the cochlear nucleus results in trigeminal system compensation for the loss of auditory inputs. Responses of DCN neurons to trigeminal and bimodal (trigeminal plus acoustic) stimulation were compared in normal and noise-damaged guinea pigs. The guinea pigs with noise-induced hearing loss had significantly lower thresholds, shorter latencies and durations, and increased amplitudes of response to trigeminal stimulation than normal animals. Noise-damaged animals also showed a greater proportion of inhibitory and a smaller proportion of excitatory responses compared with normal. The number of cells exhibiting bimodal integration, as well as the degree of integration, was enhanced after noise damage. In accordance with the greater proportion of inhibitory responses, bimodal integration was entirely suppressive in the noise-damaged animals with no indication of the bimodal enhancement observed in a sub-set of normal DCN neurons. These results suggest that projections from the trigeminal system to the cochlear nucleus are increased and/or redistributed after hearing loss. Furthermore, the finding that only neurons activated by trigeminal stimulation showed increased spontaneous rates after cochlear damage suggests that somatosensory neurons may play a role in the pathogenesis of tinnitus.

 

[The Red Viper]

This is something I am interested in as well. There isn't much research on somatosensory tinnitus. All I can speculate is the nerves that are close to the auditory nerve may play a role. See attachment:

 

[just1morething]

I had a chiropractic adjustment today on my neck and lower back. He said I have some movement in my C1-C2 area. Spondylolisthesis. I'm thinking there is some crossover to my auditory nerves. Maybe a nuero-ablation at a higher level (C2)would knock out the noise? Still unsure what to do. With fusion surgery I would have restricted rotation of my head which doesn't sound too appealing. That leaves PT and/or nuero-ablation. I've read about prolotherapy also and may look at that again. I had some prolotherapy injections in the past to help strengthen neck ligaments that were damaged in car accident when I was younger but unsure if they helped my noise and they were all cash. I'll try a little everything on the beast to tone it down.

 

[linearb]

that's a lot of words, I think you're digging too deep. If your T is at 12k then your hearing loss is also probably over 8k. My hearing is great up to 8k, gets more lopsided at 14k where my T is.

it's possible that the dcn tm link goes both ways, but then you'd expect lots of cases of people getting nerve damage and then having loud noises cause facial pain... I've never heard of that happening.

I think you got high frequency hearing damage and then got T through the usual DCN plasticity route.

 

[Reno]

That's very interesting.

I've wondering about that as well, because while my left ear T has quite clearly been triggered by a loud music event, I also have untreated dental problems on that same side, and when yawning I can feel some mild pain again on that side only, a bit like a sore throat that extends all the way to the left ear.

The 2nd article seems to suggests that dental pain in this area could more easily be picked up as T after you've had hearing loss ? I have an almost normal audiogram up until 8khz, then again my T is over 13khz and any hearing loss is probably in this region.

I'm going to the dentist's soon for a lower molar crown on that left side, with some fear that it will make the T spike. OTOH, this article gives me some hope that fixing pain in this area could alleviate the T.

Should I try to ask for an MRI to find out ?

 

[lapidus]

it's possible that the dcn tm link goes both ways, but then you'd expect lots of cases of people getting nerve damage and then having loud noises cause facial pain... I've never heard of that happening.

It happens in some patients with hyperacusis.
http://nypost.com/2017/03/01/why-this-social-butterfly-went-from-club-waitress-to-hermit/

 

[Greg Sacramento]

Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=10609479
RESULTS: Some patients with tinnitus, but no other hearing complaints, share several clinical features including (1) an associated somatic disorder of the head or upper neck, (2) localization of the tinnitus to the ear ipsilateral to the somatic disorder, (3) no vestibular complaints, and (4) no abnormalities on neurological examination. Pure tone and speech audiometry of the 2 ears is always symmetric and usually within normal limits. Based on these clinical features, it is proposed that somatic (craniocervical) tinnitus, like otic tinnitus, is caused by disinhibition of the ipsilateral dorsal cochlear nucleus. Nerve fibers whose cell bodies lie in the ipsilateral medullary somatosensory nuclei mediate this effect. These neurons receive inputs from nearby spinal trigeminal tract, fasciculus cuneatus, and facial, vagal, and glossopharyngeal nerve fibers innervating the middle and external ear.

CONCLUSIONS: Somatic (craniocervical) modulation of the dorsal cochlear nucleus may account for many previously poorly understood aspects of tinnitus and suggests novel tinnitus treatments.

Like --- along with information from Red Viper. This is a very interesting and important thread.

Research studies also show that deep vertical fibers and facet joint tenderness has a big play as primary to tinnitus that would also include injury.
http://www.bigsportsmed.com/Auto_injury_patient_tmj_connection.php

 

[Contrast]

Searching TinnitusTalk shows that this has come up in the past but may be not quite like this.
If true, I wonder if trigeminal nerve damage can repair itself.

My short version question/hypothesis:
Dental work damage to nerves can cause T because both the auditory and facial (gum) nerves share a common nerve relay (the DNC).

Long version:
I had dental work done (upper molar crown) and then a week later got loud tinnitus.
At first I was thinking it was the dentist's loud drill and the fact that he didn't follow the ATA recommendation of 5 seconds on, 10 seconds off. But I now learned that my hearing is all in the normal range up to 8khz (tinnitus is at 12 khz). For 5 days after the dental work (and before tinnitus), I had massive radiating pain across my upper gum and slight numbness on my upper lip. Then that went away and I got T around day 8. Perhaps nerve damage from the anesthetic needle?

So today "Dr. Google" exposed me to the fact that the trigeminal nerve (which has 3 branches including gums and face) shares a relay (the DCN) which integrates nerve signals from both the trigeminal nerve and the vestibulocochear nerve (auditory nerve).

This document makes the link and suggests that facial nerves can impact a middle ear nerve and T.

Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis.
https://www.ncbi.nlm.nih.gov/pubmed/?term=10609479
RESULTS: Some patients with tinnitus, but no other hearing complaints, share several clinical features including (1) an associated somatic disorder of the head or upper neck, (2) localization of the tinnitus to the ear ipsilateral to the somatic disorder, (3) no vestibular complaints, and (4) no abnormalities on neurological examination. Pure tone and speech audiometry of the 2 ears is always symmetric and usually within normal limits. Based on these clinical features, it is proposed that somatic (craniocervical) tinnitus, like otic tinnitus, is caused by disinhibition of the ipsilateral dorsal cochlear nucleus. Nerve fibers whose cell bodies lie in the ipsilateral medullary somatosensory nuclei mediate this effect. These neurons receive inputs from nearby spinal trigeminal tract, fasciculus cuneatus, and facial, vagal, and glossopharyngeal nerve fibers innervating the middle and external ear.

CONCLUSIONS: Somatic (craniocervical) modulation of the dorsal cochlear nucleus may account for many previously poorly understood aspects of tinnitus and suggests novel tinnitus treatments.

And in this document, the reverse linkage is described: how middle ear nerve damage can affect the face! (in guinea pigs at least):

Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614620/
Abstract: Multisensory neurons in the dorsal cochlear nucleus (DCN) achieve their bimodal response properties [Shore (2005) Eur. J. Neurosci., 21, 3334–3348] by integrating auditory input via VIIIth nerve fibers with somatosensory input via the axons of cochlear nucleus granule cells [Shore et al. (2000) J. Comp. Neurol., 419, 271–285; Zhou & Shore (2004) J. Neurosci. Res., 78, 901–907]. A unique feature of multisensory neurons is their propensity for receiving cross-modal compensation following sensory deprivation. Thus, we investigated the possibility that reduction of VIIIth nerve input to the cochlear nucleus results in trigeminal system compensation for the loss of auditory inputs. Responses of DCN neurons to trigeminal and bimodal (trigeminal plus acoustic) stimulation were compared in normal and noise-damaged guinea pigs. The guinea pigs with noise-induced hearing loss had significantly lower thresholds, shorter latencies and durations, and increased amplitudes of response to trigeminal stimulation than normal animals. Noise-damaged animals also showed a greater proportion of inhibitory and a smaller proportion of excitatory responses compared with normal. The number of cells exhibiting bimodal integration, as well as the degree of integration, was enhanced after noise damage. In accordance with the greater proportion of inhibitory responses, bimodal integration was entirely suppressive in the noise-damaged animals with no indication of the bimodal enhancement observed in a sub-set of normal DCN neurons. These results suggest that projections from the trigeminal system to the cochlear nucleus are increased and/or redistributed after hearing loss. Furthermore, the finding that only neurons activated by trigeminal stimulation showed increased spontaneous rates after cochlear damage suggests that somatosensory neurons may play a role in the pathogenesis of tinnitus.

Thank you so much for this informaton.

 

[cspc]

that's a lot of words, I think you're digging too deep. If your T is at 12k then your hearing loss is also probably over 8k. My hearing is great up to 8k, gets more lopsided at 14k where my T is.

it's possible that the dcn tm link goes both ways, but then you'd expect lots of cases of people getting nerve damage and then having loud noises cause facial pain... I've never heard of that happening.

I think you got high frequency hearing damage and then got T through the usual DCN plasticity route.

I have facial pain from loud sounds such as live music after my trigeminal nerve injury, it becomes less frequent over time but my ear nerves and facial nerves get irritated sometimes. Most people don't complain because they find unhealthy ways to cope with the pain such as smoking and drinking.

 

[Greg Sacramento]

Most of the time it comes to physical nerves, nerve bundles, trigeminal nerve. VIII cranial nerve - but this is a trick and a half to treat as it's relation to the trigeminal nerve. Deep vertical fiber trauma and facet joint tenderness within the neck is common.

I stood with these thoughts a year ago and my neuros disagreed. My neck tinnitus is now gone from simple pushing back shoulders and stretching neck upward relieving nerve fibers, facet joints and cranial nerve pressure. I had 42 problems show up on testing within my neck from whiplash. My neck still gets sore from incorrect posture and head bending.

I still have tinnitus but it changed pattern. It now only associates with gum nerves, facial nerves and the trigeminal nerve. My facial and mouth nerve pain is unreal. I may not be really bothered with tinnitus anymore, but I can't deal with physical cut nerve (gum) pain.

 

[cspc]

Most of the time it comes to physical nerves, nerve bundles, trigeminal nerve. VIII cranial nerve - but this is a trick and a half to treat as it's relation to the trigeminal nerve. Deep vertical fiber trauma and facet joint tenderness within the neck is common.

I stood with these thoughts a year ago and my neuros disagreed. My neck tinnitus is now gone from simple pushing back shoulders and stretching neck upward relieving nerve fibers, facet joints and cranial nerve pressure. I had 42 problems show up on testing within my neck from whiplash. My neck still gets sore from incorrect posture and head bending.

I still have tinnitus but it changed pattern. It now only associates with gum nerves, facial nerves and the trigeminal nerve. My facial and mouth nerve pain is unreal. I may not be really bothered with tinnitus anymore, but I can't deal with physical cut nerve (gum) pain.

Since August 2016 I'm dealing with something similar but it goes to the opposite direction. First nerve pain, then whiplash in accident 2 weeks after wisdom teeth surgery as my nerve was healing. Also, severe tmj on one side post surgery. A couple of months later 3 - 4 maybe I still had nerve pain, sore neck but then I had sensitivity to loud sounds both ear and facial nerve. August 2017 some ear ringing but no ear pain. Neck issues got worse in 2017. My tinnitus became constant after an acoustic trauma in February 2018. I have 3 types of tinnitus. A pulsatille from my neck, a beep tone from my ears and something like electric signals from my trigeminal nerve and gums.

 

[Greg Sacramento]

@cspc Our situation is similar, but as you mention the timing of events are opposite. Most studies including the link that I posted above say that an injury to the neck will cause TMJ 87% of the time. Your situation is different from that. In your situation, your pulsatile T would be from your neck as you said. It would be the VIII cranial nerve. I also have severe TMJ on one side from dental surgery whiplash.

I have to go the doctors, but I would like to talk more about what could maybe help you with your neck. Facial with TMJ is difficult to treat. I have some exercises, but within a day they do help the TMJ part at first, then by a couple of hours into the day the exercises don't really help. Could you send me a (message or post) on if you have eye pain, headaches, temple pain, burning sensations on lips or in the mouth or a sore throat - upper or lower. Does any liquid build up in mouth. Also areas of your neck that hurt and if your T increases from turning your head or forward bending.

 

[cspc]

@cspc Our situation is similar, but as you mention the timing of events are opposite. Most studies including the link that I posted above say that an injury to the neck will cause TMJ 87% of the time. Your situation is different from that. In your situation, your pulsatile T would be from your neck as you said. It would be the VIII cranial nerve. I also have severe TMJ on one side from dental surgery whiplash.

I have to go the doctors, but I would like to talk more about what could maybe help you with your neck. Facial with TMJ is difficult to treat. I have some exercises, but within a day they do help the TMJ part at first, then by a couple of hours into the day the exercises don't really help. Could you send me a (message or post) on if you have eye pain, headaches, temple pain, burning sensations on lips or in the mouth or a sore throat - upper or lower. Does any liquid build up in mouth. Also areas of your neck that hurt and if your T increases from turning your head or forward bending.

I am interested in learning the exercises.

I have eye pain. Headaches in the back of my head above the neck. Constant burning sensation in my mouth and constant sore throat. Burning lips from spicy food since surgery. Bending forward increases my T.

 

[Greg Sacramento]

@cspc We got to be related craniomandibular dysfunction. They say it doesn't matter which came first, neck, trigeminal or facial. There's two pathways to the auditory parts of the brain. The auditory nerve is one, but with somatic dysfunction a second pathway - the parallel pathway is also used and more irritation to noise happens. I didn't know this a year ago.

I have oromandibular dystonia and dystonia in my neck. I don't have paresthesia, but I have mandibular nerve damage and some inferior alveolar damage. My digastric throat muscle is always intense causing a sore throat. Antibiotic don't work for me. On top of this my lateral medial pterygoid and suboccipital need work. I managed to ease deep vertical fibers, facet joint tenderness, trapezius, sternocleidomastoid, scalene within my neck.

I have eye pain. Headaches in the back of my head above the neck. Constant burning sensation in my mouth and constant sore throat. Burning lips from spicy food since surgery. Bending forward increases my T.

I use Alpha-Lipoic acid 600 daily to help with burning lips and mouth.

Stand straight with good posture and bring back shoulders and relax them and stretch neck upwards with a slight tilt of head towards the ceiling. Alternate breathing between nose and mouth.

Studies say with craniomandibular problems that the neck needs to be treated first.

 

[Lane]

@Greg Sacramento,

I have no idea whether you might find the following information either helpful or even interesting, but it's easy enough for me to post, as I just sent out an email on it. It's some information on the Egoscue Tower.

To give you a bit of history, Pete Egoscue developed a number of "e-cises" to help people correct their structural problems. There's a good number of Egoscue clinics across the country, specializing in his approach to structural health. Apparently, Jack Nicholas credited him with saving his golfing career.

The "Egoscue Tower" is, as I understand, the #1 "e-cise" of all the ones he developed. I myself have gotten significant benefit from using it--in all parts of my body, including my neck and TMJ areas. So, below is my cut and paste. I think the first 5-MIN video is especially good. -- Best...
.....................................................

Non-video introduction and description of the Egoscue tower and supine groin progressive:
Embracing the Tower

5-min. video -- very good introduction and description:
The Egoscue Tower - Supine Groin Progressive

13-min. video which goes into greater detail:
Egoscue Tower

Series of about 30 Egoscue videos covering a wide variety of very specific topics...
Series of Egoscue Videos