Jaw/TMJ related tinnitus.

Timothy C. Hain, MD. •Page last modified: March 27, 2021 • This document is not written for or intended for use in legal proceedings.

Other major pages on this site about tinnitus: cervical tinnitusTreatment of Tinnitus

Introduction:

There is reasonable support for a connection between Tinnitus and TMD/TMJ (temporomandibular joint disorder). The most authoritative discussion of this to date is that of Bousema et al (2018), who stated that "There is weak evidence for ... a bidirectional association between tinnitus and TMD. " These authors also noted that the literature was biased, and this conclusion was made after adjusting for bias. So they are essentially saying that you shouldn't believe everything you read, but there is something there. Several other systemic reviews have noted high prevalence of tinnitus in TMJ patients. Skog et al reported "The prevalence of tinnitus in patients with TMD varied from 3.7% to 70% (median 42.3%) whereas the prevalence in control groups without TMD varied between 1.7% and 26% (median 12%). "Mottaghi et al (2019) noted "The odds ratio of suffering from tinnitus among patients with TMDs was 4.45 (95% CI 1.64-12.11. P = 0.003). Thus, despite the limitations of the included studies, this review demonstrates that the prevalence of tinnitus in TMD patients is significantly higher than that in patients without TMD. "

Some persons with severe TMJ (temporomandibular joint) arthritis have severe tinnitus. Generally these persons say that there is a "screeching" sound. This is another somatic tinnitus.

TMJ is extremely common -- about 25% of the population. The exact prevalence of TMJ associated tinnitus is not established, but presumably it is rather high too. Having TMJ increases the odds that you have tinnitus too, by about a factor of 1.6-3.22 (Park and Moon, 2014; Lee et al, 2016). This is the a large risk factor for tinnitus, similar to the risk from hearing loss (see table above).

It is also very common for jaw opening to change the loudness or frequency of tinnitus. This is likely a variant of somatic modulation of tinnitus (see above). The sensory input from the jaw evidently interacts with hearing pathways. The muscles that open the jaw are innervated by the same nerve, the motor branch of 5, that controls the tensor tympani in the ear. In other words, changing tension in the jaw may also change muscle tension in the ear.

Diagnosis:

Tinnitus is almost always subjective, while TMJ is somewhat objective, as the clinician can detect joint clicking, and imaging procedures can visualize abnormal joints. Thus this is a similar situation to the jutaxposition of other symptoms with signs. Causality is lacking, but it would seem worth trying.

Implications for treatment:

One might think then that treating TMJ might alleviate some tinnitus. Skog et al (2019) reported "The eight treatment studies indicated that treatment of TMD symptoms may have a beneficial effect on severity of tinnitus. However, only one treatment study included a control group, meaning that the overall level of evidence is low. " So again, it seems that there is a consider possibilty of bias in work done done on this subject.

It has not been our observation that treatment for TMJ is very effective, and failures in finding an effect might be related to both lack of a causal relationship between TMD and tinnitus, as well as a lack of an ability to modulate TMD. Nevertheless, if we find reasonable evidence for TMD in a patient with distress from tinnitus, we think it is often reasonable to ask them to see their dentist.

References:

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