Somatic Tinnitus Causes (TMJ, Neck, etc.): Is There a Way to Tell?

So that means one is screwed? One would need to fix both his neck and jaw issues and even then, he could have cochlear damage? However if one does get damage, wouldn’t it show as hearing loss? Or at least pain? Or is the fleeting tinnitus / changes in tinnitus pitch a sign of such degeneration / circulation?

On that last part, I read on success stories that many find improvement from drinking ACV. Since ACV’s only relevant action is improving blood circulation, same as Ginkgo (?), doesn’t it give us a clue as to what’s happening (meaning the veins)?

 

Summary from the best researchers to date: Just one mention in one study of many: See Conclusion.
https://www.hindawi.com/journals/prm/2020/1202751/ (Also read articles on right side)


The location and type paratympanic fissure may be a predisposing factor for tinnitus, especially in patients with TMJ. The type of condylar displacement of the temporomandibular joint may be essential for tinnitus induction.

Other causes of somatic tinnitus:
Arthritis of the C spine - More so with mid to lower vertebrate.
C1 - occipital complex
Sternocleidomastoids or any deep deep neck muscles.

Reasons for cause are multiple - neck.
They include posture, whiplash, muscle spasms that may straighten C spine.

Ear pain and ear fulness can be caused by the jaw and teeth - infection and this:
https://pubmed.ncbi.nlm.nih.gov/1411217/

 

Is an MRI to the face/head or one with liquid to the veins (I think it is for nerves?) be helpful to detect any nerves pinched, any muscle imbalance, ears condition, ETD, TMD, and rule out some things? Some mention that anatomical changes can occur to the back of the head or the jaw that mess everything up, how can a physiotherapist possibly detect that without an MRI?

Everyone stresses the importance of quick action against somatic tinnitus because it can stay for ever or get nastier as time goes on if the root cause isn’t identified, as it can damage the ear. My question to this is, can it happen without any signs at all? Or is it only when hearing loss occurs? I mean, I suppose muscle tension dragging the ears out of place, their bones and ligaments or whatever the hell they have. Won’t an MRI show this too?

Unfortunately, my instinct tells me that when you get something that has no direct cure, it usually tends to stay. How on earth can one fully reverse this, even if you do we’re talking nerves and brain. That thing may very well stay as it is regardless. But we surely do avoid a much worse tinnitus or ear damage, I guess.

I mean, how does one actually go for fixing TMD with a splint etc when there are muscles from the neck influencing the jaw, and muscles all the way down to lower back influencing the ones on the neck... how does one work synergistically with all these hoping to get rid of tinnitus?

 

@donotringatme could not agree more. I have TMJ, forward head posture, according to audiograms (standard) no hearing loss and tinnitus in right ear - the TMJ side. Basically you have to try to develop your own plan. I am over 8 months in and guessing.

 

"The jaw issue is that by manipulating the upper palate, I created a bigger gap in my teeth as we go back to molars, which forces my teeth to close with a faulty jaw position, or not meet when the jaw position is correct. This led to muscle imbalances and pressure near my ear, also causing trouble to the Eustachian tube function."

@donotringatme That would probably mean some infection travel going on. This may be why your sounds are gone after sleeping - less movement.

TMJ and neck:

Lets say that a person is driving their car thru a forest fire and a tree falls on the roof. The frame of the car is discs, bones and joints that hold everything together, including the seats which is soft tissue. Soft tissue being neck muscles and soft palate in mouth can also weaken the frame as being discs, bones, joints and teeth. The tires represent body posture, which is the amount of air in each tire. Fire smoke represents bacteria infection. If damage to the frame happens, as being C spine and jaw disc, this may cause other damage. A car has a thousand parts, just like our head. Like with a car, when parts in the head are damaged that have electrical wiring, the radio can pick up static to say the least.

Summary:

The location and type paratympanic fissure may be a predisposing factor for tinnitus, especially in patients with TMJ. The type of condylar displacement of the temporomandibular joint may be essential for tinnitus induction. (second to last paragraph is also now highly noted.

Other causes of somatic tinnitus:
Arthritis of the C spine - More so with mid to lower vertebrate. Arthritis of jaw.
C1 - occipital complex
Sternocleidomastoids or any deep deep neck muscles.
Occipital Emissary Vein
Infection - enters soft tissue, gum pockets, soft palate and muscles - muscles of neck , jaw/mouth and ears.
Posture, whiplash, muscle spasms that may straighten C spine.
Always with TMD: A splint is needed.

Petrotympanic fissure provides direct
contact between the auricular cavity and the middle ear.
Often divided into paratympanic or petrosquamous, the
petrotympanic fissure may be used by infectious pathogens
for a bidirectional transmission. Moreover, the dis-
placement of anatomical structures in the temporoman-
dibular joint can cause a variety of symptoms associated with
otological dysfunctions. One of the multiple theories
attempting to explain the association between otological
symptoms and TMD assumes that TMD results are either
from excessive mechanical pressure on the discomalleolar
ligament or from direct strain on the auriculotemporal nerve.
It is also believed that the increased muscle tension
of the jaw observed in patients with TMJ might result in a
significant increase of the pressure on the temporoman-
dibular joints and, thus, overloaded the surrounding tissues
and muscles. Although in our sample, all subjects had
arthritis, the presence of increased muscle tension cannot be
excluded. Muscle tension as a response to psychosocial
stressors occurs in all patients with TMJ.
structures within the petrotympanic fissure (e.g.,
an anterior tympanic branch of the internal maxillary
artery) could likely undergo mechanical stimulation due
to the changes in the tension of maxillary muscles
at, in turn, could lead to changes in cochlear micro-
circulation, such as hypoxia or even ischemia, and both of
them are known to significantly affect the cochlear
function by inducing degenerative processes,
which in some patients could be responsible for the
generation of tinnitus.

Aberrant serotonin signaling has previously been implicated with hyperactivity in the DCN related to tinnitus. Tang identified that serotonin does not simply or globally increase activity in the DCN, but rather appears to suppress signaling through the auditory pathway while enhancing transmission through a multisensory pathway. This activation may have positive biological implications, such as integration of multisensory input for response to salient environmental events or negative implications, such as tinnitus and help explain modulation of tinnitus with head movement and changes in jaw position.

Ear pain:
Phylogenesis, ontogenesis and anatomy explain the close relationship between temporo-mandibular joint and the middle ear and can therefore help understanding otologic symptoms such as: otalgia which often correspond to articular and muscular pain irradiation (coming from sterno-cleido-mastoid, lateral and medial pterygoid, deep layer of the masseter and temporal muscles); acouphens and ear block sensation that could be caused by a spasm extension of the manducatory (i.e. medial pterygoid) to levator and tympani tensors. These three muscles, which originate from the first branchial arch, have a proprioceptive sensitivity and share the same innervation. What is more tensor and levator veli exchange certain muscular fibers. Tensor tympani spasm can be held responsible both for a decrease or abolition of the Klockhoff's reflex, together with a decrease of the stapedian reflex, the latter due to tympani rigidity induced by a spasm of the tensor tympani.

 

This post is pure gold Greg, thank you so much. I translated and printed it to have some ground when I make my next visits to doctors and therapists.

Regarding the infection travel going on, I don’t follow. Do you mean there is an infection in my ET or an infection to my jaw/teeth? Truth be told, the cortisone did help with my ETD but it was just a one-week treatment and my ENT didn’t mention an infection or fluid in the ear (he blew air to the ear drum and said it goes back-forth so no fluid behind).

“Aberrant serotonin signaling” I guess that’s what people call “stress related tinnitus” then and the reason why medication seems to lower it sometimes?

 

@Greg Sacramento forgot to mention that since the start of tinnitus I’ve had a weird metallic / bitter taste but not in my tongue, it was on my skin everywhere. Which seems to have disappeared just today. I thought it was from cortisone so I never mentioned it, however online it seems to be tied to ear infections and CNS / head trauma, lol.

 

@donotringatme

With the problems mentioned in your MRI, your arteries, soft tissues and nerve roots are intact. Disc problems.

You do have some arthritis - more than age related, maybe from over using your back and neck when doing pressure point activity. Posture pressure stress from lifting and exercise. With this, from what I can see with X Ray view, tinnitus could happen when turning to the right as small nerve fibers from neck to ear may become sensitive. This may be the problem with everything.

 

Thank you @Greg Sacramento. I’ve done physiotherapy today. I did electrotherapy, a laser (some German one, which has heat, I’ll remember the name next time), also did EMS (that thing sounds like an MRI).

My occipital “area” (as far as I found out, atlas misalignment cannot show on MRI as we talk millimeters and the area has 4 muscles on each side) is very stiff. That alone, can either have an impact on nerves or cause pressure at the surrounding tissue (not sure of the terminology, forgive me) that “hugs” the brain. That can cause migraines, vertigo and such.

Funnily enough, when the physiotherapist went on that area (c1, c2) with the laser applying heat, my tinnitus would change both in pitch and intensity and then subside once he stopped, you could literally control it. Also the level of heat from the laser would do that. I don’t know if there lies the root cause (theoretically it could) or if the area just influences this but given the fact the area itself is messed up, safe to assume it’s also the cause. I forwarded him the suggestion of lower c and muscle spasms, one said unlikely, the other one said “could be but not necessarily”, however I’m working on loosening the area. The ET are also connected to all this somehow as is the jaw, as my neck improves so do they, without someone touching my jaw at all. Right now my tinnitus is on the louder side, it happens every time but it subsides. It used to be this loud all the time on the first week, overcoming certain sounds.

I’ll keep pursuing this and updating, got some more people to check it with plus a neurologist and a TMD doctor, hopefully this week.

 

@Greg Sacramento Jesus... I’m reading up on ear infections and realize I’ve had plenty of symptoms and I think the tinnitus came from it.

Before tinnitus
- ETD for quite a while
- Itchiness around/behind the ear
- Extreme ear fullness, pressure and pressure on the entire area from ears to eyes, where the ET are
- No dizziness or at least no significant one
- Extreme daily itchiness for 2-3 months in the ear canal and use of q-tips to relieve it
- Sometimes a slight sensation of fluid coming out but I don’t know if it’s that or sweat or whatever
- Ear wax not cleaned for 6-7 years, pushed in from q-tips
- Mild occasional dermatitis
- Ear fullness getting worse the few days prior
- Very rarely some pain slightly inside the ear canal and laterally down

ENT cleared the wax out, claimed my ear drum was a bit inflamed / tired. Air pushed to the ear drum, moved, concluded no fluid behind and no ear drum perforation. Audiogram up to 8 kHz, will do one to 20 kHz. Took Medrol a week after onset for only one week, metallic taste on my skin/mouth/tongue since onset.

Afraid it’s inner ear infection although most of the symptoms I don’t have and no hearing loss. Middle ear infection I had completely clear sinuses but ETD also, cortisone definitely helped tremendously with it, although still not cleared. Jaw and neck seem to help with it as well, maybe they caused it in the first place, ETD slowly caused infection and infection set tinnitus. Outer ear infection I think I may have but I did not have an eye-catching inflammation otherwise the ENT would tell me. Itching was mad though.

I’ll go to the ENT tomorrow. Anything specific I should ask or push for? Is cortisone revisit going to be beneficial at almost 4 weeks in?

I have 2 tonsils that aren’t out and won’t ever be probably. X-ray shows no issues. No other problems with the teeth, I did have a tiny break on my front tooth that I fixed, not deep enough to have caused something.

 

@just1morething any change, for the better I hope? I am sure you like others trying to rule out one by one. This is definitely a marathon. Mine stays pretty constant. I may pursue an extended hearing test just to rule it out. I also might seek a consult with a Oral/Facial surgeon. TMJ joint and jaw line still sore/inflamed under ear. Follow up with TMJ doctor on 10/13 and that will be 16 weeks. Pain better but not sure what's next. Steroid shots in TMJ? Not sure. Still working on neck/back posture exercises...

@Greg Sacramento what are your thoughts on TMJ arthrocentesis?

 

@donotringatme Vestibular injury ( a notch is seen) can come from direct diffuse damage or from fractures that may involve herniated C spine discs. It can also come from damage to the nerves in the brainstem that feed into the inner ear or C spine straightening from neck muscle trauma that also can cause problems in surrounding area. With this any ear wax with eardrum sensitivity can add to tinnitus from neck trauma. With neck trauma, fluids can then develop within facial areas. With a neck injury, the C1 - C2 are often effected and occipital nerves become inflamed. Lots of biology conditions to be considered, especially if there's dizziness and headaches.

It really does seem apparent that muscle spasms of back, shoulders and neck from exercises - has caused your situational problems. Use warm, cool and laser on higher neck area, If you can't use some abdominal muscles, then be ever so careful with exercises and twisting neck hard to right. With this, your T may disappear completely.

@KWC Be patient. It will take several more months for your jaw to align with use of a spilt. I would not consider all these other treatments, including surgery that you have mentioned - not at this time. Also be careful with neck exercises - outward extension therapy would be probably OK - as that doesn't place pressure on the C spine, which is important with a TMJ disc problem. Get needed dental work done, but wisdom tooth removals if needed, need to done with emphasis on having TMJ. With this, you should be another tinnitus success story.

 

@Greg Sacramento I will continue the treatment then. I was just worried because you mentioned “infection” and when I put two and two together about how my ears were before tinnitus, it seemed I am having an infection. Thank you for your help so far.

 

Can't say that ear wax wasn't cause or ETD. On the list of things that you above-mentioned with your ears:

Metallic taste could point to ear infection, but not with dermatitis. More likely cell accumulation from ETD or a cold. You have an appointment with your ENT today. No cheek swelling, lips hanging to one side, redness behind ear or soreness in SCM muscles.

It may be multi-system and this is very common. Started with neck muscle spasms pressuring c-spine, then with pressure to jaw, eyes soreness - (that can happen in so many ways - hypertension. SCM muscles ?), lowered resistance of cells and either caused or increased EDT or a cold virus (metallic taste) and fluids from that traveled to ears where ear wax had accumulated.

You have no hearing loss, so be careful with getting neck muscle spasms and hope for the best with ears. Your tinnitus isn't severe and you have times of relief, but turning head sets it off. I can't make a complete call from where I'm sitting, but I think that neck muscle spasms started the chain of problems as seen in MRI and X ray view.

 

@Greg Sacramento truly, you’re right on point. Spine -> Muscles -> face -> jaw -> ETD (the precursor) -> probably an infection / middle ear pressure issues -> tinnitus

Let’s see how this pans out

 

Apparently ETD can be caused from GERD as well, whether it’s mild or not, with or without annoyance in the stomach valve. Looks like ETD is the silent killer in most cases. Interesting.

Now that I think about it, the pressure difference may be the sole cause of tinnitus and may explain why I had some 1-2 second tinnitus for the past few months that would go away by closing and opening my ear a few times, as that changes pressure(?) or why my tinnitus sound on week 1 completely vanished (although with horrible fullness) after being on a car going 150km/h with windows open. If that somehow increases pressure outside and sort of equalizes it with the one in the middle ear (which normally is higher), that would explain the tinnitus going away? @Greg Sacramento

@KWC I’d say keeping our ET clean gives us time to figure out how to make them work properly again (if possible). My jaw is definitely behind it in part, I believe yours too. Has your TMJ specialist mentioned anything about ET function in relation to your splint therapy?

 

I would agree. I have had/have GERD/Allergies, sure some sort of ETD, jaw issues. I agree my jaw is definitely part of it as years of bruxism have contributed to it.

Not sure about other countries, in the US everyone is a generalist or specialist in their own specific area. To answer your question, no he has not mentioned it. It is very frustrating. It would be nice to have a doctor who is your lead and works with others to help diagnose issues and works out a plan. I have been to ENT's, Neurologist, Dentist, PT, TMJ Doctor and had MRI's of the brain, CBCT of the jaw, CT scan of the neck, you name it. Nothing comes back conclusive except being told my jaw issues (posterior condyle) which @Greg Sacramento confirmed can impact your nerves, ear, etc.

Weird how mine started, headache/ear ache/tinnitus/ear infection and then my jaw pain took off. Trying to re-evaluate what to do next.

 

The last few days, I've been in severe pain from just previous moderate pain on left side - both top and bottom of oral cavity that is also causing ear pain, fullness and some hyperacusis. I do have oral infection that antibiotics have not solved.

Discussion reasons:

Infection - crestal alveolar bone loss - more advanced in posterior regions
Referred pain
Anterior open bite with the only apparent tooth contact occurring between molar teeth.

TMJs - Me - Condyles are normal size and shape. The osseous components of the TMJs are smooth, rounded and there's no evidence of subchondral defects. Cortical thickening along the superior surface of the condyles.
In a closed position, the right condyle is anterior to the center of the fossa and the left condyle is nearly centered within the fossa. The resultant posterior space is wide in the right TMJ. But TMJ is on left side as right side feels no trauma. I think reason is because the mandibular plane is steep and the angles are obtuse on right side. And I have anterior open bite with apparent root contact contact occurring between molar teeth. My palatal vault is relatively steep and narrow. I have hyperostosis extending from the lingual side of the alveolar ridge in the molar regions.

These are all spatial relationships that can associate to TMJ.

Infection - bacteria develops in gum pockets, where problems advance causing teeth to move and then nerve roots are inflamed.
This can weaken teeth. All of this is causing pain. I have no cavities.

TMJ was caused from dental whiplash where neck muscle spasms straighten c spine with mouth open and caused joint space narrowing, sclerosis, flattening and osteophyte formation in the medium atlantoaxial joint.

ALL very ironic for me, as I have spent much of my my life in the study of whiplash - neck and jaw, hypertension with developments that associate to pulsatile tinnitus, including eye problems. I became a victim of all of this.

The jaw and neck is a two way street - and often TMJ starts with neck and then oral trauma can also set in when mouth is open too long - the camel's back is broken if trauma does not happen immediately after a neck injury. Both neck and jaw trauma can happen at the same time when the head is jolted or from head injury. Muscles spasms of neck often have a place. Clenching can happen from stress and sometimes due to an added injury to neck or head.

Severe bone loss or bone trauma of neck or oral cavity can be enhanced secondary to traumatic occlusion.

 

@Greg Sacramento you have my utmost sympathy. You are unselfish in your feedback to help people.

Thoughts and prayers to you.

Ken

 

ENT appointment in an hour. @Greg Sacramento I know I bombarded you with questions and for that I apologize. However, I’ll upload my X-ray from my jaw in case you have anything to pinpoint. Finding a “TMJ specialist” in my country is apparently harder than curing tinnitus.

 

@donotringatme

Scans look remarkable. Nerve roots are also remarkable. Very slight hyperostosis (large molar) with right, but not a concern. These two scans are like an overall snapshot, where a large series would provide more information, but from what is seen with these, I really doubt that your jaw has anything to do with tinnitus.

 

That’s good to hear but my dentist said it was so bad (the side being off) that I might even need surgery haha. Christ...

Just had another ENT check up. Hearing is exactly the same, he used a camera and went up to the ET, the entrance is clean, nostrils are clean, no show of inflammation, yet my middle ear pressure is exactly the same, double what it normally should be. Not only that, but given the fact I can modulate my tinnitus with two jaw movements, one neck movement and a heat laser on my c1 and c2, ENT wrote me an MRI for the head (angiography) as he said it’s probably a vessel issue and might also be due to my jaw.

My theory is that by thrusting my tongue to my upper palate for the past year and a half, trying to “fix” my overbite and mouth breathing, I ended up either expanding my mandible and the area around it (temples and such), possibly changing the anatomy of my ear (probably a stupid theory as I doubt my tongue is that magical but visual changes did occur). Or I messed up my bite (which honestly I felt months ago, as if my molars had more gap and the overbite became worse) and that messed up the muscles around which messed up the muscle responsible for opening my ET (palatini) , maybe the tympani too (slight sensitivity to sounds) and coincidentally the middle ear pressure difference gives me tinnitus. Lots of examples of people suddenly having a pop in their ears and tinnitus going away. My ET are considerable better after Cortisone which ended two weeks ago but still not functioning properly, they don’t open at all if I yawn or open my mouth wide and try to pop or when I lie flat on bed. So I assume the issue is anatomical.

My lower jaw is true that after doing that tongue technique, it shifted even more on my right (you could even see my lower lip being a bit off). By opening my mouth slightly and moving my lower jaw forcibly on the left for a few reps, my RIGHT ET can then pop when I open my jaw and tense.

One of my tonsils is also kind of bent to the side but they told me it’s far away from anything to give me tinnitus on both ears and that they probably will never come out.

 

@donotringatme did you have a CBCT scan done?

 

No, I had a panoramic done. CBCT has kind of a bad rep due to the radiation amount I think. I don’t know much about this field, haven’t visited the TMJ doctor yet but there are some more specific xrays you can take etc, @Greg Sacramento mentioned it.

This thing is a mess dude. Bunch of vessels, nerves, canals, pressure here, strain there. This is gonna take a long time to figure out so right now I drove and bought some kickass melatonin haha. I’ll keep us updated and hopefully we can figure it out and get rid of this noise.

 

@Greg Sacramento this is my audiogram and CT scan of the neck... audiogram looks good I think. Would even getting an extended audiogram really matter? I do not have a copy of my CBCT of jaw.

 

There is nothing in these two scans that I can see that would show concern and I used enlargement of small sections to full page view. An overbite would not be seen from these views. Your teeth are straight, even for a mouth breather, which is same with me. I had a cone beam with over 300 scan pictures that was sent to me, so I was able to view interior problems. I also have two scans like yours and all sorts of unbalanced problems can be easily seen. I also have soft and hard palate issues, nerve issues, salvia gland issues, lip issues and had tongue issues as well. My cause was dental whiplash that messed up my neck, caused TMJ and dental problems. Dental errors were also made.

From your scans of neck, there are noted problems. So many possibilities that need radiological exam, but I think that your neck is primary - as to where things began. One of many possibilities:

https://www.epainassist.com/back-pain/upper-back-pain/can-a-herniated-disc-in-neck-cause-jaw-pain

 

Thanks. One bad habit of years old was "cracking" my neck. No doubt it did not help. Slowly working on neck exercises gently. Neck/Jaw, etc. as you noted all integrated. My neck has some tightness/slight soreness... my TMJ is more sore and that area below my ear lobe along jawline is sore... (maybe because jaw is being repositioned)

Not thinking worth pursing extended audiogram. May have to look cervical imaging/testing/etc.

 

Yep I use melatonin every night... time release for longer duration and fast dissolve to kick in my sleep. I also use Lunesta. And sound at night... sound machine plus ambient noise on my phone.

 

Dear Greg,

You mention hard and soft palate issues. Would you elaborate on that? Could someone who alters his tongue resting position from bottom to the roof of his mouth - in an attempt to correct mouth breathing - and applies force to his hard palate, lead to issues (such as severe muscle tension, imbalances, irritate nerves, if combined with clenching)? I don’t know what kind of issues you’re dealing with but I wonder. I’m trying to gather as much information as possible before the TMJ doctor’s appointment. Thank you in advance, you’ve been of tremendous help so far.

 

@KWC There are many articles that discuss CBCT - cone beam, including radiation dose. Sites can be found that list all the many manufacturers and models with amount of radiation dose. With this, there's is a lot of dose variations. A thyroid shield should be used. Leaded glasses - will block up to 50% of radiation, but opacities such as etiology in the optic canals anterior to the optic chiasm, can't be seen with leaded glasses.

@donotringatme Periodontal is a good place to start. Initial visit may be just one hour, but additional appointments may last up to two hours. Your concerns and what you are describing may need onsite examination.

With Radiological, MRI has some advantages over CBCT or cone beam, but CBCT and cone beam also has some advantages over MRI. Two separate site searches - CBCT and cone beam will bring discussions that I had involvement in. You can use the search at the top of this page or any page.