Severe Recent Spikes: Should I See an Audiologist, TMJ Specialist, Physiotherapist, or Oral Surgeon?

[Aquaticon]

I've had mild tinnitus in my left ear for several years now and had grown habituated to it after negligently being informed that nothing can really be done about it. I knew it was most likely derived from poor posture and TMJ issues, but I didn't realize somatic tinnitus was very much treatable at the time. I attempted to consciously correct my posture, and after a while, it seemed to help quite a lot until just recently.

Fast forward to the present, I've suffered a series of anxiety attacks induced primarily from external stress but also the worsening tinnitus surely didn't help. I woke up with a less significant but still persistent ringing in my right ear, but it's recently gotten just as bad as my left and sometimes worse. It became so unbearably loud at one point that it actually inhibited my ability to carry out daily conversations with people.

I've tried some of the tinnitus neuromodulation noise therapy videos posted on various websites, and while it's effective at 'diluting' the ringing to a mere auditory static, the tinnitus usually flares back up worse than before in my case. I expected this for my left ear since it's induced by muscular issues, but I can't quite discern what the cause of it is in my right ear though I suspect it's somatic as well since I can ear popping in my TMJ on the right side with a more cracking noise on the left. Long-term, I'd be concerned about potential adverse effects from these videos since I fear they may be doing more harm than good because I've more or less determined it's just masking the underlying issue rather than addressing it.

I'm quite certain my TMJ is neck/jaw related because my hearing is still fine, or at least it is when my tinnitus isn't eclipsing all other rational noise. I've never engaged in anything that's too threatening to hearing, and my tinnitus cropped up after a long period of poor posture which I've been since trying to correct but having little success with recently.

Thus, I instead started performing various rudimentary neck and jaw exercises to combat the TMJ issues and assumed nightly teeth-grinding with moderate success, although just recently I've been having spikes probably from overstretching the muscles. Some days the noise is fairly low and tolerable, but other days it's disgustingly oppressive. I'm trying to self-diagnose what's causing this discrepancy in severity, but it's difficult to really evaluate a noise as perceptually abstract as tinnitus with the multitude of factors that can contribute to it. It's gotten bad enough now that I can't sleep or focus on work. It's demanding practically all of my mental willpower just to not give in to depression at this point. I really hope this is just a spike, because this would affect my ability to even live if it maintains this intensity, though I'm guessing this recent onslaught is just derived from some inflammation that'll likely subside. I was considering taking some Advil capsules (Ibuprofen) to see if it calms it, but I've been warned about the risks of ototoxic drugs pertaining to tinnitus. My only solace is usually after a long shower, but it's obviously unhealthy and unproductive to shower excessively just for a fleeting relief.

So I'm now strongly considering having my horizontally impacted wisdom teeth extracted. I was originally blowing this off longer than necessary specifically because I didn't want to risk further nerve or auditory damage, but I might as well do it now. My bottom right wisdom tooth erupted not long before this episode started occurring which makes me believe it might be a contributing factor to the tinnitus that started in my right ear. The oral surgeon I held a consultation with seemed sincere enough, but never really acknowledged my overarching concerns with tinnitus in earnest. He suggested that I use earplugs to mitigate the noise from the drill, but I've seen many people say earplugs can actually cause even more damage than forgoing them. The noise a drill produces is one consideration, but I'm more concerned about the potential nerve damage it might coincidentally incur due to a lack of precision or just the vibrations it produces.

So ultimately, I was wondering if anyone here wanted to share any personal insights or experiences they've come across. I'm not sure if I should see an audiologist, a TMJ specialist, or a physiotherapist, or just go through with the wisdom teeth removal I've been delaying. If anyone has any insights to share, I'd really appreciate it.

Thanks for reading.

 

[Drachen]

Welcome, Aquaticon!

You appear to have quite a studied history with this condition, and for that, I am truly sorry. This symptom should not have so much of an effect on one person's life, and it's truly unfortunate you're still dealing with the problems to this day.

First, how are you so certain that your symptom is caused by TMJ or muscular issues? Have you had a history with them? Do you experience a lot of pain? Can you perform somatic maneuvers that greatly affect the level of your tinnitus?

I know you said your hearing is fine, and that is very likely what you experience, but hearing damage is a very fickle thing. You can have damage in frequencies that are not tested by typical audiograms that can still contribute to this symptom to some extent. There is no conclusive way at the moment to tell you with certainty your hearing is fine across the board.

In terms of who you should go see, frankly, I would recommend anyone. The best thing you can do is try to find high quality professionals who have some understanding of the condition and how various causes may continue. Of course, if cost is an issue due to your current state of funds or lack of insurance, I can understand wanting to specialize. I don't know enough about the TMJ side of things to offer you a suggestion in that respect, though it is almost imperative you ensure the professional you go to seek knows something about tinnitus. Too many doctors out there either don't know or don't care about the condition, and you end up having your time wasted by some jackass is a white coat who admits he/she can't help you but will gladly take your money anyway.

I certainly hope you are able to overcome this spike you are experiencing. Best wishes!

 

[Chris S.]

Hi, Aquaticon,

I am new to this forum and will write an introduction soon. I have been suffering with (at times) severe TMJ problems for the past 6 years, and with tinnitus (loud noise induced) for the past 12 months.

Since I only recently experienced a bad tinnitus spike (previously it was mild and constant for about 10 months), I don't know enough about it to provide any good advice. I can tell you a lot about TMJ issues, though. Mine used to be severe (I feel severe pressure in my jaw muscles) and were triggered by having a wisdom tooth removed. I saw many TMJ specialists and orthodontists in the past 6 years, spent many thousand of dollars in therapies, occlusal splints, and also somehow endured three years of orthodontic treatment that required me to fly from the US to Europe every 3 months for about 2 years, and then to finish the job in the US. In the course of all these consultations and treatments, it became clear that my TMJ problems were the result of a very deep overbite that had always been an accident waiting to happen (no dentist that I had visited prior to the onset, however, had been knowledgeable enough to recognize the dangers of pulling out wisdom teeth and destabilizing the bite). The orthodontic treatment improved greatly my bite and made it almost regular. The TMJ issues improved considerably after the treatment finished but did not go away and there are bad periods still that sometimes last for 6 to 8 weeks.

Here is my opinion about the various dental, etc. specialists that you might consider visiting: TMJ specialists are questionable at best. Their fees are very high in the US (usually start at 700-800 USD but can be as high as 2500 USD for first consultation and evaluation - and no health/dental insurance would cover those) and the help that they could provide is often insufficient. They will almost always recommend an occlusal splint of some sort to alleviate the stress on the muscles and the joint (whatever you do, avoid hydrostatic splints like Aqualizer), some might try TENS therapy, and others might try to improve your posture. There are people who specialize in medical massages for the TMJ area - you might get some relief, but in time, at least in my case, my jaw muscles quickly relapsed back.

Oral surgeons are not more knowledgeable from my experience - they do not understand bite/occlusal problems well and neither do ENT doctors. Some orthodontists genuinely try to find solutions, but TMJ problems are due to many factors and if those problems are not primarily occlusal and postural, you will find no relief from any dental long-term intervention.

What helps, then? An improvement in posture and a soft diet (I chop raw vegetables or puree them with a blender/chopper) certainly do help. If needed - a treatment to improve the bite (through orthodontic braces). Not thinking about the TMJ area pressure/pain helps further. Enjoying a hobby of some sort also does. Exercise helps if it is moderate - straining other muscular groups has a negative impact on the TMJ muscles. Acupressure is pricey but helps too if done by someone who knows well what they are doing. Sleeping with a custom made bite guard also helps to prevent grinding or clenching at night and worsening the problem. Sleeping on your side helps. Certain medications also help - but many of those are not available in the US and I can find them only in Europe (they contain a very mild dose of codeine phosphate and should be taken only occasionally). Finally, time/habituation also helps.

I've tried countless other TMJ area creams, hot/cold therapy, CBD oil, magnesium pills or transdermal magnesium oils, applying headache patches over the TMJ area, etc. - those did not really work for me.

I hope that my experience can help you decide what kind of TMJ specialist to visit (if any). I am not going to make a recommendation because each case is unique and if your TMJ issue is not primarily occlusal, no orthodontic intervention will help.

Finally - I've been on an anti-depressant, Remeron (mirtazapine), which has helped, but it is quite impossible to wean off from. It gives terrible nightmares at lower doses in which I often struggle for breath, and I have not been successful in terms of stopping it. At my current dosage, 30 mg., I have no issues.

 

[Aquaticon]

Long story short, I fucked up cleaning my ears causing a spike then fucked up even worse by trying to use white noise and other audio techniques to mask the spike. Upon realizing this, I went to an ENT who then attributed it to earwax and performed a microsuction which might have made it even worse as I wasn't aware of just how dangerous the procedure could be at the time. I took prednisone after out of paranoia which may or may not have helped.

I can still hear the loud hissing, and the crickets flare up with my newly developed hyperacusis (it's actually harder for me to sleep with a fan running when I previously used one to mask my mild somatic tinnitus entirely). And of course, the pure tones persist albeit not as badly as I feared they would which gives me hope it's getting better. I believe most of my current tinnitus is derived from overstimulated nerves from messing with too many of the self-help neuromodulation videos or something of the sort. I have high frequency hearing loss, but nothing severe enough to be outstanding. I also have a lesser whining in my right ear that I'm quite sure is derived from an impacted wisdom tooth, but now I'm considering delaying that removal surgery due to all the ear trauma I've experienced recently.

Right now, I'm desperately trying to come to terms with it, but still have some hope that there might be something I'm capable of doing to help the healing process (if it will ever occur) without further damaging my ears as I've been doing. And the most frustrating thing of all is just knowing that every single thing I did probably just made it drastically worse

Given how negatively it impacts my mental health and career, I find it very difficult to just pray for it to heal on its own even though that has become the clear thing to do. At the very least, I was contemplating trying a few more supplements to see if any had even a slightly positive effect that I could cling to. Namely, a combination of Magnesium, Lion's Mane Mushroom, Nicotinamide Riboside, and Resveratrol as in hopes that something of them might at least help repair the damage slightly, but I know purely supplemental remedies are largely futile for tinnitus.

Any advice would be appreciated.

 

[ajc]

microsuction

Yikes. Avoid that one in the future. Hindsight 20/20 I know.

a combination of Magnesium, Lion's Mane Mushroom, Nicotinamide Riboside, and Resveratrol

Isn't this close enough to Paul Stamets' neurogenesis stack? A good set of supplements.

I also have a lesser whining in my right ear that I'm quite sure is derived from an impacted wisdom tooth, but now I'm considering delaying that removal surgery due to all the ear trauma I've experienced recently.

Yea, the nerves are very close. I would take out the wisdom tooth, might relieve things.

from messing with too many of the self-help neuromodulation videos or something of the sort.

Stop with the neuromodulation. Can you just have some simple indoor water fountain in your apartment? A bit of background noise but not too much.

I think you'll be fine. Gut feeling.

 

[Aquaticon]

Yikes. Avoid that one in the future. Hindsight 20/20 I know.

Isn't this close enough to Paul Stamets' neurogenesis stack? A good set of supplements.

Yea, the nerves are very close. I would take out the wisdom tooth, might relieve things.

Stop with the neuromodulation. Can you just have some simple indoor water fountain in your apartment? A bit of background noise but not too much.

I think you'll be fine. Gut feeling.

Thanks for the reply. Hindsight is definitely 20/20 and I will exercise great caution in the future. I failed to realize the risks in neuromodulation especially when my tinnitus was primarily non-auditory in nature.

I've read varied success with bits and pieces of the neurogenesis formula, so I had some interest in trying it. I don't expect any miracles, but it would give me peace of mind knowing that I'm at least taking something to -maybe- promote nerve healing.

 

[Aquaticon]

I'm still pretty early into my new onset tinnitus, and while I've definitely improved over the past month, I don't want to be complacent and hope natural healing will do away with the residue I have. I was planning on doing an anti-oxidant flush with NAC, ALC, and maybe Pine Bark Extract for now. If that doesn't get results in a few weeks, I was going to do a longterm dose of more neurogenic supplements like Nicotinamide Ribosome for a couple months to encourage and bolster the natural healing instead.

My major concern is that I'm being too overzealous in trying to remedy tinnitus myself rather than letting my body heal normally. I'm a little over a month in now and I can still hear crickets (mostly overlaid with louder sounds) and a buzzing that shifts between ears and tones. I know time is of the essence when dealing with tinnitus, but overreacting has done more harm than good in my case.

At what point should I be worried enough to start experimenting with supplements and treatments?

 

[Aquaticon]

Is there anything I should be considering before I resign to my fate? My case isn't horrible like some I've read, but one month in, I can still hear crickets over noises, passive hearing test tonal beeps, and cicadas crying. Listening to anything through headphones seems to trigger my tinnitus as well. It all started when I was listening to some white noise with crickets and cicadas after rupturing my ear drums.

Should I just wait and see or is there anything left for me to try while still somewhat acute?

 

[Michael Leigh]

Should I just wait and see or is there anything left for me to try while still somewhat acute?

Give your ears time to heal so leave them alone and don't try any treatment for now. Keep away from headphones, earbuds and headsets.

 

[Aquaticon]

Give your ears time to heal so leave them alone and don't try any treatment for now. Keep away from headphones, earbuds and headsets.

Thanks for your input, Michael.

I was scheduled to have my wisdom teeth removed a week from now after I realized one of my tinnitus tones (a buzzing, slightly obnoxious) is likely as a result of my bottom right wisdom tooth coming in. My reasons for believing this are firstly that I felt sharp pain from it for a week or so, then this buzzing started to appear. In addition, by pressing on various parts of my jaw where the wisdom tooth is centered, the buzzing fully dissipates. Should I reschedule this in light of my recent sensitivity to sounds and noise exposure?

I've been browsing this forum and have read mixed opinions on the subject, but most seem in favor of accepting the inevitable dental work and the liabilities of potential acoustic and nerve agitation it comes with. I'll have to call to see if the surgeon would be willing to accommodate my circumstances by drilling sparingly.

The bottom two are impacted at an angle so I will have to get at least those ones removed at some point.

Edit -- I should also clarify that the only real severe exposure to noise I experienced was the microsuction at the ENT's office, everything else was just white noise therapy -- albeit with headphones -- when my eardrums were ruptured. I think having the impacted earwax removed is also contributing a lot to my hyperacusis.

 

[Michael Leigh]

Should I reschedule this in light of my recent sensitivity to sounds and noise exposure?

HI Aquaticon,

As you know it's important that we look after our teeth and regularly attend the dentist for a check-ups. Only you can decide whether to have the procedure done on your wisdom tooth. If I were in your position I would go ahead. I have fluctuating tinnitus that can reach severe levels. Over the years I have had tooth extractions, root canal work, fillings and seen the dental hygienist. Thankfully my tinnitus hasn't been affected nor have I asked any dentist to take their time whilst carrying out treatment. I appreciate everyone is different so only relaying my experience.

Since COVID-19 I haven't been to the dentist in over a year. Prior to this I regularly attended for check-ups. Thankfully, I haven't had toothache or other issues and think there's a specific reason for this. I used to have problems with plague. My dentist told me this was going to lead to gum disease if I didn't take immediate action. He suggested seeing the hygienist, start flossing regularly and buy a Waterpik water flosser, available from Amazon. Within three months all traces of plague had gone which impressed my dentist. If you don't floss regularly and haven't got a Waterpik, I suggest you try it as it's remarkable. I use Dentek floss sticks as I can't cope with the string and use the Waterpik twice a day. I brush my teeth two or three times a day with an electric toothbrush.

Edit -- I should also clarify that the only real severe exposure to noise I experienced was the microsuction at the ENT's office, everything else was just white noise therapy -- albeit with headphones -- when my eardrums were ruptured. I think having the impacted earwax removed is also contributing a lot to my hyperacusis.

Whenever you are having earwax removed by: microsuction, ear irrigation or manual removal by curette. Apply eardrops/olive oil, three times a day to each ear for 7 to 10 days before having the wax removed. This way the wax will be loose and not impacted which helps lower the risk of complications when the wax is removed. Nothing is guaranteed, so problems could still occur whichever method of earwax removal one goes for. I have had microsuction three times, ear irrigation the same, and never had any problems.

All the best
Michael

 

[Aquaticon]

My wisdom teeth are a problem -- horizontally impacted and erupted, but my recent hyperacusis and tinnitus are worse. I scheduled an appointment to have them removed this week, but the anxiety is killing me. I can't decide if the risks outweigh the merits. I feel like I'm rushing too much to try and find a solution when everything I've done so far has just made the issues worse, but I've also been delaying this for too long as is.

My tinnitus and hyperacusis were both improving, but due to a combination of stress plus the subsequent teeth clenching, stopping supplements that would interfere with recovering from the surgery, and lack of sleep from the above, I'm reverting back to my previous terrible condition. Distortions are subsiding a bit which tells me my hyperacusis is getting better, but I can still hear crickets from a month ago. I really don't think I could survive an oral surgery drill screaming in my head along with them.

I've read most of the threads on this subject, but I feel my circumstances are slightly unique because I'm grappling both old somatic tinnitus which the surgery could help, and new acoustic-related tinnitus/hyperacusis that might be worsened via the drugs and noise. Should I just give it another month and see?

Any advice?

 

[ajc]

My wisdom teeth are a problem -- horizontally impacted and erupted, but my recent hyperacusis and tinnitus are worse. I scheduled an appointment to have them removed this week, but the anxiety is killing me. I can't decide if the risks outweigh the merits. I feel like I'm rushing too much to try and find a solution when everything I've done so far has just made the issues worse, but I've also been delaying this for too long as is.

My tinnitus and hyperacusis were both improving, but due to a combination of stress plus the subsequent teeth clenching, stopping supplements that would interfere with recovering from the surgery, and lack of sleep from the above, I'm reverting back to my previous terrible condition. Distortions are subsiding a bit which tells me my hyperacusis is getting better, but I can still hear crickets from a month ago. I really don't think I could survive an oral surgery drill screaming in my head along with them.

I've read most of the threads on this subject, but I feel my circumstances are slightly unique because I'm grappling both old somatic tinnitus which the surgery could help, and new acoustic-related tinnitus/hyperacusis that might be worsened via the drugs and noise. Should I just give it another month and see?

Any advice?

Your impacted wisdom teeth could be making your ear issues worse. No question about it, have them removed.

 

[Aquaticon]

Your impacted wisdom teeth could be making your ear issues worse. No question about it, have them removed.

Thanks, I like the vote of confidence. I definitely intend to get them out one way or another, I was just contemplating letting my ears recover a little longer from their traumatic encounter at the ENT to mitigate the likelihood of the dental drill causing more damage, but I wasn't sure if I'm just being overly paranoid or underestimating the potential downsides to delaying dental work.

 

[aot]

@Aquaticon, how did it work out? Did you get the teeth removed?