Ear buzzing

• Clinical Definition: Tinnitus has been long associated with damage to the inner ear, especially due to excessive noise exposure, though many patients experience symptoms caused by dysfunction of the temporomandibular joints and hyper-tension of their mastication muscles.

• Red Flag Indicators: Auditory distortions localized unilaterally with severe unilateral jaw locking, sudden shift in bite, severe unipolar facial pain, or constant dizziness (vertigo).

• Common Recovery Options: Custom made occlusal splints for each patient, TMJ arthrocentesis (injection of fluid into TMJ space), physical therapy (for jaw and facial muscles), botulinum toxin injections directed at specific areas of hypertensive musculature, and/or definitive prosthetic/orthodontic treatment for correction of malocclusion.

Symptoms include:

• Distortion of Sound: Ringing, popping, clicking, humming, etc. in the absence of an outside noise, constant or intermittent.

• Fullness in the Ears: The feeling of pressure or blockage on either one side or two sides of your head (ear fullness).

• Jaw/Masseter Tenderness: A mild ache found in the temporomandibular joint (TMJ), masseter muscle, temples or surrounding areas that is worsened by chewing or speaking.

• Grinding/Creeping Sounds During Jaw Movement (Crepitus): Clicks are audible while you move your jaw opening/closing due to the improper fit within the TMJ and/or internal damage to the joint.

• Headache Pain: Pain radiates upward from the neck and shoulders, or creates a headache type of pain.

• Tinnitus (Ringing): When tinnitus is pulsating it means there is a rhythm to it and the timing of this rhythm matches the heartbeat of the patient suggesting a vascular anomaly may exist.

• Sudden Sensorineural Hearing Loss: Acute loss of sensory nerve function in one ear over a very short period of time.

• Neurological Problems: Patients who experience facial paresthesia, persistent vertigo, visual disturbances, or swelling of the area.

• Lockjaw/Acute Trismus: Patient cannot open or close their mouth completely.

Reasons for problems include:

• Grinding/Clenching: The repeated grinding/clenching of your jaws puts a tremendous amount of pressure on the temporomandibular joint complex causing inflammation and acoustic interference in the middle ear.

• Improper Bite Alignment: An improper bite causes your lower jaw (mandible) to sit at an abnormal angle, thus changing how the condylar disk fits within the glenoid fossa.

• Loss of Back Molar Support: Not replacing back molar teeth creates a decrease in vertical dimension and moves the jaw joint posteriorly thereby putting pressure on retro-discal tissue which is made up of nerves and blood vessels.

• Trauma to Jaw/Head: A whiplash injury or a blow to the jaw/head can disrupt both ligaments and discs of the TMJ.

Factors that increase your risk include:

• Stress: High levels of stress increase central nervous system stimulation resulting in involuntary contractions of your masseter and temporalis muscles.

• Food Choices: Eating very hard, chewy or tough foods (for example, chewing tough meat, eating raw tapioca or other hard snack items) repeatedly put additional mechanical stresses upon TMJ tissues that are already damaged.

• Arthritis (Osteo/Autoimmune): Both degenerative joint disorders will damage the fibro-cartilage surfaces of the mandibular condyle.

• Posture: When you spend most of your day working with your head in front of your body (i.e. looking down), it will pull your mandible posteriorly and strain your TMJ.

Your first step should be a safe preliminary evaluation performed at home with a mirror:

• Palpation: Using your index fingers place them gently on top of each ear (the front part, just behind the ear lobe called the tragus), then slowly move your jaw from side to side. Do you feel any pain, clicking or grinding?

• Auditory Shift Test: Bite down on the back of your molars while listening to how loud or high/low pitched your tinnitus sounds are. If there is a difference in loudness or pitch, your condition is most likely somatosensory related (to the TMJ).

• Range-Of-Motion Check: Try to slide three of your fingers into a space vertically between your upper and lower front teeth. Can you do that easily? Are you comfortable doing that? If not, you may have limited ability to open your mouth (trismus).

• Symmetry Evaluation: When you look in the mirror and open your mouth as far as you can; does the jaw drop down in a straight line or does it tilt, veer off-center, or zig-zag toward one side?

The clinical exam includes:

• Clinical Visual Examination: Palpation of the muscles outside of the mouth (extraoral masticatory) which include masseter and temporalis muscles and inside the mouth (intraoral) including lateral pterygoids. During the examination, your doctor will also search for referred pain associated with trigger points in these muscles.

• Occlusal Analysis: Uses either articulating paper or digital T-Scan technology to evaluate the way your upper and lower teeth come together. This type of analysis is used to determine if there are areas where your teeth contact before they are supposed to and whether the forces acting on your teeth are evenly distributed throughout your dentition.

• Advanced Imaging Studies (CBCT): A Cone Beam Computed Tomography (CBCT) provides a 3-D image of the bony structures within the temporomandibular joint (TMJ), the joint spaces surrounding those bony structures, and any potential damage to the condyle (a bone structure within the TMJ).

• Advanced Imaging Studies (MRI): An MRI provides a detailed view of the soft tissues surrounding the TMJ. Specifically, an MRI can show the location of the articular disc (a fibrous membrane that cushions the joints) and its movement when you open and close your jaw.

• Audiology Assessment: Conducted by an Ear Nose Throat (ENT) specialist to help eliminate other conditions such as sensorineural hearing loss, acoustic neuroma, and Meniere’s Disease as causes for your symptoms.

• Occlusal Customized Stabilizing Appliances: Made from hard acrylic in the form of precision nighttime guards or stabilizers to un-weight the retrodiscal tissue, and reduce nocturnal bruxism as well as to de-compress the TMJ.

• Physical Therapy/Dry Needle Therapy: Directed at relaxing the hyperactive masticatory muscles (masseter and pterygoids) and restoring cervical spine posture.

• Medications: Muscle relaxants, NSAIDs, and low dose neuro-modulators to terminate the pain spasm cycle.

• TMJ Arthrocentesis: Local anesthetic lavage of the joint to remove proinflammatory cytokines that cause inflammation and free the entrapped articular disc.

• Botulinum Toxin Intramuscular Injection: Injections into the hyperactive masticatory muscles (temporalis/masseter) to decrease involuntary mandibular clenching force.

• Complete Mouth Full-Mouth Prosthodontic Reconstruction: Restoration of lost vertical dimension with use of durable ceramic/porcelain restorations (crowns) of the lost posterior teeth.

• Orthodontic Alignment: Using either removable plastic orthodontic devices or fixed stainless steel brackets to create a stable occlusion/bite relationship among all of the anterior/posterior teeth.

The expense of treatment will depend upon several factors including the degree of clinical complexity involved in each case and/or which of these treatment options is chosen:

Insurance Coverage: Cosmetic dental treatments are always out of pocket expenses. TMJ treatments that involve purely functional treatments/joint lavage/reconstructive treatments due to necessity of medicine may have some portion covered by private health insurance and/or corporate health plan.

• General Dentist: Generally the first point of contact for patients with a variety of dental needs including preliminary evaluation, bitewing radiographs, simple custom-fitted night guards and referral to specialists when indicated.

• Prosthodontist: A specialist who focuses primarily on restoring a patient's complex bite problems and restoring their vertical dimension to normal, replacing missing teeth, making advanced occlusal appliances, etc.

• Oral And Maxillofacial Surgeon: Can be mandated for some advanced structural cases that require TMJ arthrocentesis, arthroscopy, surgical repair of the temporomandibular joint, etc.

• Ear Nose Throat (ENT) Specialist/Otolaryngologist: Will evaluate the patient for possible primary pathology of the auditory pathways, middle ear infections, inner ear disorders, etc.

• Orofacial Pain Specialist/Physiotherapist: Provides non-surgical treatment based upon the principles of neuromuscular rehabilitation of the head and neck.

• Emergency/Urgent Care (Within 24 Hours): Conditions which develop suddenly such as ear buzzing after an acute facial trauma, sudden severe jaw locking, ear pain with fever/dizziness.

• Semi-Emergency/Urgent Care (Within 1-2 Weeks): Conditions that develop slowly over time such as daily ear buzzing with increasing jaw soreness, morning headaches and/or difficulty chewing solid foods.

• Routine/Scheduled Consultations: Mild, occasional ear ringing/clicking with no discomfort/pain or inability to open mouth.

1. Does a poor bite or a lost rear molar really contribute to ringing in my ears?

Yes. A poor bite with a lost back molar(s) causes the lower jaw to lose its structural support and move backward towards the ear canal. This changes TMJ alignment. It places pressure on nearby nerves and blood vessels as well as creates muscle spasm which causes ear "buzzing" or fullness.

2. Are common ear drops or hearing loss remedies going to fix the ear buzzing associated with TMD?

No. Common ear drops or hearing aids treat the auditory canal and inner ear structures directly. The ear buzzing you experience is likely somatosensory — caused by your jaw mechanics being strained from your TMJ muscles being overactive. You cannot expect your ear buzzing to stop until you correct the muscle spasms and jaw mechanics.

3. How long does it take for ear buzzing to stop after I start TMD treatment?

The amount of time it takes to get relief from ear pressure and buzzing varies depending on the severity of the case. Generally speaking some patients report lessening of ear pressure and buzzing within 2 to 4 weeks after beginning custom splint therapy and physical rehabilitation for their TMD condition. However, those who have been diagnosed with chronic conditions due to structural joint damage may need to receive comprehensive care for 3 to 6 months before they begin to see consistent improvements.

• Temporomandibular Joint Disorder (TMJD): Internal derangement, osteoarthritis or disc displacement — affects how well your joint works.

• Cervical Spine Dysfunction: Tight neck muscles and postures in your upper body can irritate the trigeminal nerve pathways and cause facial pain.

• Tension Headaches And Migraines: They often occur at the same time as masseter muscle strain and chronic jaw clenching.

• Sleep Apnea / Upper Airway Resistance Syndrome: During sleep when you breathe through your mouth; your brain sends signals to your jaw to help keep your airway open; these signals cause reflexive jaw clenching.

• Long-Term Protective Appliances (Nighttime Bruxism Guards): These devices protect against excessive grinding and biting of teeth, as well as ensure that all the joints involved in chewing are stable during the time period following initial treatments.

• Behavioral Therapy (Stress Management & Biofeedback): This is an effective method of eliminating unconscious jaw clenching and muscle tension throughout the body.

• Periodontal Stabilization: Ensuring that supporting bone and gum tissues are healthy enough to support bite realignment procedures. All patients undergoing bite realignments will require some level of support from their periodontist prior to being treated by their dentist or orthodontist.

A multi-disciplinary approach including both dental and ENT professionals along with physical medicine professionals is critical when treating non-auditory ear buzzing. The majority of cases of tinnitus caused by TMJ disorders are misdiagnosed and treated incorrectly using only local ear remedies. Effective comprehensive stabilization of the entire masticatory complex, neuromuscular strain management and restoring proper bite equilibrium provide the best results for resolving symptoms over the long term. Patients who experience continued ear buzzing associated with jaw symptoms need to have a complete structural and occlusal evaluation completed quickly to avoid long term damage to their TMJs as well as chronic somatosensory sensitization.