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

I have been told that trigger points can be felt with much training. However I have come to doubt this over the years. I now believe it may be more likely that trigger points should be located by searching and asking the patient for a referral pattern. If a referral pattern is triggered you know you have found a trigger point. You may also include local pain as an indicator of a trigger point. It is this two-way searching testing and communication that I think may be the correct method to find trigger points. This is not something most PT's or physicians are comfortable with. They want to find something quickly and all by themselves.

 

Hello everyone, I've had tinnitus for about 15 years now but it was very very mild and never an issue. It ramped up 3 months ago due to, in my mind, medication I was on. After going through many different doctors it was suggested I check out a TMJD specialist.

And, lo and behold, I have it. I am not sure if they are related at all... in fact I am leery that the TMJD is causing my tinnitus... but I suppose TMJD could make existing tinnitus worse, right? What I'm most curious about is if anyone here has had their tinnitus lessened with a splint or TMJD treatment? In reading it doesn't look good and most of the talk is dedicated to other aspects of orofacial pain.

I suspect the doctor I saw did the trigger point test as she was poking my face and neck all over but I felt no sensitivities. She tried to make my tinnitus louder too and didn't seem too pleased when she couldn't. Then I mentioned I could do it myself by manipulating my jaw and she gave me a 50/50 shot that the ringing could be related to the jaw.

Just took some x-ray's and went over them with her today and she upped that to 70/30 as I guess my jaw was basically sitting on my ear. However, she said both sides looked equally bad even though the left one is the one that pops the most and is also the ear that rings the most.

That makes me think it's not related but I'm not sure what to do. Take a shot at the cure? From what I see splints are really iffy anyway... it's setting me back $1250 but ugh... does this have any hope of working?

Thanks.

 

In all likelihood you do not have a TMJ or jaw originating problem. By that I mean the joint itself. You also likely do not have a problem that can be fixed dentally or is caused by bad teeth. You may have a TMD problem that is part of a muscle trigger point problem that originates in the muscles of your neck and upper back.

I've been at this for years. Unless you have joint pain or an honest orofacial pain specialist says you have a jaw joint problem, then you probably just have a problem originating from muscles and likely not due to a dental problem.

I would not get the splint. I have spent a lot and my jaw was very bad. it calmed down a lot on its own after the initial flare up. You will still have it, but if it is really bad and you are worried then give it 6 months if it just started. It is not caused by the jaw. In some cases a person can have dental or jaw problems, but you likely don't.

 

Being able to manipulate T sound with neck, jaw etc movements (i.e. somatic T) does not automatically mean there's anything wrong with jaw, neck etc. The current theory on this is a malfunction in a part in the brain called Dorsal Cohclear Nucleus (DCN) which 'mixes' signals from the ear, nerves and the muscles to create auditory sensations. For example if DCN area is stimulated with electricity with a simple TENS device (see another thread about it here) it can quiet down T totally in some T patients.

 

@applewine How would I know if it is caused by muscle versus the joint? And what kind of home remedies are there? I did try to do some at home searching and usually they say use anti inflammatory drugs and stay away from crunchy foods. I would love not to use this splint but I just don't know. Should I seek a second opinion?

I don't have any pain in the jaw muscle. Just some tenseness. My left jaw does visibly pop out when I open my mouth... it feels like a bone popping out of a joint. But does that necessarily mean it's caused by the jaw?

The doctor I spoke with seemed to think so and showed me on the x-ray how it was grossly misaligned. If I treat with the splint will it not change the muscles as well? Can it cause more damage?

I really am conflicted.

@Sound Wave I brought this up with the doctor too. And she seemed to say fairly equivocally that no it's not that common at all to have tinnitus that's easily altered and not be related to the jaw in some way. But again, this is a specialist only looking in this one particular field. What is it they say? If you show a cancer doctor a patient's chart they will diagnose with cancer, if you show a heart doctor etc etc?

I really don't know what to do.

My jaw doesn't hurt. It clicks and doesn't feel right. I had braces when I was younger and maybe this plays a part in it.

Should I have asked about the TENS machine? I considered it but I thought that was used when trigger points were found?

I should mention that my left ear does show slight hearing loss at 8khz too. And by slight I mean if you look at the chart and 25 is the threshold mine is between that and 30. I don't know if it's enough to cause tinnitus this badly and doctors don't know either. Every patient is different.

 

You guys might want to check out this page. What is interesting is the mention of face symptoms mimicking bell's palsy sensation without the loss of control. It also mentions the accessory nerve (CN XI and also some kind of vagus / cervical nerve) which innervates the SCM and trapezius. http://www.webmanmed.com/disorders/disorders_files/musclgd/antneck/11679703.html
Try looking up the nerve complexes and nerves mentioned. Also notice the orbicular is oculi is mentioned. My vision shakes on close objects which is supposed to be caused by that muscle.

 

@applewine

Thanks for all the information you have provided!!

I want to let you know that I talked to a girl today that has been through a lot of the same stuff we have. She did see a physio for the first time a few days ago, and when the physio was manipulating two muscles in her neck (she did not know the name of the muscles, but they were located each side at the back of her neck), so I suspect trapezius or the SCM, she got water sensations and pain in her legs, and got so dizzy that she couldnt walk out of the physios office. Interesting indeed.

 

I am familiar with the DCN and have talked about it before. I hope that none of us have damage to the DCN, but we probably can't know and no doctor would be able to test for such a subtle thing.

The DCN could be where the confusion is coming in though. The DCN is a two way network. If there is somatic dysfunction then the DCN will have to compensate by increasing the other side of the input. This would lead to tinnitus, or the somatic noise is being fed through the DCN and being read as tinnitus. Suppressing the DCN or modulating it could lesson tinnitus (if you could or even wanted to do that), but it does not mean that is where the true problem is.

 

@Mr. Cartman How did you encounter this girl? Maybe you could ask her to ask which muscles they were next time. Did she volunteer the "water sensations" information? Do you know if she had any precipitating event to cause injury? (I did not, except weight lifting, maybe military press machine).

I'm curious to learn more about that case including all symptoms. I'm also curious if the water sensations were cold (like mine).

I did some searching and found a user called "fubar" here: http://www.anxietyzone.com/index.php?topic=1563.0

They mention face tingling (I'm getting this all the time), neck muscle tension and water sensations throughout the body on the skin.

 

Its a girl that lives not too far away from me, and I sometimes accidently stumble upon her when Im outside and such, and we always talk a littlebit.. I didnt ask her anything about the leg stuff, she just told me when I asked about the physio visit, because she became very ill for a while after the treatment.. She said feeling of water and bad pain in her legs together with severe dizziness. I know she has had some frequent facial pain (pretty much every day) and occasionally tinnitus (but not 24/7, just on and off) and her doctor just prescribes pill after pill, until she one day decided to try physio. Ill ask her some more stuff next time I see her.. She cant pinpoint a cause that set it all off, she simply believe it was caused by stress, because it happened during a very emotional stressful periode in her life, and she complains about tension and aches in the back, neck, jaw, shoulder and head area.

Also, the physio told her that those muscles were swollen and that it was a serious matter. Kinda curious about what muscles the physio was referring to myself. She tried to show me though, and she pointed her fingers at the back of her neck.

--

And about an hour ago I talked to the husband of another girl I know, which I know has been disabled for a year or so because of severe facial pain and tension in the shoulder, neck and jaw area. She had injections done at a hospital (not sure what and where), seen neurologists, a few doctors but nothing helped, until a friend of her gave her some kind of a massage (some asian stuff), and after 2 weeks she got completely rid of the pain and she is now 100% back to normal with a fulltime job. Her husband called me because they know of my situation and told me she know how to do this massage, and told me she would give me the same massage for a few weeks (for free) in hope that it could do the same thing for me. Im very skeptical to stuff like that, as I dont really believe that it could work, but I figured Ill give it a try as well.

 

The thing about massage is that it could work. I would not be surprised if massage worked better than dry needling or injections. Massage has to be done right for trigger points though. It can't be your regular massage aimed at relaxing. It has to be a type that will pull the trigger points out. I saw a chinese guy on youtube who seemed to know what he was doing. It was some traditional chinese massage. He seemed to know about trigger points and was treeting neck muscles for menieres disease.

He knew you applied heat, not cold and he also had his customer drinking ginger water for some reason. I think I posted him before. A lot of massage therapists that say they know trigger points have told me to put ice on them. This tell me they don't even know the first thing about trigger points.

 

Could be though.. Who knows.. At least Im open to anything, and Ill give it a try. If it works by some miracle, Ill tell her to invite you for a massage as well (seriously)

Im pretty sure that something is going on in my neck though.. Theres something that simply doesnt feel right..
My scalenes feels very tight, to the point that they hurt. Levator scapulae as well. My SCM and trapezius hurts on palpation. When I retract my neck and move my head upwards, theres some pain going on in the C2 area. T1 (the spot between my shoulderblades) are also painful. If I press my shoulderblades together while having my arms in shoulder height, I get this weird tingling feeling in my face which seems directly linked to this painful spot in the T1 area..

 

Hi guys,

Just an update of how I'm doing.

In the meantime I went on holiday,by airplane.

I was very nervous as I didnt know what to expect. I bought me some earplugs and what happened was that the engine of the airplane echoed in my ear. So this increased the volume of the T during the flight and it was kind off painful and annoying. First day in Ibiza was also terrible, cuz even the sound of the wind sounded like a knife was going through my head... But I was very anxious about the holiday as I didnt want to screw it up for my gf.

I took a diazepam and went to bed. Next day everything was better. Only thing which was really annoying during the rest of the holiday was that my neck hurt like shit at time and was itching and felt soar, especially after a bus trips where I didnt support my neck . Besides that the airco on our room was also annoying, because for some reason I'd prefer being in a silent room. But I slept good during the rest of the holiday so that was good. The flight back home was also way better.

Also I called my parents during the holiday that i couldnt take it anymore. This was the first day though when I was very tired and anxious. This resulted in my dad giving my doctor a visit which he happens to know in private. He told her everything I experienced and that I was thinking about changing doctors and that I didnt felt being taken seriously. It finally appeared that she finally showed some respect for my issues and she could give me some accupuncture address and was wiling to help me according to my dad.

Anyways, yesterday I went to the neurologist and this guy was way better than the ENT. He explained the results of the mri to me. And listened to my symptoms. He is now going to investigate my blood vessels in my neck area in a short 2 weeks. And Im getting a mri of the neck and upper chest.


However he told me that I shouldn't expect to much of it. Most times it's just hard to find a cause for T. And he told me that it is like a tennis elbow. People may experience it for a a year or so and then all of a sudden it may be gone without knowing the cause. Anyways I told him I could clearly feel things are not rite. But ye I'll just have to wait but I m not gonna expect too much of it.

I liked the post about the muscle tension you posted @Mr. Cartman.

I read it during the holiday and it made me feel good. Didn't read the rest of the posts though. Will do later. So I'm not sure what you guys all found so far, but i just wanted to update you guys.

For now, well things are not great, but more or less Alrite.

I'm playing a game again, and while playing my neck hurts, tingles, burns... Especially below the jaw/ear. And in my left shoulder.

But ye I'm playing for hours, so that is not great as well, but i'm addicted haha. Going to buy a new chair which perhaps supports my neck more, cuz this one doesn't have nay neck support at all.

The sound is still annoying me from time to time, as it is quite loud. I sleep without any masking sound as this only may make it sound worse. So i sleep in absolute "silence". I fall asleep quite easily. Sometimes a bit harder. I know also sleep on my side again. But e neck is just annoying and the weird feeling, because it remind me of my T. During the day I mostly forget about it, also when playing the game I completely lose my attention to it, but it only lasts until i notice the damn feeling again.. In my opinion these two are related to each other. So the T and the feeling. Anyways I'll just wait for the mri and the duplex and see what they will point out.

I hope you are a little updated again now.. Keep on investigating, I'll read the rest of it later

Good nite

 

Welcome back dude! Im happpy to hear that you had a pretty decent trip to Ibiza (except for the first day) And that you are back as well
Also great that your doctor is finally taking things a bit more serious

Im pretty much in the same state as you.. Not doing great, but not jumping off a clip either.. Although, things have improved!

Im up for about the same MRI as you are (had neck and upper back done a few days ago), next will be done in mid september. I believe that with a little luck, they will be able to pinpoint a pinched nerve or something similar if that is the case.

You are probably right when you say that this feeling and the tinnitus is somehow connected.. It literally feels like muscles are straining to keep up with something.

Its great that theres a couple of us up for MRI though, and hopefully it could provide some clues.

Too much gaming might not be the best medicine right now though

 

A newbie MRI question -> does one need to 'focus' the MRI into some part of the head / body, or do you get a complete picture for example from the head, from which you can diagnose the ear, ETD, muscles etc?

 

Without being any MRI expert, I think that they select the area of the body they need to scan on a remote computer. If you want your neck scanned, they will draw a frame around your neck from an "overview" image taken while you are positioned in the machine, and the MRI will follow those instructions.

You also have different MRI machines, 1T, 1,5T, 2T, 3T, where T would refer to Tesla (I would think) and the number would refer to the strength of the magnetic field. Ive read that magnets they use in the junkyards for lifting cars are usually around 1,5T

 

@Sound Wave

I just found something interesting:

( Source: http://www.ncbi.nlm.nih.gov/pubmed/11224783 )


Evaluation of eardrum laser doppler interferometry as a diagnostic tool.
Huber AM1, Schwab C, Linder T, Stoeckli SJ, Ferrazzini M, Dillier N, Fisch U.

OBJECTIVES:

Laser Doppler interferometry (LDI) of the eardrum allows noncontact optical analysis of its vibrations in response to sound. Although LDI has been widely used in research, it has not yet been introduced into clinical practice as an adjunctive test for otological workup. The aim of this study was to evaluate LDI as a diagnostic tool in the clinical sphere.

STUDY DESIGN:

Prospective.
METHODS:

A measurement system was developed based on a commercially available scanning He-Ne laser Doppler interferometer. The study included 129 eardrums of 79 subjects that were divided into 3 groups: 1) normal subjects and 2) patients with sensorineural and 3) conductive hearing loss (HL). All the patients suffering from conductive HL underwent ossiculoplasty, which allowed confirmation of the final diagnosis, and patients were assigned accordingly to the subgroups malleus fixation, incus luxation, and stapes fixation.

RESULTS:

The modified LDI system allowed bilateral evaluation of a subject within 30 minutes. No significant difference between normal subjects and patients having sensorineural HL were found. However, it was possible to distinguish between normal subjects and patients with conductive HL. Furthermore, the system had the ability to differentiate between various middle ear diseases. These groups differed statistically significantly in terms of manubrium vibration amplitude and resonance frequency. In malleus fixation significant differences in tympanic membrane movement patterns were found.

CONCLUSIONS:

Our LDI is applicable in clinical otological practice and serves as a valuable addition to the routine audiological investigations for preoperative evaluation of the mobility and integrity of the ossicular chain.

---------

I found it particulary interesting that no significant difference between normal subjects and patients having sensorineural hearing loss were found (obviously). Maybe laser doppler interferometry could be a great tool for validation of the integrity of the ossicular chain.

Maybe its even possible to DIY


(Image: Wikipedia)

 

@Mr. Cartman What do you call and what does your physical therapist call it where you are when they do manual trigger point therapy? Are they doing massage therapy for trigger points? Do they call it massage therapy?

If I mention "massage" I'm sure any physical therapist I talk to will say they don't do that for trigger points or anything else.

I want to know what you call it and what they call what they are doing so I can use the same terms and ask our physical therapists here.

Could you try calling it trigger point massage or something and see how the react to the word "massage" for trigger points? I think massage is probably the closest word to what the hands are doing, it is just done in a way to remove trigger points which is different than a non-medical massage.

 

I think the closest english word for that would be "manual trigger point therapy" or just "manual therapy"?

I find it weird that they havent offered you any manual therapy yet.. As that seems to be very common among physios here.. They will work with your muscles and loosen up trigger points/muscle knots or whatever those knots are

 

@Mr. Cartman


When you say "work your muscles" do you mean massage? We do call it manual trigger point therapy, but that is what massage therapists do since they are not allowed to use needles like physical therapists. Also just massaging or working the muscles in a way that is not based on trigger points will do nothing to cure the condition, it will just feel good and then that will stop as soon as the massage is over.

My physical therapist would do two things. He would stick needles where he thought the trigger points would be and poke all around there. He would also give me a list of exercises to do there at his practice when I would visit and that would be the second half of the time. He would also do tests like turn my head this way or that and ask what caused pain, or maybe test strength.

I don't think any physical therapist I've ever visited would "work my muscles". I remember asking about manual trigger point therapy when calling up places years ago and a few said they might do it as a small fraction of the time I was there. I also told you about this guy: http://www.issapt.com/

I was hoping he would be willing to do manual trigger point therapy because he was the only physical therapist I could find anywhere that had the CMTPT, or claimed to have it. The certiciation has be kept current to verify it on the granting institutions website and very few seem to pay to keep it current, so many say they have it, but are not listed if you somehow found the obscure website which I'm sure nobody looks.

He said he would only do needles because they were much more effective.

Is there a difference between "manual therapy" and "massage therapy"?

This is the Wikipedia page on manual therapy: http://en.wikipedia.org/wiki/Manual_therapy

It mentions "massage" is one "style" at the bottom.[/QUOTE]

 

I wouldnt directly call it a feelgood massage as it hurts.. They will stretch the muscles that are stiff and shortened, work on the painful parts of the muscles and kind of loosen up and crunch those muscle knots with their hands.. This was going on all the time I was seeing the physio. I never did any exercises by myself at the physios office, but I got a few exercises I could do at home.. I guess you could call and ask a few physios though..

 

Interesting. How long are the visits and do you have any idea how much they are billing and how much you pay? I've seen these places which run people through like shops. They have one PT assistant just running around telling 4-5 people to do exercises there at the office. That is a waste of time.

The places I went they would try to do 15 min 1 on 1 and then 15 minutes with me doing exercises there. I thought that wast stupid as I had to leave work to do that.

The places that do all 1 on 1 for 45 minutes will do dry needling and you pay about $150 or more, I can't remember and then insurance will pay you back a part of that.

 

15 minutes of care doesnt sound too long though.. And especially if they dont do much..

The physios I have been to, especially the first one which I will continue to see in a couple of weeks had sessions lasting from 45 minutes to an hour, and most of the expenses will be covered by social security. In fact after you have paid roughly $320 everything will be covered by social security for the entire year. So you will have to pay maximum $320 each year and then you can see a physio pretty much as many times you want or as many times the physio think you might need in order to "get well".

When Ive seen a physio it has always become somewhat personal as Ive seen the same physio over a prolonged time, which makes it easier to kind of work together and solve stuff. Im definitely going back

 

@carlover

Just curious if you have received your night guard yet, and if its comfortable "in vivo"..

 

@Mr. Cartman
Ours works differently. We basically have to get our insurance through our employer, which good jobs offer. It is still hundreds of dollars taken out of your salary every month, but the cost is more hidden. Ever since after WW2 the tax code was changed that way to eliminate free market insurance from being affordable. You can get it outside of your employer, but it will be maybe $600 a month or something. But that is pre-paid discounts and stuff. Catastrophic coverage is about $100 with high deductibles.

My plan works so I pay $35 per visit for physical therapy and I think I get up to 30 visits per year. After that I'd have to pay all myself I guess. The visits are very short though. I think every 15 minutes is considered a "unit". I think I pay per visit, not units. So if I get 30 minutes I pay the same as 15 minutes, but the physical therapist has to want to spend that time with me. I think that is how it works. It is strange. It seems a scam to me. The way they like to do it is have you spend half the time with them and they are often talking to other people and not fully paying attention in a large room with lots of other people. Then the second half they want you to stay there and do exercises.

The alternative way is to go out of network and I pay maybe $150 per visit and get a good 45 minutes of dry needling and insurance will send me a check for 70%. However, to get that money I have to reach a deductible of hundreds of dollars I pay first.

Either way none of the PT's I found were willing to do manual trigger point therapy even if I paid them direct in cash.

The only people who will do manual trigger point therapy from what I have found have the LMT license which medical service / insurance do not recognize as a valid license for any medical activity. These are licensed massage therapist.

A licensed massage therapist will cost about $250 for the first visit and $150 for each visit after that and there is no limit to what I have to pay since insurance / medical services does not recognize that license for reimbursement. Insurance will pay if a physical therapist does it, a chiropractor does it, a physician does it, just about anyone, except the one type of practitioner who is willing to do it or knows how to do it.

Here is an interesting question that may tell me how dedicated they are. When the PT is working on you is it in a private room alone or in g big room with a dozen other people?

When I pay an out of network provider meaning I pay up front and get reimbursed they spend a lot of time with you and focus on you in a private room. These are the ones that cost maybe $150 or more for 45 minutes and there is no limit to how much I have to pay.

When I go to the in-network co-pay route these are the big shops with lots of patients in the big room with the tv going and PT is chatting with other PT's and patients and they try to get done quickly.

 

At least it seems like your insurance will cover some of it though.

Ive always had therapy in a private room. Just me and my phyiso for the entire time.
Not sure if I would have loved the concept of receiving that kind of therapy in a big room with a dozen of people.

Im going to try out this asian massage stuff in a couple of days though.. I dont expect anything from it, but as its free I think its worth a shot.

 

Hello buddy ,well ,my tongue is no longer bleeding from biting into it but thats about it at the moment!!

 

Hi!

Hehe, at least your tongue seems to benefit from it!

I hope that it will do something to the other stuff as well though.. Please keep me updated!

 

I tried to locate a map of how the the nerves are connected regarding the ear and the muscles that seems to affect my T, but couldnt really find any so I made one. Ill share it in hope that someone will find it interesting. Its not complete but at least its what I was able to put together based on information I found on Wikipedia. Its probably not 100% accurate as well (yet)

@chronicburn
@Sjtof

 

@Sjtof

I thought you migh find this information interesting.

( Source: http://www.dentistrytoday.com/pain-management/1569 )

The most common cause of atypical tooth pain is referral of pain from muscles of mastication. Muscle pain tends to be deep pain, which is not location-specific. The two most common pain referral patterns from muscles of mastication are the masseter muscle referring to mandibular posterior teeth, and the temporalis muscle referring to maxillary posterior teeth.8 A common cervical muscle referral pattern is when the sternocleidomastoid (SCM) refers pain to the ipsilateral periorbital area. The trigeminal nerve travels primarily to the trigeminal ganglion, but some of the neurons synapse with the superior-cervical ganglion, which can elicit a response from cranial nerves Nos. 7, 9, and 10. Atypical pains in the head region referred from the SCM can be mistaken for vascular headaches or atypical facial neuralgias.9 Furthermore, nociceptive input from virtually the entire head and neck converge on the trigeminal spinal nucleus, which can also lead to unusual pain referral patterns.10,11 Nociception from deep structures (muscle, vasculature, and joint) is generally non-topographic in nature and often difficult for a patient to localize.12 Regardless of the exact mechanism, referred tooth pain does occur.8 Thus, many patients with pain of muscular origin are misdiagnosed with other conditions.13

It has been reported that between 75% and 85% of the patients with atypical toothache also have pain and dysfunction in the cervical region.14 The connection is the stabilization kinetic chain (muscles are used to keep joints in place at rest, resist gravity, and stabilize a joint when a structure is moved in a certain direction or held in a certain position). An example is when the abdominal muscles are contracted, the back muscles contract to keep the person upright. The muscles in the shoulders and upper chest must contract to stabilize the torso, and the muscles of the neck contract to stabilize the shoulder. Considering normal daily activity, the muscles of mastication (masseter, medial pterygoid, lateral pterygoid, and temporalis) are among the most frequently used of all muscles, and contraction of the neck muscles plays a role in stabilizing the jaw. Trauma, hyperextension, hyperflexion injuries, and prolonged opening of the mouth have been related to discomfort reported by more than 50% of all patients with temporomandibular dysfunction.15