Tinnitus, TMJ, Headaches, Neck Pain, Facial Pain, etc. — Possible Treatment

No not really. A person could have closed lock with full range of motion. This would not show up on a CBCT nor a clinical exam, but would only show up via an MRI. This is especially true if the person has formed a pseudo disc. CBCT is actually of extremely limited clinical value for TMJ/D. The top surgeons in the US (read Mayo Clinic) told me it was utterly useless and didn’t want to waste their time reading the one I had done by a different professional.

 

Not ready? I basically did a cut a paste from a radiological site. The article was more than three years old. Newer specialized 3D scans have improved. These are those that can be found at a radiological center and not those used in a dental office. A MRI as I agree is best for what you mention, but other indications for a 3D would be enough to know if a MRI is needed. I hate to recommend a MRI first because of their noise levels. A 3D exam is often only 30 seconds, not loud and exam time is never more that a minute. Anyone can get one without a doctor's referral and noted by a radiologist at least in my area. My report is 65 pages long that includes pictures and the summary page is written in simple language. I also have a CD that a lay person can study. Besides, you are only placing value on disc where problems often are elsewhere. For me, I found cause and value from my 3D and not from my MRI.

 

I had recently posted that my health provider will longer provide MRIs for tinnitus patients unless there's certain suspected issues. Even the list of suspected concerns is debatable so I won't provide a list - I'm not a doctor.


Osteoarthritis of the TMJ is an age – related degenerative disease seen in almost 40% of patients above the age of 40 years. It causes bony changes in the TMJ like flattening, sclerosis, formation of osteophytes, erosion, resorption of the condylar head, erosion of the mandibular fossa and reduced joint space. Flattening (59%) and osteophyte (29%) are the most prevalent degenerative changes seen on CBCT.[14] Many in vitro cadaveric studies have explored the role of CBCT in assessing bony defects and osteophytes. Erosive changes in the TMJ are most effectively diagnosed using CBCT in the 6 inch FOV as compared to the 12 inch FOV.[15] Alexiou, et al. used CBCT to evaluate the degenerative changes and concluded that patients in older age groups are expected to have more frequent and more severe bone changes than those in younger patients.[16] Alkhader, et al. performed a comparative study between CBCT and MRI. According to them CBCT is better than MRI in detecting changes in shape (flattening, osteophyte formation or erosion) rather than changes in size. They concluded that this was probably because MRI had limited spatial resolution and increased slice thickness (>3mm) in clinical use. Also other problems like presence of fibrous tissues inside the TMJ, proximity of lateral pterygoid muscle to the articular surface of the condyle and presence of air spaces in the temporal bone can impede the accuracy in the interpretation of MRI.[17] However there is a poor correlation between condylar changes observed on CBCT images and clinical signs and symptoms seen in patients with TMJ osteoarthritis (TMJOA).[18]

CBCT plays an important role in diagnosing early stages of juvenile idiopathic arthritis (JIA) in children which, when undetected, can damage facial development and cause growth alterations. Farronato, et al. concluded from their study that CBCT can be used to volumetrically quantify the TMJ damage in these patients by measuring condylar and mandibular volumes.[19] Condylar asymmetry is very common in children with JIA. CBCT shows a wide variety of condylar destruction patterns which could be small erosions within the cortex to almost complete deformation of the head of the condyle.[20]

 

I have seen my local Dr. to get a referral to a Mayo TMJ specialist but they wanted $5000 up front as I lost my major medical insurance temporarily due to missing a month premium accidentally.

I had some bad experiences from Mayo Rochester in the past even though they are supposed to be world renowned.
I had tore my left ACL in late 1997 and they didn't think I should have it reconstructed even though I was playing tennis at the time. I ended up having a patellar tendon graft done from somewhere else and it has never popped out since. That was in 1999. I damaged more meniscus by not having it done right away I'm afraid.

 

I'm seeing a TMJ surgeon at the end of this month. Hissing in left ear driving me nuts. Crunchiness and clicking in my left jaw. I think my noise is from inner ear muscles.

 

Me too, I am pretty sure I have massive hearing loss combined with mechanical problems in the inner ear. A shotgun to my head would be a cure, but coming short of that I'm stumped. Let me know what the surgeon says, dry interested. Good luck.

 

When you say you're stumped do you mean an axe and a tree stump? I tend to wake up with the loudest noise whether it be a nap or overnight. I will keep you updated.

 

@Daniel Lion, I did see a TMJ surgeon on Thursday 7-31-19 and he said I wasn't a candidate for TMJ surgery. So all I can do is continue to wear my oral appliance every night.

 

That’s good news I believe.
You must, or should try, sacral cranial massage and swimming. Light exercise.
Busting a nut, is not exercise, joking.
Seriously, acupuncture and massage for that region.
Lane, a member here, knows a lot about holistic therapies and TMJ.

Be mindful of your posture and be weary and super cautious of chiropractors, they could damage you, in my humble opinion.
Try everything, including hot baths.

Best of luck, keep me posted.
We are in this together.
Hoping you have a few good days

 

I'm talking about a spinal CSF leak not a cranial CSF leak, which is the Cerebrospinal fluid (CSF) rhinorrhea.

However, there is another condition which has very similar conditions to a spinal CSF leak and that is Cranio Cervical Instability and I this is more likely perhaps if severe headaches are not happening when getting up, but I'm not sure because I've seen all the videos of Dr. Ian Carroll and he says the chronic form doesn't have that.

I know this from many sources, but I also found this more recently: Brainstem Mechanisms Underlying Temporomandibular Joint and Masticatory Muscle Pain: https://www.tandfonline.com/doi/abs/10.1300/J094v07n01_15?journalCode=imup20

Craniocervical Instability can cause compression of the brainstem this then causes compression of cranial nerves, face pain, tinnitus, intermittent hearing loss, eye muscle control problems. It is related to medulla compression or similar. These are all cranial nerves. It can also cause fatigue and a lot of muscle pain around the body as the condition progresses. It can also cause dysautonomia and ME/CFS type symptoms. It may look like chiari malformation in some people.

I also learned that the Craniocervical Instability may be caused by a condition called Tethered Cord and the tethered cord may be hidden "occult". Also, the occult tethered cord is more likely to happen in those who have either spina bifida, including the occulta variant or ehlers danlos syndrome (EDS). I was diagnosed with spina bifida occulta as a child and I had growth issues. I was never tested for emtpy sella or tethered cord. If there conditions are untreated they can progress to craniocervical instability and a host of other complications slowly over many years.

So, the correct thing to do is find the world expert on tethered cords and get tested for that, though it may not show on all scans which is why it can be occulta. You can also do a scan for Cranio Cervical Instability which is an upright MRI dyanmic (flexion and extension) positions. A rotation scan using CT scan can also be done.

The MRI may find syringomyelia, fatty clumps or be tethered due to a connected filum terminale. It is a big subject. There are also other related conditions such as intercranial hypertension and empty sella, which is a condition which effects the pituitary gland. I may have had all of these which were undiagnosed.

Also, there are some symptoms for tethered cord. They are called "The 3-Bs sign" which is useful for initiating suspicion of tethered cords syndrome. They include 1) bending slightly (over the sink), 2) Buddha sitting with legs crossed (like the Yoga pose) and 3) Baby holding (or equivalent weight) at the waist level.

For me I get pain in the groin area when I do buddha sitting, folding my legs I also have had tailbone area pain. I also have a history of some other symptoms related to tethered cord which I didn't know about. It is very possible that this is a congenital conditions that has been progressing for decades resulting in greater syndromes and debilitation and disability and hell for me. I think I am getting closer to figuring this out though. I wa

I don't think about this forum much since tinnitus and face and jaw muscle pain is just one of my many symptoms, but I thought I'd give an update.

Best wishes to all who may read this some day if you find this. I must have put in tens of thousands of hours of research into this.

 

I also had this diagnosed at age 15. I had no problems other than a fluid - filled cyst development at this age.
I had lumber muscles spasms upon receiving a front lower dental implant. This extended to my cervical muscles while in the dental chair which caused loss of normal lordosis. As you mentioned, I also had cranial involvement.

Taken from research: Araz Server et al (2018)
"It is presently considered a problem when there is mechanical compression during head rotation due to muscular and tendinous, osteophytes, around the C1-C2 level. As the vertebral arteries enter the vertebrae around C4, it can also occur at lower levels. As about 50% of c spine rotation occurs around C1, this is likely the reason for the predominance at this level. Reduced blood flow in the ipsilateral vertebral artery when the head was both hyperextended and rotated. This happens in dental offices. This will also lead to pulsatile tinnitus, after receiving somatic tinnitus.

I had other arteries compressed as well.

Pressure to my jaw with association to the above.
Mechanism of injury to my TMD.
A sequential injury extension-flexion of the neck accompanied by simultaneous jaw movement resulting in shear stress and compressive forces in the retrodiskal tissues. An anteromedial displacement of the articular disk as a result of direct trauma to the TMJ during cervical hyperextension of implant placement. This caused the pull of the lateral pterygoid muscle in combination with the force of trauma caused stretching of the posterior attachment of the disk. This is significant if the trauma occurred when the mouth was open and the attachment was already stretched. This is sort of like whiplash-induced, a myospasm that leads to abnormal jaw posturing and parafunctional activity that results in eventual dyscordination and internal derangement.

For sure @applewine We both have thousands of hours spent on physical tinnitus research. I honor your past postings. I consider forward head hyperextension with cervical exam notations as a major concern to control all mechanisms to not increase problems or spike tinnitus.

Wishing you the best.

 

Hi @applewine, very interesting post. I too have ME/CFS, and feel quite certain it is primarily caused by some form or degree of CCI/AAI. I suspect you're familiar with Jennifer Brea's story, and another CCI/AAI story by a young man named Jeff. I thought I'd leave a link to a post I made, which included Jeff's compelling story.

 

@Lane, I'm very happy to see you here. Yes, I am very familiar with Jennifer and Jeff and have been following them very closely for a while. Jeff also did a podcast interview recently where he shared that he discovered he had tethered cord after doing his CCI/AAI surgery. The symptoms he had as a child in his legs came back. I then learned about Dr. Petra Klinge and watched her presentations.

I think when I pull my head up it heals with the facial pain. It is hard to replicate exactly, but when the pain is bad I think I've noticed several times it will make a crunch sound and the pain gets better. However, I can hear another crunch like the head is going back down and the pain returns sometimes fairly soon.

That is when I remembered my spina bifida and also found I had some of the symptoms of tethered cord. I've had lower back pain since I was a child. It is very frustrating to have so many spinal and cranial nerve problems and see countless neurologists for decades and none of them think anything is wrong with the spinal cord or brainstem. They all say my brainstem and spine look fine and that nothing neurological could be causing systemic symptoms like this unless maybe it is auto-immune. Perhaps, but perhaps not.

I am still pursuing auto-immune for IBS and I did test positive on the antibody to the nerves using IBS Smart test. I had anti-vinculin at 2.7 out of 0 to 4. So, I may have that and it could be a complication of the underlying condition, or not related. Treating that is difficult. I need to get a methane breath test and the drug to treat that infection is still in trials.

I actually saw a neurology consultant today who specializes in movement disorders because my doctor thought that might be the closest thing if I had a brainstem or spinal issue. The neurologist looked over my last MRI from 5 years ago and said my brainstem looks fine. He said that tethered cord is rare and he pretty much would have never thought of it. I told him I'm seeing a neurosurgeon to talk about it and he said he would leave it to them. So, basically, the neurologists and even neuro-surgeons don't seem to be aware of this condition. Or, if they are they consider any rare condition not worth testing for or telling you about no matter how long you have been sick. To them, rare means it doesn't exist.

I'm trying to remember everything from Jeff, but I know according to CCI/AAI you can't tell like from a scan like that. However, Dr. Petra Klinge just asks for a regular cervical MRI for tethered cord.

 

Symptoms of TMJ Disorder
Temporomandibular joint disorders (TMD) may start with a simple click when you yawn or chew your food – but this symptom can progress into something more uncomfortable. It usually begins in girls after puberty and spikes again in women in their late 40’s and early ’50s, around perimenopause. Clicking may progress to jaw locking and often occurs in women with systemic joint laxity and clenching.

With TMJ syndrome you may experience:

• Clicking, popping, or grinding noise as you move your jaw
• Jaw pain
• A tight feeling across your face
• Headache around the temple
• Ear pain
• Dizziness
• A feeling of fullness or ringing in the ear (tinnitus)
• Difficulty opening your jaw
• Jaw lock when you open your mouth
• Pain when chewing
• Pain in the mornings, or when stressed

https://www.drmichaelgelb.com/not-just-a-jaw-click-the-consequences-of-untreated-tmj/

 

I’m almost positive my left ear hissing is from barotrauma in left ear in 2008 or TMJD. Left TMJ clicks and is crunchy. I’ve seen a few TMJ Dr.’s with no luck so far in getting better. I have an elastic mandibular advancer but think I need injections of some kind. God darn it! I need to grab one of those doctors by their turkey neck and demand some treatment.

 

I have TMJ. I have clicking/pop on my left jaw but my tinnitus is on my right side. I always thought my tinnitus was due to stress/anxiety. But I am not sure now. When I press/put pressure on my right side of jaw, there is a shift in noise, so is applying acupressure. My bite's off too. Most dentists recommended wearing a splint. Is this enough?

Any suggestions or input as whether this is what may have caused my tinnitus and/or what to do help it get better is appreciated.

 

@MichaelSF -- I think it's quite possible (perhaps even likely) that this is what is causing your tinnitus. I suffered a head injury/whiplash as a teenager, and experienced many difficult symptoms from then on (hyperacusis, but not tinnitus). I got some specialized upper cervical work done over the years, but the things that helped my neck the most were: 1) AtlasPROfilax; 2) Nasal Specific; 3) Self-Acupuncture; and 4) Reflexology technique for the neck.

I've written on some of these on this forum, so you could do a search on these words under my username if you wanted to follow up. The first two I mentioned were particularly helpful, and I immediately felt significant shifts in my TMJ area. I used to suffer chronic daily headaches (for decades), and these have now become much more manageable. -- BTW, I got tinnitus two years ago from a single dose of an ototoxic medication, but I believe my neck issues are a contributing factor.

 

The more I talk to people here with specific issues relating to the neck and jaw and the eustachian tubes, the more I'm certain they at least play part in my tinnitus. Symptoms and onset match a little too much to just be a coincidence or me trying to be hopeful about a possible recovery. Especially the neck, which has been causing me issues for a while now. I know noise induced is the most common type, but I've genuinely been careful... while it can be accumulated, the way mine started just doesn't make any sense at all.

@MichaelSF as for you, all I can suggest is looking into TMJ treatment. I think you need to talk to a dentist about it, but it's known to cause tinnitus from what I've read. Good luck!

 

@Lane Did the AtlasPROfilax lower your tinnitus? Did you try any conventional chiros before?? About 4 weeks ago I started wearing a posture corrector 2 hours a day and a week in I gained almost full range of motion looking up and my neck loosened up, but didn't help my tinnitus.

 

I hope I can try another steroid injection into my left TMJ. Last time it really opened up my Eustachian tubes. Thought I was cured but it didn’t last.

 

I got a virtual appt. with Dr. Kevin Reid in August. He looked at my TMJ MRI report they tell me. I wonder if he needs the imaging sent to him. CDI could send him a disc.

I wonder if this would stop tinnitus in some cases?

https://www.mycdi.com/services/injections-and-biopsies/stellate-gangion-block/

 

This is a quite old study relating to tinnitus. It probably doesn’t apply to many people.

https://www.jstage.jst.go.jp/article/kurumemedj1954/31/4/31_4_295/_pdf

 

I got the book "structures of the head and neck" by Frank J Weaker. I know I have to read it on a tablet or computer, which will take forever, as I don't like reading with those devices... the book looks good! Has anyone read it?

 

This definitely needs a read from anyone with tinnitus, I went through every page. Lots of scattered information here, someone needs to make a sticky with certain links, @Greg Sacramento you really are a saint. I sincerely wish that your tinnitus goes away completely.

 

Thanks. @KWC should also read posts #163 and #171.

 

@Greg Sacramento I will take a look, thanks.

 

@just1morething I hope you are doing well buddy!

 

@Mr. Cartman, long time no see! I hope you are doing well too buddy! I am about the same. Sometimes my noise goes away but comes back upon awakening. I have grade 5 internal derangement in left my TMJ, so am looking at that as well as sleep.

 

I should probably know this information, but how can I look up posts by the numbers you gave. I’m interested in reading more related to this thread. Thanks!

 

Hi @Cher2 -- Here you go... #163 -- #171