docCan Your Tinnitus be Caused by TMJ?
What is tinnitus? Tinnitus is the perception of hearing some form of sound without there actually being any sound at all. It could range from ringing, hissing, buzzing, and chirping to other sounds as well. It could also vary in intensity and duration. Most people notice this condition when they are in a quiet place, like when trying to fall asleep. Sometimes this condition gets so bad that the individual might not be able to rest well due to all the perceived noise. It could also start spilling over to daytime activities. Imagine you are trying to listen to someone or focus on something and there is some incessant construction noise in the background.
Tinnitus – Prevalence and Causes
Tinnitus is estimated to affect nearly 50 million people in this country, which means almost 20% of the population suffers from this condition. And the most common cause of this condition is exposure to loud noise either chronically (going to rock concerts) or even as a one-time episode (a bomb exploding). Of course, these are only examples and the source of the sound could be anything that is uncomfortably loud. While loud noise is the most common culprit, there are a number of other ailments and diseases that can also lead to this condition. Some examples are:
- Injuries to the head and neck
- TMJ or other facial pain
- Some common drugs and certain cancer medications
- Wax build-up or other blockages of the ear canal
- Meniere’s disease (which affects the inner ear due to the collection of fluids)
- Otosclerosis – stiffening of little bones in the middle ear
- Other medical conditions like high blood pressure
- A growth (tumor) invading the nerve or the middle/inner ear
To better understand tinnitus, we need to understand how we hear sounds.
Sounds – Real Noise vs Perceived Noise
Sound is a form of energy, similar to light. If you disagree, stand in front of a loudspeaker. You “feel” the energy. Normally, when the sound enters our ear canals and hits the eardrums, it causes them to vibrate. This “vibration” results in them (the eardrums) sending nerve signals to the brain for processing. Once the brain receives the incoming signal and processes it, that is when we perceive the sound. Of course, our brain processes the information instantaneously with virtually no delay. However, sound can also be perceived without the presence of any noise. In the eardrum-nerves-brain pathway, if the nerves are stimulated by something other than sound, we can perceive sound. The same is true if the part of the brain that processes sound information is stimulated.
Tinnitus and TMJ
What is the connection between TMJ and tinnitus? While the exact reason is not known, there are several theories about how TMJ can lead to tinnitus.
- Excessive muscle activity
One theory is that excessive muscle activity (such as those observed in a TMJ patient) places excess tension on the eardrums. This increased tension results in the eardrums sending a signal to the brain, therefore, resulting in tinnitus.
- Circulatory system anomalies
Another theory has to do with the anomalies seen in the circulatory system (e.g. arteries and veins). Let’s say a blood vessel sits very close to the eardrums or the nerve. When this blood vessel gets engorged, it can place some pressure on its immediate neighbors. This pressure can then generate a nerve signal and is then interpreted as sound by the brain. These anomalies can be seen in anyone and are not specific to TMJ patients only.
- Information processing by the brain
Another theory has to do with how the brain processes incoming signals from the ears and the jaw joints.
In our brain, we have 12 cranial nerves (CNs) that transfer information to and from the end organ (e.g. the tongue, eyes, ears, nose, etc.) and the brain. You can think of cranial nerves as highways connecting various parts of the brain to our end organs. The nerve to our TMJ is part of CN-5 (cranial nerve 5). The nerves involved in the auditory pathway are part of CN-7. However, these 2 cranial nerves both terminate in nearly the same part of the brainstem called the pons, side by side. Therefore, a reasonable theory is that overstimulation of the pons from the CN-5 pathway can lead to the perception of sound.
However, as mentioned earlier, since these are all theories, we cannot be certain for sure which one(s) (if any) is the main cause. But one thing is for certain. Tinnitus is seen in a high percentage of patients with TMJ symptoms, especially the more chronic the symptoms are.
Tinnitus Treatment
So what does this all mean? It really means we need to figure out the source of the tinnitus to be able to treat it properly. For example, if one of the medications the patient is taking is causing tinnitus, then it would be good to change out that medication, obviously with the involvement of the doctor who prescribed it in the first place. If there is a growth an ENT and an oral surgeon and an oncologist should be involved. If the patient has TMJ symptoms, a TMJ dentist should be consulted for further evaluation and treatment. This is why diagnosis is so important.
If you or a loved one suffer from tinnitus and also have other types of facial and/or TMJ pain or difficulties (i.e. range of motion, tired jaw muscles, etc.) give us a call. Our doctor has extensive specialized training in the field of TMJ and is able to help you resolve this issue if related to your TMJ.