Tinnitus
Characteristics of tinnitus:
Tinnitus is defined as a sound sensation occurring more than twice a week and lasting for at least five minutes. It affects 10–15% of the general population, occurs most commonly in middle-aged individuals, and is twice as frequent in men as in women.
Tinnitus can appear in many different forms. It may affect one or both ears, and can be constant or intermittent, occurring in pulses or cycles. It may present as a high- or low-frequency sound that increases or decreases with certain head or neck movements or changes in body position. It can occur on its own or together with other symptoms such as dizziness or hearing loss. The perceived sound may take the form of buzzing, hissing, ringing, whistling, chirping, roaring, or crackling in the ear.
According to current scientific understanding, tinnitus can have numerous causes. These may include cortical damage, psychosomatic conditions, blood pressure or circulatory problems, noise exposure, as well as temporomandibular joint dysfunctions — for example, displacement of the cartilage disc in the TMJ or teeth clenching and grinding.
Tinnitus caused by temporomandibular dysfunction:
The structure of the temporomandibular joint (TMJ) is anatomically similar to other joints in the human body. Under physiological conditions, the TMJ consists of a joint head (condyle) and a joint socket, with a disc (discus) located between them. A chewing muscle (the superior head of the lateral pterygoid muscle) attaches to the disc. Behind the disc lies a connective tissue system separated from the inner ear by only a thin layer of bone. The inner ear contains the auditory ossicles: the malleus, incus, and stapes. The stapes is connected to the smallest muscle in the human body, the stapedius muscle.
In certain cases—such as when the articular disc shifts out of place—the attached chewing muscle becomes tense and pulls the connective tissue system behind it, exerting increased pressure on the inner ear. As a result of this pressure, micro-twitching of the stapedius muscle may occur, which the individual perceives as tinnitus.
The resting position of the jaw is when there is a 2–3 mm space between the upper and lower teeth. This means that when the mouth is closed, the upper and lower teeth should not touch — neither at the front nor at the back. If the teeth make contact, the chewing muscles activate. If they press together tightly, the load on the muscles increases even further. With continuous “work,” the chewing muscles become tight and painful. The lateral pterygoid muscle — whose superior head attaches to the disc — also becomes tense, pulling on the connective tissues behind it and triggering the same pressure-increasing mechanism that may lead to tinnitus.
Treating tinnitus with TMJ physiotherapy:
When tinnitus is noticed, early medical evaluation is essential. Currently, there is no universally accepted treatment for tinnitus. If no medical cause is found, a TMJ assessment is recommended. If the tinnitus has a muscle-related component, TMJ physiotherapy can provide effective relief. The earlier temporomandibular treatment begins, the greater the chance of reducing or eliminating tinnitus.
TMJ physiotherapy is beneficial only if the tinnitus has a muscular origin. The most common TMJ-related causes of tinnitus are disc displacement and teeth clenching/grinding during sleep and/or wakefulness, which lead to excessive tension in the chewing muscles.
During TMJ treatment, oral and lifestyle habits that may maintain the tinnitus are identified and addressed. Soft-tissue mobilization and physiotherapy exercises help relax the chewing muscles, reducing the intensity and frequency of tinnitus. With continuous relaxation and the release of established spasms, muscle-related tinnitus can be significantly alleviated.
In the first half of 2019, we conducted a study with 155 patients diagnosed with temporomandibular dysfunction. We found that 41.29% of our TMD patients experienced tinnitus. After TMJ physiotherapy, 82.81% of them reported improvement in their tinnitus symptoms.
If you are experiencing tinnitus and have not yet found relief, it may be worthwhile to consult a physiotherapist experienced in temporomandibular therapy to determine whether your tinnitus has a muscle-related component.