Tinnitus from TMJ Disorders - Is That Possible? (Case Study #10)

Tinnitus from TMJ Disorders – Is That Possible? (Case Study #10)

A Case of Tinnitus from TMJ Disorders at Our Clinic

In this case study, we examine Tinnitus from TMJ Disorders, or TMD (temporomandibular disorders), which is an umbrella term for over 30 conditions that can trigger orofacial pain.

Ms A, 27, visited Nourish Dental Sleep & TMJ Care complaining of ear pain (Otalgia), persistent ringing in the ear (Tinnitus), and bite change (“my upper and lower teeth do not meet the same way anymore”).

She had previously visited numerous ENT (ear, nose and throat) specialists, who had ruled out any ear or hearing pathology. Dentists she had visited had also ruled out any dental causes of her tinnitus, ear, and orofacial pain.

One dentist in particular, however, ground down her back molars to try to make the bite fit, terming it ‘occlusal equilibration’. This compounded her pain and problems, as she now had the additional issue of teeth sensitivity. She was unable to bite on the shaven teeth, and couldn’t consume hot or cold foods and drinks, as they provoked a sharp increase in dental pain.

*Disclaimer: As of March 30, 2020, the ADA (American Dental Association) has officially recognised Orofacial Pain as its 12th dental speciality. Any reference to ‘specialisation’ is made in the context of the United States of America. Please read our Disclaimers and FAQ pages for more information.

A Thorough Analysis of the Patient’s Ear Pain, Dental Issues & Tinnitus Symptoms

After a thorough analysis at our clinic, a few main issues become obvious, namely:

  1. Tinnitus in the absence of organic ENT pathology. Meaning to say that even though her pain and symptoms were experienced in the ears, it had in fact, nothing to do with them.
  2. Uneven occlusion – where the upper and lower teeth on one side come into contact more than the other side.
  3. A deflected lower jaw.
  4. Limitation in mouth opening, and pain when attempting to do so.

What is Tinnitus, and What are the Signs & Symptoms?

Tinnitus is neither a syndrome nor disease, but rather, a symptom where the patient ‘hears’ sounds in one or both ears, whether these sounds are real or not. It is a heterogeneous condition, which is to say that the origins and causes are manifold; They can stem from otologic, neurologic, infectious, pharmacological, systemic, metabolic, vascular, muscular and even psychological factors (Rocha and Sanchez, 2007). As such, Tinnitus treatments can and must be adapted according to the symptoms of each individual patient.

The most common complaint of Tinnitus is ringing in the ears, and this is often accompanied by ear and jaw pain. The combination of these symptoms and pains are not only annoying, but can have a huge and negative impact on the patient’s quality of life. Severe tinnitus can lead to mental health issues such as depression and anxiety, and compound sleep disorders.

Some other common symptoms that often accompany Tinnitus are: ear pain, dizziness, hearing loss, a feeling of pressure in the ear, and jaw pain (Algieri et al., 2016).

Tinnitus from TMJ Disorders

For a subtype of Tinnitus, the TMJ is the most commonly affected region, but can improve with the right treatments and maintenance (Wright et al., 2000). Studies have shown that 42.1% of patients with Myofascial Pain Syndrome in the face and neck regions also had Tinnitus. Patients with bruxism (teeth clenching) issues combined with Tinnitus also complained more of orofacial pain than those who only had bruxism (Rocha and Sanchez, 2007; also see Camparis et al., 2005; Fricton et al., 1985).

Males tend to be more prone to Tinnitus, and other common factors include ageing and hearing loss. Yet, Tinnitus from TMJ Disorders stem from a different origin, where these factors play less of a role. Hence, diagnosis can be more complicated. A knowledgeable orofacial pain specialist should be consulted for proper examination and diagnosis in such cases.

The Intimate Connection Between the TMJ, Head & Ear

The middle ear is anatomically linked to the TMJ (Saldanha et al., 2012), thus, Tinnitus from TMJ Disorders is not uncommon. On top of that, the trigeminal nerve is one of the most widely distributed nerves in your head that’s attached to your brain. It is responsible for sending pain signals and sensations from your face to your brain, and works with the TMJ to help you chew and swallow. The nerval inputs of the trigeminal system may be linked to the inner ear as well (Bernhardt et al., 2011), and dysfunction can set TMJ Disorders, orofacial pain, ear pain, and/or Tinnitus into a vicious cycle.

Diagnosis & Treatment of Tinnitus from TMJ Disorders at Our Clinic

There are two main causes of jaw deflection and uneven occlusion. It may be of a muscular nature, and can also be induced by the jaw-joint. In the case of Ms. A, she had both muscle and TMJ disorders, which contributed to all of her above-mentioned signs and symptoms.

TMJ Disorders can be tricky to diagnose, as they can present as a collective of symptoms that can be hard to pinpoint to a singular cause or area. Depending on the severity and how often it fluctuates, TMD therapy has been shown to improve symptoms of Tinnitus from TMJ Disorders anywhere from 46% to 96%, and some patients even reported that their symptoms resolved (Wright et al., 2000).

TMD therapy itself is a combination of various holistic therapies, medical treatments and pain management strategies. Some of these include: medications, counselling, occlusal splint therapy and physical therapy. It is best to seek the help of an orofacial pain specialist for proper diagnosis and treatment of Tinnitus from TMJ Disorders, as every patient’s symptoms, medical history, comorbidities and pain experience differs widely. Suitable treatment for one may be unsuitable for another.

Long-Lasting Damage from Inappropriate Dental Treatments

Ms. A’s Tinnitus and TMD symptoms subsequently resolved upon treatment at our clinic. The only issue that remained was the low bite (“shorter teeth”), teeth sensitivity and pain, which was caused by the previous dental treatment she had where the other dentist shaved her teeth down. We had to refer Ms. A to a prosthodontist we trusted, so that veneers could be fitted onto her damaged teeth.

It is important to note that many cases of uneven bites, paradoxically, have nothing to do with the teeth per sé. Inappropriate dental treatments, such as in Ms. A’s case, can cause more harm than good with irreversible damage or consequences. When in doubt, always consult a dentist who is formally trained in orofacial pain.

How Nourish Dental Sleep & TMJ Care Can Help with Tinnitus from TMJ Disorders

Dr. Eric Chionh runs the practice at Nourish Dental Sleep & TMJ Care, together with a dedicated team. He has over 20 years of hands-on experience in the treatment of Orofacial Pain and TMD, including Tinnitus from TMJ Disorders. He keeps himself updated on the latest scientific and dental literature, in order to serve his patients to the best of his abilities.

We use the necessary technologies combined with in-depth physical examinations to diagnose our patients. From there – together with the patient – we determine the best course of treatment and management for their pain or dental issues.

Dr. Chionh is formally trained in Oral Medicine and Orofacial Pain, and holds a Singapore Dental Council approved qualification in these areas. You can learn more about Dr. Eric Chionh on our About page, and view all services provided by Nourish Dental Sleep & TMJ Care here.

References:

  • Algieri, G. M. A., Leonardi, A., Arangio, P., Vellone, V., Di Paolo, C., & Cascone, P. (2016). Tinnitus in temporomandibular joint disorders: is it a specific somatosensory tinnitus subtype?. The International Tinnitus Journal, 20(2), 83-87. Retrieved from: https://www.tinnitusjournal.com/articles/tinnitus-in-temporomandibular-joint-disorders-is-it-a-specific-somatosensory-tinnitus-subtype.html
  • Bernhardt, O., Mundt, T., Welk, A., Köppl, N., Kocher, T., Meyer, G., & Schwahn, C. (2011). Signs and symptoms of temporomandibular disorders and the incidence of tinnitus. Journal of oral rehabilitation, 38(12), 891-901. https://doi.org/10.1111/j.1365-2842.2011.02224.x
  • Camparis, C. M., Formigoni, G., Teixeira, M. J., & De Siqueira, J. T. T. (2005). Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics. Journal of Oral Rehabilitation, 32(11), 808-814. https://doi.org/10.1111/j.1365-2842.2005.01519.x
  • Fricton, J. R., Kroening, R., Haley, D., & Siegert, R. (1985). Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral surgery, oral medicine, oral pathology, 60(6), 615-623. https://doi.org/10.1016/0030-4220(85)90364-0
  • Rocha, C. A. B., & Sanchez, T. G. (2007). Myofascial trigger points: another way of modulating tinnitus. Progress in brain research, 166, 209-214. https://doi.org/10.1016/S0079-6123(07)66018-X
  • Saldanha, A. D. D., Hilgenberg, P. B., Pinto, L. M. S., & Conti, P. C. R. (2012). Are temporomandibular disorders and tinnitus associated?. CRANIO®, 30(3), 166-171. https://doi.org/10.1179/crn.2012.026
  • Wright, E. F., Syms III, C. A., & Bifano, S. L. (2000). Tinnitus, dizziness, and nonotologic otalgia improvement through temporomandibular disorder therapy. Military medicine, 165(10), 733-736. https://doi.org/10.1093/milmed/165.10.733