Research Confirms TMJ-Tinnitus Connection
The connection between temporomandibular joint disorder (TMJ) and ear dysfunction was first researched by Drs. David Goodfriend and James Costen in the 1920s. Hearing loss, tinnitus, vertigo and nausea was often mentioned in case histories of TMJ patients.
Most recently, the association between TMD and tinnitus was confirmed by Harold Gelb, DMD, at the Tufts University College of Dental Medicine; Michael L. Gelb, DDS, of the Department of Oral Medicine and Pathology at the New York College of Dentistry; and Melinda L. Wagner, DMD, of the University of Medicine and Dentistry of New Jersey. Earlier this year, they reported that patients with craniocervical mandibular disorders can present with tinnitus as a primary or secondary complaint. ("The Relationship of Tinnitus to Craniocervical Mandibular Disorders", The Journal of Craniomandibular Practice, Vol.15, No.2)
Their findings validated an earlier study by William S. Parker, DMD, Ph.D., and Richard A. Chole, MD, Ph.D., who reported clinical confirmation of the association between TMD and tinnitus in 1992. The University of California-Davis researchers cited the correlation in their findings of a controlled study involving 1,032 patients. ("Tinnitus, Vertigo, and Temporomandibular Disorders," Archives of Otolaryngology-Head and Neck Surgery, Vol. 188).
Douglas H. Morgan, DDS, an oral and maxillofacial surgeon, who has specialized in TMJ treatment for over 30 years, was sponsored by the American Tinnitus Association to do a special clinical research study. Twenty patients who suffered with tinnitus were chosen. These people had been to ENT specialists to rule out any organic or other otologic causes of their tinnitus. Also, none of these patients complained of jaw joint or facial pain and were not aware of any jaw joint dysfunction. Dr. Morgan conducted an eight part comprehensive TMJ diagnostic study of these tinnitus patients. Among the tests used was a complete radiologic evaluation, which included transcraniel lateral oblique x-rays, tomograms and magnetic resonance imaging in order to evaluate the condition and shape of the joint bones and meniscus. Electromyographic studies were also used to evaluate hyperactivity in the jaw and surrounding facial muscles. Other assessments included palpation of the TMJ area, orthodonic examination, range of jaw motion studies and joint sound evaluation.
The findings of this study were most interesting. Of that group of twenty, ten were tested positive for TMD in all diagnostic tests. Nine tested positive to one or more of the diagnostic procedures. Only one patient had no positive results of any jaw joint dysfunction. Dr. Morgan's findings were published in The Journal of Craniomandibular Practice ("Tinnitus of TMJ Origin: A Preliminary Report," Vol.10, No.2).
In another research project with Richard L. Goode, MD, professor of ENT and Head and Neck surgery at Stanford University's School of Medicine. Drs Morgan and Goode were able to establish the mechanical connection between the ossicles in the middle ear and the capsule and disk of the TMJ. ("The TMJ-Ear Connection," Journal of Craniomandibular Practice, Vol. 13, No.1).
Fortunately, non surgical treatment can restore function of the joint with surprising results. Clinicians who have treated individuals with TMD have noted that related conditions such as tinnitus have been improved and, in many cases, eliminated."
Non-surgical treatment is appropriate in cases where the symptoms are related to mild joint damage, muscle hyperactivity and/or dental-skeletal malalignments.
These interventions include application of heat and cold; injections of a local anesthetic into muscle trigger points; passive and active jaw exercises; medications--such as muscle relaxants and anti-inflammatories; multivitamins--neuromuscular orthotics; biofeedback and acupuncture; transcutaneous electrical neural simulation; coronoplasty; and cortisone injections.
Surgical intervention can range from arthroscopy to a partial or total TMJ implant. Dr. Morgan uses a specially designed implant that does not cover the petrotympanic suture on the temporal bone in the posterior socket of the temporomandibular joint.
Another implant was taken off the market by the US Food and Drug Administration when it was found to cause degenerative joint conditions, including tinnitus. The Proplast implant put pressure on the suture where the chorda tympani nerve, anterior tympanic artery and discomalleolar ligament passed through.
Pressure on these structures can cause symptoms such as ear pain, tinnitus, subjective hearing loss, hyperacusis, vertigo and muscle pain.
When the Proplast implant was replaced by Dr. Morgan's articular eminence device, patients reported either a vast improvement or a cessation of the ear symptoms they had been experiencing.
If there is no obvious otologic reason for a patient's tinnitus, audiologists may want to develop a questionnaire that will help determine if the condition is linked to a jaw joint dysfunction. For example, clinicians can question their patients about whether they clench or grind their teeth. Many people do this because there is pathosis in the jaw joint structure. It is not necessarily caused by stress.
Audiologists also should determine if the patient has grating, popping or creaking sounds in the jaw joints. This indicates a misalignment or tear in the miniscus of the joints.
Dr. Morgan believes tinnitus patients should see a TMJ specialist to determine if they have a TMJ condition that contributes to their problem.
Currently, Dr. Morgan is conducting clinical research on the relationship of temporomandibular joint disorders to fibromyalgia, chronic fatigue syndrome and hyperacusis.
Based on:
"Research Confirms TMJ-Tinnitus Connection"
Russell Crane
ADVANCE for Speech-Language Pathologists & Audiologists
June 2, 1997
Copyright © 1997 by Merion Publications, Inc.