Tinnitus is an auditory disorder that manifests itself in intermittent sounds like ringing in the ears. It can also be triggered by non-auditory incidents occuring in the head, neck and often the jaw. This relationship is rooted in the development of the middle ear with the trigeminal system of the jaw.
Tinnitus consists of the sensation of perceiving a sound that is not objectively present. Since tinnitus generally concerns ear structures, it is included in ear pathologies and the specialist mainly involved is the Otorhinolaryngologist. In many cases, however, no ear disease is found in the patient who reports it.
The connection between teeth, jaw and tinnitus may seem strange but it is extremely common. The central node is in the temporomandibular joint. One of the consequences of TMJ disorders can be tinnitus. The onset of tinnitus, although usually related to ear pathologies, can also be determined by non-otological factors starting from head and neck areas and, in particular, from the jaw and the temporomandibular joint. There are numerous findings of the frequent association between tinnitus and jaw problems.
Temporomandibular disorders (TMDs), such as temporomandibular joint dysfunction (TMJ) and bruxism (a problem in which you unconsciously grind or clench your teeth), are the main cause of tinnitus in people with dental problems. Studies have shown that the auditory symptoms experienced in TMJ and bruxism patients are the result of the reciprocal influence between the temporomandibular joint and the auditory system.
Bruxism can lead to the onset of tinnitus. Those suffering from bruxism tend to bring the two dental arches into forceful contact. This type of repeated action keeps the jaw muscles in tension. Grinding your teeth, especially if you do it frequently, has a number of consequences, which also affect the hearing system.
On the one hand, teeth and supporting structures suffer damage, with a progressive increase in dental mobility. On the other hand, the temporomandibular joint also undergoes damage, with critical issues affecting the ear and hearing.
At the origin of tinnitus caused by TMJ there is a dental malocclusion, or an incorrect closure of the two dental arches present in the mouth. Malocclusion can be due to factors including a particular conformation of the bones, crooked teeth, and lack of teeth. All these elements lead to a malfunction of the jaw joint and its muscles, which put pressure on the tensor tympanum and other auditory structures, generating tinnitus.
The diagnosis of tinnitus associated with TMJ and bruxism is made following a coordinated evaluation by the dental specialist and by the otorhinolaryngologist specialist, who deals with the diagnosis of hearing conditions associated with the presence of tinnitus.
Some characteristics of tinnitus can more easily hypothesize that the triggering cause is TMJ or bruxism, and consequently orient the therapy in this direction. First, in these cases, tinnitus is referred mainly from the same side of the affected joint. Sometimes by clenching the jaws, the patient can perceive a variation in the pitch and intensity of the tinnitus.
If TMJ is involved in the onset of tinnitus, ringing in the ears is rarely the only reported symptom. In addition to local symptoms that strictly concern the joint (pain, noises associated with jaw movements), other symptoms not related to the ear or jaw may be present, including headache, facial pain, and neck pain. However, other hearing conditions may be present, such as:
When tinnitus is caused by TMJ or bruxism, restoring proper jaw functionality is an effective treatment. The specific treatment for temporomandibular tinnitus involves the use of the bite and physiotherapy. The combination of these two approaches has been studied extensively in recent years with scientific studies demonstrating its effectiveness in reducing the intensity and severity of tinnitus. Other potential treatments include:
The use of a specific bite device is the most effective and immediate remedy to relax the TMJ muscles, removing forms of bruxism and teeth grinding, especially if the bite is custom designed for the patient, which allows the teeth to limit shocks and facilitates the correct position of the jaw and relaxation of the muscles.
Mouth guards and bite devices can be a useful aid in improving temporomandibular tinnitus because it helps to re-establish correct support of the teeth and consequently to "release" the masticatory muscles.
There are various models and each has a specific mechanism of action and must be tailor-made by a dentist specialized in gnathology. A generic bite device will probably not solve TMJ or bruxism. The bite device is not always the solution; this is why it is important to visit gnathological first.
Physiotherapy is usually effective in the case of TMJ. With specific massages and targeted exercises, a specialized physiotherapist can reduce tinnitus. Physiotherapy massages unlock the joint when there is a blockage of the temporomandibular joint. Myofascial techniques serve to reduce any contractures and muscle pain.
In addition, specific exercises are prescribed to continue the treatment set by the physiotherapist even at home independently by the patient and maintain the results obtained over time.
People who do not have hearing disorders can benefit from a physiotherapy and gnathological treatment that may reduce tinnitus even if it has been present for a long time. The multidisciplinary approach (physiotherapist + dentist specialist in gnathology) is the best solution to treat many chewing problems, including temporomandibular tinnitus.
Tinnitus may disappear if it has a specific cause that can be identified and treated. As described above, if tinnitus is caused by TMJ or bruxism, by undertaking a suitable treatment agreed upon with a medical specialist to address these temporomandibular issues, there is a very good chance that your tinnitus may disappear.