Advice on Chewing Increasing Tinnitus

[Sailboardman]

Dr. Nagler,

Hope you are doing well and your recent spike has quieted down some.

Briefly, my T is in my right ear. My hearing loss is classified as SSHL, at 65 Db's, from 2-8K. Probably higher, but standard test seem to measure only up to 8K, normal speaking range, I'm told. I do wear a hearing aid/masker, which allows me to hear, some of those lost high frequencies.
I had an Intratympanic injection of cortiosteroids done, last June, at the Silverstein Institute, here in Sarasota, Fl. No appreciable results occurred, from this proceedure.

My question relates to chewing, which increases my T some 50%. Every bite I take, or just clenching my teeth on the right side, produces this increase. Additionally, pushing inward on my chin or jutting my lower jaw out, temporarily, causes more T noise.

How can these seemingly, mechanical functions, cause an immediate, increase in T? Is this because the ear is so closely tied together and connected to the TMJ?

You have written, that tremendous fortunes have been made, on TMJ specialists and theraphies, so I'm inclined not to seek out their advice. Is this wise?

Btw, before T, I had clicking sounds, whenever I chewed on my right side. I noticed post T, those clicking sounds stopped. I have no pain in my jaw, however, I'm a teeth clencher and grinder and do wear a night guard now.

Any advice would be greatly appreciated.

Sailboardman (Leslie is my name)

 

[Dr. Nagler]

Hope you are doing well and your recent spike has quieted down some.

My spike hasn't quieted down at all, but I'm doing great! Thanks for asking.

My question relates to chewing, which increases my T some 50%. Every bite I take, or just clenching my teeth on the right side, produces this increase. Additionally, pushing inward on my chin or jutting my lower jaw out, temporarily, causes more T noise. How can these seemingly, mechanical functions, cause an immediate, increase in T? Is this because the ear is so closely tied together and connected to the TMJ?

Well, most everybody with tinnitus will notice an increase upon pushing up on his or her lower jaw against resistance - so I don't make much of that. It's a direct result of either a transient increase in intracranial pressure and/or (as you note) the proximity of the ear and related neuromuscular structures to the TMJ. The reason I don't make much of it is because you don't go around all day long pushing up on your lower jaw against resistance. But if every bite you take really causes a marked increase in your tinnitus and it's very bothersome to you, then that's a horse of a different color. Because ya gotta eat, no? So in that case, yes, I'd see a TMJ specialist. But before you consider any procedures he or she might recommend, I'd get a second and even possibly a third opinion.

You have written, that tremendous fortunes have been made, on TMJ specialists and theraphies, so I'm inclined not to seek out their advice. Is this wise?

That's why the second and third opinions.

Hope this helps.

Dr. Stephen Nagler

 

[Sailboardman]

Dr. Nagler,

Thanks for your expeditious response to my chewing question. I have been recommended to a TMJ specialist, by my dentist. However, his initial evaluation, before any actual work is done, is $495. Seems a bit steep to me, so I will search out some other specialists and do a comparison of services. In my area, this just might be the going rate? I'm beginning to see, how fortunes have been amassed, in this particular field! I guess that's true, with all dentistry.

Again, I appreciate your quick response.

To quieter days ahead!

Sailboardman

 

[Dr. Nagler]

Thanks for your expeditious response to my chewing question. I have been recommended to a TMJ specialist, by my dentist. However, his initial evaluation, before any actual work is done, is $495. Seems a bit steep to me ...

Hi Leslie -

Allow me to take a moment to break this down for you and possibly save you a good chunk of change.

A TMJ specialist is always going to find some indication for putting you in a split or doing some sort of fancy schmancy expensive procedure ... just like a chiropractor is always going to find some indication for adjusting your back. That is not necessarily a matter of their ethics but rather it is an almost expected byproduct of their clinical tunnel vision. It happens in tinnitus as well, by the way. If you go to TRT clinician because of your tinnitus, in many cases that's what you will wind up with whether or not something simpler and less expensive will do the trick. In fact, I would venture to say that if you go to a Neuromonics clinician, it will happen pretty much 100% of the time!! But I digress.

OK. So as I understand from your original post, your tinnitus is not caused by your TMJ, but rather the loudness of that tinnitus is briefly exacerbated when you chew. Moreover, since you have already seen an ENT, I am going to assume that your tinnitus is not caused by any of the very rare conditions that represent a threat to your health or life - or the ENT would have told you. And I am also going to assume that your tinnitus is not caused by one of the (also rare) conditions that in 2015 we can fix and hopefully in-so-doing fix your tinnitus - or ENT would have fixed it. With me so far?

So all that having been ruled out by your ENT, what you are left with is (for lack of a better term) a nuisance. It can be a HUGE NUISANCE or a little bitty nuisance or anything in between. And what, if anything, you choose to do about it should be dictated not by its existence, but rather by how much of a nuisance it is.

Back to the TMJ specialist. If the brief exacerbation of the loudness of your tinnitus when you chew is not particularly bothersome to you, then I would not do a thing about it. Take the money you would have spent on a TMJ procedure ... and go on a cruise or something, because that is precisely what the TMJ specialist would have done with your money had you undergone the procedure! On the other side of the coin, if the brief exacerbation of your tinnitus loudness on chewing is, indeed, very bothersome, then you want to find out from the TMJ specialist exactly what the likelihood is that whatever he or she proposes to do will markedly improve the brief exacerbation of your tinnitus loudness every time you chew. Do not be misled by the litany of other things that the procedure will purportedly accomplish, because those things do not present a significant problem for you. In your due diligence focus only on the issue at hand, the issue I put in bold italics above.

Hope this clarifies more than confuses.

Dr. Stephen Nagler

 

[Sailboardman]

Dr. Nagler,

Your expanded explanation is spot on. Yes, my two independent ENT's, have ruled out my T being anything other than SSHL. Additionally, my MRI supported, there were no issues with acoustic neuromas, etc.

My current dentist and dental surgeon agreed, I most likely don't have TMJ. Other than chewing issues, I have no pain or clicking in my jaw. So I agree, throwing a bunch of money at this, might not be prudent. Yes, it's annoying when eating, but then again, it's annoying when I'm not.

My T is relatively new, 14 months now and unfortunately, my brain has not yet accepted it's existence as being non threatening. Yes, it's a major annoyance! basically, loud and high pitched. Also, being unilateral, it has a lopsided effect on me. I assume, new neuro-pathways, or neuroplasticity, have not yet developed?

Btw, I was intially given anti-anxiety and anti-depressants, but I believe, they make me feel worse. I don't use them. I also worry about the ototoxic nature of these meds. I have been taking only natural vitamins and supplements, which do little for me, other than Vinpocetine and NAC. These do quiet it down a bit.

So, like most newbies, I suffer. I miss the peace and quiet, I use to cherish. I recently retired and relocated from NYC to Florida, but only had 16 months of peaceful living, before Mr. T showed up. Timing is everything I guess?
However, for those who have endured this dreaded condition, for many years like yourself, the timing is never right. At least, I had 62 years of peace and quiet.

Thanks, for the expanded explanation.

Leslie

 

[Dr. Nagler]

Thanks, for the expanded explanation.

You are welcome.

On a different note, the Doctors' Corner is not designed to promote back-and-forth discussion. It is sort of a one-shot Q&A. That is the reason that nobody has "reply privileges" here. You have managed to dance around that concept by starting new threads on the same topic, and I have merged those threads to keep things simple. But while I am very flattered that you would would want to carry on a discussion, in the interest of my trying to get to everybody's questions (I'm still some twenty-five behind!), I would like to respectfully discourage you from doing so.

Thank you.

Dr. Stephen Nagler