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

This friend of mine is more than willing to paralyze my lateral pterygoid, but he havent injected this muscle before in any of his patients so he's not quite sure what to expect.. And it would be nice to have someone experienced doing this.

I do agree, treating the last muscle in the chain will probably not fix the problem at all, but it would be nice to know if this muscle is causing the tinnitus all by itself, and what other stuff is caused by it. Theres no doubt in my mind that this muscle is not a healthy one in my jaw.

Ill give it a few thoughts though.. But Ill probably shut this muscle off in a little while, just to see what happens

 

@Mr. Cartman I hope you do not mean paralyze. That would mean using a botulinum toxin. You probably mean anesthetize.

I'll tell you how my myofascial release goes this Friday with the new person.

I once had a muscle injected by a dentists who advertises TMJ pain, but it was by a dentist and he went from the inside of the mouth. It may have been the lateral pterygoid. I think my mouth felt better for a few hours. I'm not sure you should have these injected by a doctor who doesn't know the procedure. I'll lookup my medical books I pasted a link to and I think it will describe how to inject those muscles. It will be from the outside though. Those books are expensive because they are professional medical books, but you may want to buy just volume one which is the upper body. Volume 2 is lower body. You can buy them separately. http://www.amazon.com/dp/068308366X/?tag=tinntalk-20

These are what physiatrists own, or really anyone who treats trigger points is supposed to have these books. The latest is second edition, but I'm not sure if that is on both volumes. You could learn more from the upper body book.

I also think I had a needle put in there by a multiple physical therapist. They do everything from the outside. They didn't really feel anything like resistance or seem to think it was doing anything though. Maybe it is a referral pain. It can be a little scary of a place when the needle goes in there. I think once it was a little sharp. Like I said it could all be secondary. Of course it could also be the starting point, but at this point I'm kind of doubting that. I want to start with the back/neck, even the hip. My right hip lower back hurts and it is my right jaw that hurts more and my right tinnitus which is louder.

 

Yeah, those books could be nice to add to the book collection indeed

Ill read up a bit on the subject myself.. I think it could be worth a shot though.

Im very excited to hear about your sessions (thanks for letting me know .. Hopefully this guy might know something

 

@Mr. Cartman Ah, here is the one I bought. This is the second edition of volume 1, the upper body.

Amazon confirms I bought it about 3 years ago: http://www.amazon.com/dp/0683083635/?tag=tinntalk-20

These are medical textbooks basically, so not cheap. Very detailed and technical.

 

@Mr. Cartman

I had both Temporalis and Masseter muscle pain too. Right side strange enough. Weeks.
Neurologists said it does not seem like trigemenal neuralgia to him, mostly tissue pain.
Now my T is down to 1/10 for already a couple of days. Biggest impact ATM is my neck. The most pain now comes from the muscles attached on the lower back of my head.
I can modulate T volume by presses there. Last fleeting I had was 17 september. Last major fluctuation I had was last friday, saturday some fluctuation but less than before. Also has to do with A LOT of sleep. Sometimes I do 12 hours a day.

Physiotherapy tomorrow again. My left ear still has some hyperacusity, but less with rattling keys than before. To conclude: improvement.

 

@Sjtof What head shocks are you talking about?

When my problems started in 2008 I used to get electric shock / ice pick stabbing sensations in the ear. It would normally be a few in a row out of nowhere. I believe these were from the clavicular division of the SCM. I was also experiencing altered balance sensation which lasted 24/7 for a month. The clavicular SCM causes ear pain and also balance disturbances.

Very early on I would experience random extremely pain and nausea attacks that started with a strange sensation of churning at the base of the neck. This would cause extreme nausea and maybe dizziness and extreme discomfort that was like a sickness.

The weird thing I see to be the only one getting is weird cold/wet water sensations I'll get in my feet legs, even ear, arms or fingers. I've found others on other forums which get these two. I'm not sure if they have neck pain or not or other upper body body stuff going on, including T.

 

Hi Codaz

Im very happy to hear that you have some improvement

Did your physio have any clues about how to treat this stuff? And do you have any idea if he/she has treated similar cases before?

 

When I first got in (6th of June) I was at a loss. I still did not knew what happened to me, I thought my life was over.
He suggested we could have a look as he saw a lot of T patients. 27 years physiotherapy experience, and years with T patients. He said 1 in 3 patients are treatable who come to see him and have T. You have to show improvement after 5 of my treatments otherwise it's a waste of time and money. And in that stage it was from really loud to a little bit less loud. So I continued. On the first intake meeting he started to inspect my jaws, neck, upper back, and wrote all in his computer. He said I have some patients that were cured. 5% of them is recidivist, so T is gone but comes back later. He said it might be more, but 5% of my patients experience T again and come to see me. Maybe others go elsewhere.

He always reminds me to keep the positive track in my mind. When I lose control of progress, if it goes louder or I have more pain he sees the improvements. Not only physical but also with my coping. He sees a fixation on complaints. I do it and a lot of T patients do it, because we are worried. Especially with pain and tinnitus you are on it 24/7 a day. You have to avoid that, the fixation is worse than the T he said. My body now is unbalanced, so lot of weird , unexplainable pains can come and go now.

He's very well knowlegded about the impossibilities of current medical world. He knows the incompetencies and unwillingness of neurologists / ENT's to understand problems, not only T but also when people have vision problems and turn to an oculist and they found nothing. Cervical issues can be the root of that problems also, he told me today.

In short: I learned a lot the past six months. He surely knows how to treat it, a man was cured some weeks after I joined the physiotherapy centre. That man spends 20 mins a day on fitness machines and if he does not do that, he has T the whole evening.
In my case: C1,C2,C3 blockages in both the left and right side. Although after 6 months of treatment 2 of them are coming loose at the left side now. TMJ both sides, right side was/is worse. He noticed general improvement of movability. Because I doubted if T was any better, it is because of better mobility and less pain. So yes, we are going forward. I already have been to his collegue, who is a back specialist / fitness instructor. From january 2015 (I think) I will start fitness, as he made a training scheme with me. Reason that I did not start yet is that I have / had a lot of pain and eustachian tube issues that I want to have inspected.

General T improvement after 6 months: 30 to 85% (fluctuates enormously and between the ears, head and neck).

 

Thank you so much for taking the time to write such an informative post!

It all sounds very familiar.. Im currently trying out some stuff myself, mostly related to muscle function and so on..

Ill let you know if I find something that really works! Its probably no quick fix though, but regain some proper muscle function might be a good idea anyways..

 

Strange thing is, the Tinnitus lowered the last months significantly. But it is harder to deal with emotionally. Because it takes so much months already and I have been through a lot of ear pain, jaw pain, neck pain, back pain, pain in the face. And I'm very afraid it returns in a couple of months / years or whatever. I quit the psychologist because she did not have a clue what tinnitus is, and she could not find a suitable psychologist that can handle it. There is a special tinnitus psychologist about 80 kilometers away, but prices start at 1500 euro for TRT. For that kinda money, I can do 30 physiotherapy treatments.

Plus I hate it that my left ear still contracts on sounds of rattling keys etc. Some say it's tensor tympani others say hyperacusis others say eustachian tube problems.

And the bill of physiotherapy is already big. I did not know stress was so expensive.

 

Yeah, I understand exactly what you mean.. I hope this condition will resolve one way or another..

 

Good information, well delivered. As a retired ENT surgeon, I fully agree that TMJ Syndrome can be a treatable cause of tinnitus as well as deep-seated ear pain. Many ENT doctors miss this diagnosis. Sadly, many dentists also miss the diagnosis. Mention the possibility yourself.
Ask if it might be an underlying problem for your ear pain or tinnitus.

 

Hi Dr Charlie! Just wanted to say thanks for taking the time to share some of your knowledge in this thread!
Its very much appreciated!

It seems like a Danish ENT surgeon, Hylmar Myrhaug catched up on quite a lot of ear related symptoms due to muscle tension in the jaw and neck back in 1964 (from what I have read). I think he published his findings in the British Journal of Oral Surgery. One of his findings was that the constant load from the tensor tympani slowly made the eardrum stretch and he was able to diagnose jaw and neck tension by looking at how the eardrum reflected light. Also, theres a ton of TMJ related information floating around the internet..

.. But every ENT, neurologist, dentist I have seen havent even mentioned TMJ dysfunction or muscle tension being a remote plausible cause of ear pain, tinnitus, headaches etc..

At least your post is encouraging

Again, thanks for chiming in Doc!

 

@Dr. Charlie @Mr. Cartman The issue is that TMJ syndrome is not a syndrome within the TMJ or a dental problem. It just means there is muscle pain in the many muscle that move the jaw. That muscle pain is most likely cause by other muscles in the neck and back which most likely are also in pain. The few dentists who talk about TMJ syndrome almost always say it is a dental problem and try to treat it themselves rather than referring you to a physical therapist. All of these dentists good and bad are not also your regular dentist you will see in the first place. If you get to a physical therapist almost none have any training in manual therapy or myofascial release which is the only treatment. Any ENT who did even one google search for causes of tinnitus would know that somatic tinnitus is a cause. Most ENT's have never tried to find anything out about tinnitus on their own and that goes for doctors in general even when their patient has the symptom.

 

For those interested, a paper on somatic tinnitus and Craniomandibular disfunction from 1999. I have made some sections yellow as those interested me the most.

I can agree with @Dr. Charlie that the TMJ diagnose was missed by any ENT I consulted for tinnitus. Only 1 audiologist knew about it, and I have seen about 5 of them. Her standard question was can you modulate the tinnitus by moving your neck or jaw. At that time, I was already 5 months beeing treated for neck and TMJ disorders. My physiotherapist says that only a few dental surgeons are interested in TMJ. However, Gnatologists (sometimes dentist-gnatologist) know about facial pain and possible tinnitus combinations. Always pursue everything possible.

 

@Mr. Cartman I went to my first appointment with the John F. Barnes expert level physical therapist who does just myofascial release. He got started and worked on my muscles above my shoulder blades. He said you need to hold for up to 9 minutes and a minimum of 3 minutes ! This sounded good to me because this is exactly what I have been thinking.

I told him about the people who say don't press for longer than 12 seconds and he said that won't do anything and they say that because they are pressing very hard. I agreed that that was their approach. There are many approaches. Some apply incremental pressure like squeezing an orange so you increase as the pain subsides as if you are emptying out the trigger points. This is not what he described, but the John F. barnes type does seem to be all about long pressure. They also seem to be about the fascia a lot instead of just trigger points. I told him I was sceptical of the fascia people and he said that a lot of people are doing fascia that are just a modification of massage. That is exactly what I had experienced. I'm not sold on the fascia thing, but I agree that what he is doing sounds good to me compared to others.

I only got one hour session and the next is two weeks from then. I only have one hour a week. I'm suspecting that to get any treatment it might require a lot more than that.

If you take a drug that drug is acting on you all day for weeks. I suspect that if I got physical therapy two hours a day for a month it would work. If somebody is messed up that is how long it might take. I was originally thinking doing two hours a week.

There is also a dedicated week long treatment plan you can do at the dedicated treatment centers. I'm not sure if it is all day or what. The thing people don't understand about physical therapy is that I think it doesn't work well in such low doses. It probably has to be applied for extended time over a short period to work. You could do it once a week for a year and that would never do anything, but if you go once or twice a day for a month it would. Physical therapy is almost never applied this way and of course for trigger points it is never applied at all with manual therapy or myofascial release.

If you take a drug it will say twice or once a day for x weeks. You never see a drug say take it once or twice a week.

 

@Mr. Cartman I also bought a back knobbier which arrived.http://www.amazon.com/The-Backnobbe...&qid=1416689225&sr=8-1&keywords=back+knobbler

Many of the positions I can't hold for longer than 15 seconds because my muscles fatigue. I don't have the leverage to press myself, which is why I need a physical therapist. However, it seems I can do the shoulder blade muscles with the leverage because it requires very little muscle activity in my arms. The lower back is too hard with the back knobbier though.

I'm pressing on around my left shoulder blade and I just noticed a subtle pain in the left side of my face, so that is interesitng.

 

My physiotherapist said that it's not the time of the treatment, but the intensity. Sometimes he treats me for 10 min, sometimes for 20.

 

@applewine

Thanks for all the great information you are sharing!
Im going to try out some of the stuff this John F. Barnes expert level therapist you are seeing suggested. I really hope that he is able to at least give you a few clues as to what muscles are involved (if muscles are involved) etc..

The backnobber seems like a nice tool to bring some attention to the muscles in the upper back though, as they are kinda hard to self-massage. Also, I have the same thing going on, if I work on my upper back and neck, there are certain spots that radiate pain around my head/face, especially around the levator scapulae area.

@Codaz

Thanks for the document! I read through all of it!

 

@Mr. Cartman So far I have noticed that in the right upper corner pocket of my mouth on the inside the skin hurts there and I can't open my mouth all the way. The PT guy used a glove and must have pressed really hard on that lateral pterygoid. He knew that side was bothering me so he must have tried hard. He started out really slow though and didn't just press hard right away. He also said it should never be above a 7 on the pain scale, otherwise it will have the opposite effect.

I worry because my lateral pterygoid doesn't seem to have much involvement, yet I still have tinnitus. The right side was where I used to have a restriction so I couldn't jut my jaw out all the way. I was told by the TMJ dentist guy to stretch that way. I didn't get it fully stretched for some years because I didn't do it all the way or know how to do it right. About a year or two ago I finally removed that restriction.

I would make a mouth position like "eeeeeeee" and then "ooooooo" and when I say "ooooo", but without sound I would jut my jaw al the way forward. Somehow making this shape with my mouth gave it an extra stretch.

I worry now that maybe I may have stretched it and done something bad. Maybe I tore the microfibers or something and that is why I still hear the tinnitus, because I needed to have the trigger points removed, but instead stretched the contracted fibers.

The thing is that is the side I hear the hissing sound and the lateral pterygoid is what (I think) moves the jaw forward. I know it is what opens the jaw (hence why it hurts to open right now after that treatment on Friday).

It makes too much sense that that was the side I had the restriction on that I felt when I jutted my jaw forward and that is the muscle that is most likely to also cause tinnitus and that is the side I heard tinnitus on. Yet, I no longer have the restriction and also when the PT pressed on the muscle it didn't really hurt or anything.

I've heard that you can't really fully access the lateral pterygoid, so maybe he wasn't on the part of mine that has the problem.

I looked up the cost of the "full treatment" at the John F. Barnes treatment center. I don't have all the info, but I think it may be something like day long treatments for 2-4 weeks. 2 weeks costs about 10k, so it isn't cheap.

Each hour with the expert level guy near me costs $200. If it works it is well worth the money. Again though the frustrating thing is that insurance doesn't seem to see the value in physical therapy or pays very little and seems to think one short visit spaced out works. That is like saying if you take a drug pill once a weeks it will work. Medicine often has to be taken continuously for a short period of time. Hence every day for 2-4 weeks could cure somebody. But once a week for 6 months may do nothing.

 

Thats a quite an expensive treatment indeed.. If it make things go away, yeah.. Its sure worth it, but who knows.. I kinda feel bad for the fact that you have to spend that much money on such a treatment when its impossible to predict the outcome in any way.. What about giving it a few tries, and if it doesn seem to do anything, then just stop?

I know that theres something bogus going on in my lateral pterygoid area.. It feels tensed and its very painful.. But on the other hand, it seems like the muscles that is tensed up in my jaw is closely tied up to my muscles in the neck.. Its like when I release the tension in my neck, the jaw automatically follows that pattern so to speak.. I kinda dont know what came first.. The chicken or the egg..

Regarding the "eeeee" and "ooooo" exercises, ive done those for quite some time, and it does seem to do something..
My tinnitus also _almost_ let go today.. Like completely.. Im doing neck and jaw exercises every day now. Im also releasing some tension in the muscles at the top of my head and around my eyes as they seem to be just as tensed up..

Seriously, are you having the same problem regarding muscle tension? Theres so much muscle tension going on that I didnt even know it was possible.. It starts with the shoulders and from there it goes all away up my neck and around my entire head and ends up in my jaw somehow..

Also, are you careful about your posture and such while doing computer work? Do you strain your eyes a lot and the muscles around them?

Today I did some eye exercises as well, like moving my eyes hard to the left, righ, up and down and repeating multiple times.. Even my eye muscles hurt bad after doing this and my eyes got very red, like some blood vessels had burst or something. It also made them sting like crazy.. Even doing this had an impact on my tinnitus..

I found a great exercise for the levator scapulae and the surrounding muscles though, which is: Place your elbows against the wall, extrude your shoulders (pull them backwards) then depress your shoulders (pull them down). And the shoulder pull-down should be done by your lats and the rhomboid, in other words, the upper and lower back. It really takes away tension in the upper back / neck area..

I think the suprahyoid muscles and the anterior neck muscles are very important as well, as in adding strength to them..
My suboccipitals have probably shortened a lot too, as they have carried the weight of my head for a long time, all by its own.. MRI also did show narrowing of intervertebral foramina in my neck area..

 

@applewine

And oh yeah.. If I move my eyes hard in a left-up position while keeping them closed I get ear fluttering.. I think its from the eardrum.. Maybe rapid spasms of tensor tympani..

 

The muscles related to tinnitus are exactly the ones that I have pain of. Levator Scapulae, occipitals, masseter, temporalis, etc.

See here:

http://www.physio-pedia.com/Tinnitus

And the recent paper on C2 / C3 discoveries on Tinnitus.

http://www.painphysicianjournal.com/2014/january/2014;17;E95-E98.pdf

Neck pain today drove me insane. High neckpain is low tinnitus, low neck pain is high tinnitus.

I'm going to start doing some more physical work from next week, maybe osteopathy or chiropractor's office. Also I'm trying to find a way to get one of the meds prescribed by De Ridder.

 

@Mr. Cartman @Cor
I have found some info that I definately am going to investigate further.
The myofascial aspects of tinnitus, I posted the information by Dr. Levine earlier. I found out that his office is in Israel. He used to be at Harvard Medical School.

Luckily his research material is freely available. Som of the info he found is from 1989!

http://www.tinnitushome.com/pdf-articles.php

Especially look at this article: http://www.tinnitushome.com/resources/William Teachey MD His Experience with Trigger Points.pdf

They describe that innitus origines from the sternocleomastoides and masseter muscles. Exactly those two are very painfull when I'm treated at my physiotherapist.

It also states that wearing of the splint should be done indefinately.

@applewine since you have the trigger points, look at the pdf articles and especially this one.
It talks about licoaine injections. For what its worth, I'm going to try dry needling first if possible.

Recent research on myofascial trigger points from 2012.

 

@Codaz

Thank you so much for the information you are sharing with us!!

As regards to muscle pain, Im in the same situation as you.. And the masseter and SCM are two of the painful muscles..
Also, it does seem like the lateral pterygoideus is radiating some serious pain, but I cant really tell if this muscle is the source.. I think I will have this muscle injected with anesthetics.

 

@Mr. Cartman

Why do you choose to have your muscles injected with anesthetics and not choose the botox?
Neurologist's use it for patients with forms of dystonia. See this video:

Lateral pterygoid hurts with me as well. But luckily it's gone for the last days.
I changed my pillow at night from 2 to just 1. Leaves my head much lower, but it seems to work


Please see this article from the International Tinnitus Journal:
http://www.tinnitusjournal.com/imagebank/pdf/v17n1a13.pdf

It states that:

"Clenching or dental grinding/bruxism, which promote masseter TrPs, should be treated with an occlusal splint. Stretches of the head and neck muscles and masseters are also prescribed. Any nutritional, metabolic, or endocrine deficiencies are also corrected. TrP deactivation can be done manually by local pressure termed Trigger Point Pressure Release. However, the recommended method is to needle the trigger point. This can be done with injection of xylocaine (0.1cc - 0.2cc), or without injection (dry needling). Both dry needling and xylocaine injections
are equally effective."

This paper definately addresses the points of SCM / Masseter / Clenching etc.

I'm going for this neuromuscular therapy, also called trigger point therapy.
It's far from common. A specialist treats the muscles because sometimes pain is a cyclical process. My tinnitus is too. More neck / jaw pain is more tinnitus. From the insurance part, neuromuscular therapy is seen as an alternative treatment, but it might work. Also, my brother gave me a good address to a physiotherapist which is especially focussed on backs. Craniocervical tinnitus is way understood I think. The neurologist can give you a drug (antidepressant or anti epyleptica or else) but if the spine is misaligned, things are still wrong. My physiotherapist said he had a patient with vision problems, that came from blocked vertebra's.

I saw only 1 German article about it. Which translated goes about the role of the jaw and the cervical spine in tinnitus patients. I have seen that some tinnitus patients were cured by Atlas Profilax treatments, or spine adjustments. But Atlas Profilax is dangerous, and therefore forbidden in Canada.

Moving my head to the furthest position possible (left or right) makes the tinnitus much higher.

When I press my face, neck or jaw the tinnitus goes much higher. If I let it go it goes 50% lower. I'm very curious to see if that is the case with you guys as well?

 

can overactive nerves paly a part in tinnitus in back of neck area and by the ears?? if so would medicines used for that help with the tinnitus as well?

 

@Codaz

As always, great information you have there!

I have thought about botox several time.

If I massage my masseter close to the zygomatic process I usually get a weird pressure change in my ears.. I have also found a couple of lumps in this muscle.

I might try some of the same stuff you are talking about though.. Please let me know how the treatment works out for you.

Yeah, I have the exact same thing..

 

Another decrease in volume of my T. I can only hear it faint in silence AND if I press my neck / face.
But the slight hyperacusity / tensor tympani thing when I grab keys in my left ear worries me.

Every time I get a decrease in volume I need to get used to the new level. Takes a couple of days / weeks.
Also a lot of neck pain again today.

 

My t started same day when I was lifting (overhead press) I felt different after the gym session. Sad part is that same day i was listening to some music not loud but I was playing different tones to measure the quality of the sound. I was working with 75-80db max. Then t started and since then i started to have problems with my Scm. It gets tight all the time and it does not want to relax. I do pt for my neck now but pt practitioners know little about the connection to t. I do have weird sensations in the eye , teeth and face when scm gets tight and even when it feels looser. The doctors just don't believe this is all connected to scm. Trigger points pages show that scm can be felt in those areas. I just cannot find that person who knows. Dr. Nagler made a good point once that doctors just provide a service and you must keep looking until you find the one you like.