Tinnitus & Ear Pressure

Are you experiencing intermittent or constant noise such as ringing or buzzing?  What about fullness and pressure in your ear?  These symptoms are stressful and frustrating as it greatly impacts one’s life.

Most often, patients with these symptoms will seek care from their primary care or an ENT thinking that the cause is from an ear infection.  In the absence of an ear infection or no change in symptoms after a round of antibiotics or oral steroids, patients are left clueless and hopeless.  Most patients we see are very frustrated as they have seen multiple medical practitioners without any explanations or solutions. 

There is hope.  We successfully treat patients with ear symptoms on a daily basis because we understand the interworking of the craniofacial and craniomandibular complex and thus able to accurately diagnose and treat the root cause via an unique non-invasive treatment process.  If you or your loved one is experiencing ear ringing or discomfort, fill out the form below to take the first step to uncover the source of your symptoms. 

Tinnitus and Ear Pain Explained

Tinnitus is the perception of hearing sound when no actual external noise is present.  While it is commonly referred to as “ringing in the ears,” tinnitus can also be described as buzzing, hissing, whistling, swooshing, and clicking.

An estimated 50 million Americans experience tinnitus.  Ten to twelve million people are disturbed enough to seek medical attention.  They often visit their primary doctor followed by an ENT specialist.  Unfortunately, tinnitus is a common disorder with limited treatment options.  However, over the past 15 yeas, research has identified the association between neck pain, temporomandibular joint (TMJ) disorders and tinnitus.  Up to 75% of tinnitus patients can modulate their symptoms with muscle contractions of the head, neck, and jaw.  People with TMJ problems are likely to suffer from tinnitus, and people with neck injuries may also suffer from tinnitus.  Successful treatment of the neck and jaw can improve tinnitus symptoms.

Origin of Tinnitus

Somatic Tinnitus has an origin that is a combination of muscular, skeletal, vascular, respiratory, or located in the TMJ.  Somatic tinnitus also know as Somatosound can be either Pulsatile or Nonpulsatile Tinnitus.  Pulsatile Tinnitus is also referred to as venus hum or vascular noise which pulses in sync with the heartbeat.  It is essential that these patients receive immediate medical attention.  Sources of nonpulsatile tinnitus are either muscular, respiratory, or TMJ.  An example would be a spasm of muscles that connect to the eustachian tube.

Neurophysiologic (Sensorineural) Tinnitus originates within the auditory nervous system such as the cochlea.  The cochlea is a snail-shell like structure in the inner ear that produces nerve impulses in response to sound vibrations.  Damage to the cochlea from noise exposure often results in tinnitus.

Tinnitus can be both temporary or permanent.  In general, the longer a person has experienced tinnitus the more likely it is to be permanent.  Exposure to loud noise can cause temporary tinnitus and typically resolve within few days.  Tinnitus also can be induced by a number of medications and drug interactions.

Relationship Between Temporomandibular (TMJ) Disorder and Ear Pain and Tinnitus

TMJ Disorder can cause ear and jaw pain.  In the absence of an ear infection, the pain is often related to the TMJ Disorder.  This area includes not only the jaw joint but also the chewing muscles surrounding jaw and ear.  Ear pain results when the ligament is pinched or compressed between the jaw joint and the ear canal.  Ear pain can also be triggered by muscle pain in the jaw.   The ligament and retrodiscal tissue have nerves, blood vessels and ligaments which can cause ear pain.  Many people with TMJ and ear symptoms have tinnitus which is presented by ringing or buzzing in the ears.

In summary, there are three main reasons why problems with the TMJ may cause tinnitus, or make it worse.

• The chewing muscles are near some of the muscles that insert into the middle ear and so may have an effect on hearing, and so may promote tinnitus and ear pressure changes.
• There is a direct connection between the ligaments that attach to the jaw and one of the hearing bones that sits in the middle ear.
• The nerve supply from the TMJ has been shown to have connections with the parts of the brain that are involved with both hearing and the interpretation of sound.

Treatment for TMJ Disorders

Simple changes such as a soft diet, or the use of anti-inflammatory medicines may help simple cases.  For people who grind their teeth or clench their jaw, a professionally made bite guard appliance is frequently used to protect the teeth from excessive wear.  In exceptional cases, surgery may be required to perform surgery on the TMJ.  If your tinnitus is related to your TMJ problem, the tinnitus may improve as the TMJ problems get resolved.  To learn more about TMJ Disorders, click on this link.

Relationship Between Neck Pain and Tinnitus

Studies show that patients who suffered head and neck injuries, such as a car accident, or who have neck pain or stiffness for other reasons, such as arthritis, are more likely to experience tinnitus.  In addition, nerve endings in the neck make connections in the hearing centers of the brain.  Tinnitus is often associated other symptoms such as neck pain, headache, depression, and difficulty with memory and concentration.  Some people are able to change the intensity of their tinnitus by simply moving their neck or jaw.

Treatment generally depends on the cause of the neck problem, but the results from treating the underlying neck problem are often good.  To learn more about treatment options for neck pain, click on this link.  Individualized treatment options can be discussed with a clinician that specializes in Craniofacial and TMJ Disorders.

Clenching & Grinding

Involuntary grinding or clenching of the teeth, also known as Bruxism, leads to harmful destruction of the teeth and ultimately leads to TMJ disorder.  Most people that clench and grind are unaware because it usually occurs while sleeping.   Jaw muscles generate tremendous amount of force causing wearing of the enamel, fracture, and malocclusion (misalignment) of teeth.  With repetitive jaw clenching and grinding, patients will start to develop pain in the neck, cheek, face, and temporal region, headaches, migraine, ear stuffiness or fullness, tinnitus, and dizziness. 

Typical treatment consists of root canal, tooth implant, Botox injections, and night guards made their dentist.  However, these treatments only address symptoms NOT the root cause. While most night guards can prevent enamel wear by avoiding direct teeth contact, it does not prevent grinding and clenching.  In some cases, night guard promotes activity of the muscles that clench and this makes jaw pain worse.

In a normal TMJ movement, a disc cartilage is between the condyle and the temporal bone.  It provides cushion and allows the condyle to glide along the temporal bone. As the jaw opens, the disc stays between the condyle and temporal bone.  Without this cushion, the two bones will wear each other down causing degeneration of the bones.  And if the disc is out of place (also known as disc displacement), the jaw clicks, pops, locks, and causes pain.

In most cases of TMJ disorder, the disc is displaced and causes pain, clicking, popping, and/or lock jaw.  A simple night guard does not assist in placing the disc into the correct position.  Some night guards have uneven contacts from front to back teeth or side to side to side, causing uneven muscle activation which leads to more clenching and grinding, and TMJ pain.  One of the worse types of night guards is the over the counter type because it is virtually impossible to adjust and precisely fit it to your unique bite.  Improper fitted night guards can misalign your bite and shift your jaw in the wrong position to create more TMJ problems down the road.

Fortunately, there are special oral appliances/splints that are designed specifically to position your jaw so it can unload the irritated TMJ joint and relax some of the jaw muscles.  However, this only addresses half of the problem.  There is a direct relationship between head/neck position and the jaw position.  Whenever we slouch or slump, our shoulders round forward and our head comes forward and the skull rotates up.  This position increases activity of the muscles that clench the jaw.  Another cascading effect of forward head posture is that the jaw moves back and eventually displaces the disc, causing clicking, popping, and TMJ pain.  Furthermore, it shortens the muscles in front of the neck and decreases the airway space leading to sleep apnea and swallowing impairments.

You can experience this influence of the head/neck position to the teeth by the following movements.   Sitting up straight, tap your teeth a few times to feel the contact of your teeth.  Now, tilt your head back and look up at the ceiling.  Tap your teeth a few times and observe the difference in where your teeth contact. You can clearly feel the difference in the two positions.  

Mouth breathing, obstructive sleep apnea, snoring, and upper airway obstruction has been linked to jaw clenching and teeth grinding at night.  When we limit nose breathing and breath through our mouth, the sympathetic nervous system overrides the parasympathetic nervous system and cause a stress hormone called cortisol to rise.  Therefore, patients who suffer from clenching and griding suffer from stress, anxiety, and difficulty sleeping.   

We identify and address underlying causes of jaw clenching and teeth grinding.  Solving the root cause results in relief of symptoms.   

If you are experiencing teeth grinding, jaw clenching and TMJ pain after wearing a night guard, fill out the form below to find immediate relief.