Pulsatile TMJ Tinnitus 6 Months In

Hello Fellow PT Sufferers,

Six months I ago I woke up to constant ringing in my ears. While that is my "start date", the fact of the matter is that T had been sneaking up on me for years. For a long time:
- When I yawned I heard a high-pitched whine. It had gone on so long (years) I thought it was normal
- When I swallowed a big drink (swallowing a few times in a row), my ears whined. I thought this was normal

What I didn't know was that jaw misalignment plus night bruxism was slowly pushing my jawbone further and further up into my skull, pinching and damaging my inner ear. It was getting worse for years in the background and finally became constant 6 months ago.

But when the T started, I didn't remember all this. All I knew was there was loud ringing in my ears and seemed to be getting worse. It started at a 5/10 and panic and anxiety (and unknown to me more grinding of my teeth) just made it go up as high as a 7. I went to specialist after specialist getting more desperate as I searched for an answer (I heard everything from ear infection to "you're just getting old" at 48). It took a month to diagnose that it was TMJ+bruxism with a CT scan and a brilliant specialist, but for 4 weeks I thought I was going deaf, could hardly sleep, and couldn't work or concentrate. I was in despair.

Today after 4 months of orthotics and PT - and now in orthodontics to permanently reset by bite - my T is usually at a 2/10, with occasional dips into 1 and spikes into 3. This is "manageable" - it sucks, but I can work and function. I have also adapted enough that a "2" is forgotten when absorbed into work/pleasure/reading, but I do miss my silence.

On the downside, other TMJ symptoms have shown up, including jaw soreness and tenderness of bite. So I haven't eaten anything firmer than fish for 5 months and will have a metal mouth for the next 12-18 months.

Some thoughts/tips:
- Meds - Get anti-anxiety/anti-depressant drugs and sleep meds ASAP after getting T. I was having panic attacks and took meds for that at first. After stabilizing I don't need anti-anxiety meds any more, but am still on low-dose anti-depressants, which I think has helped my general outlook on a condition I may never shake. Sleep is also critical.

- Reduce Inflammation - For TMJ and many pulsatile T sufferers, I am a big believer that inflammation is a huge part of the problem. Try to keep that low with diet, as well as NSAIDs. For me Aleve lowers my T half a notch, plus relieves pain in my jaw. Aspirin didn't do anything for my T, and Advil actually increased it a notch. You will have to experiment on what works for you.

- Try Various Therapies - When this all started, the TMJ inflammation was not only in my jaw, but had spread to my neck. I could change the tone and volume of my T by pressing on different parts of my neck for the first 4 months. I did massage therapy for three months, and still jump in the Jacuzzi daily, plus ice my jaw every evening. Now that inflammation has gone down to only my TMJ I no longer can change the tone/volume of my T by pressing on my neck - and I believe this is part of the reason my T went from a 5 to a 2. I can manipulate my T today only by rubbing on my TMJ area.

- Be patient. It took a month of orthotics and PT before I saw improvement (month 3). I then saw pretty quick improvement in month 4, then have been stalled for 2 months. My braces are on for 12-18 months, and I hope to get down to a 1, but I actually don't think I will get to a permanent "0" of clear, which gets me to...

- Acceptance. This is probably the hardest part. I accept the worse case that I will always have T (which will leave me pleasantly surprised if things get all the way better).

- Compassion. I know I am "lucky" in that I know what caused my T, have a treatment plan, and have had improvement with the potential for more improvement. While that brings hope, I know that I am an outlier, and the vast majority of people on this board (especially those with nerve damage) have to live with their condition as-is with little hope of getting better. This is why I come to this site to give encouragement and share. I also talk about my condition with others to make T of all kind better known to the world.

 

I should point out that the TMJ cannot be jammed into your cochlea; it is surrounded by solid bone. It has probably been a bit lodged into your ear canal to a degree, but that is as close to the ear as it can get.

TMJ disorder can, however, lead to problems with the muscles around your eustachian tubes, and some have suggested that it can also lead to malfunction of the tensor tympani muscle in your middle ear, which can resemble other ear disorders and cause T and other problems.
Third, there are a not of critical blood vessels and nerves running very close to the TMJ joint; if something were dislocated, it could compress those blood vessels or nerves on a positional basis. As far as I am concerned that could lead to cochlear damage (by blocking the blood supplying it), as well as other neurological problems. I don't exactly know the major blood vessels that specifically supply the inner ear, but the temporal artery runs right along there.

I learned that the hard way when lightly clearing my ears. Big muscle contraction in my TMJ area and I had sudden hearing loss and massive pressure in my left ear. Most, but not all of it, came back.

 

All I related is what the TMJ guy told me, and after half a year of bite plates, soft food and now braces, my T went down from scary levels to manageable (note my audiogram came back perfect, so they knew up-front it was not nerve damage).

So releasing TMJ stress has helped , even if he is wrong on the mechanics. And even the specialist said there was no guarantee of getting to clear, but I am happy with the progress so far. I'm living a functioning life and don't hear my T most of the time, which is a lot better when it first happened and I was effectively disabled and couldn't work.

 

Hi DirM,

I just came across this post and was wondering if you had any updates? Did your T come down to a 1 or stay stable at 2? I just got my bite splint Friday September 8 and have been wearing it 24/7. I've noticed my T slightly go down during the day sometimes and early in the morning but those moments dot last long. But it hasn't even been 2 weeks with TMJ treatment for me yet

 

Hi @DirM

My dentist suggested my left ear pitched T could be due to TMJ. He recommended a very expensive dental guard that would lower my lower jaw by millimeters and hence give some space between the bone and the socket next to the ear canal. I am one month into it and still no change in sound. Do u take NSAID without any signs of inflammation? I have cooking sounds in my jaw when I remove my guard and try and eat. Did u have similar experiences? Also I got PT in my right which changes when I press my right shoulder muscles. How is ur T now? Do u continue to get treatment from the orthodontist?