The TMJ and Tinnitus

“My tinnitus reduced to almost complete silence and I have now been vertigo free for over 12 months.”

— Alison – Melbourne, Australia

Somatosensory Tinnitus

Tinnitus is defined as the perception of sound without an accompanying external auditory stimulus.

Subjective tinnitus, often perceived as a nonspecific buzzing, tonal sound, hissing, humming, ringing, or roaring, can be triggered by a variety of causes. In most cases, no single factor such as chronic progressive hearing loss is considered sufficient to elicit tinnitus; instead, symptoms develop when more than one factor act synergistically (Rally et al. 2017)

When tinnitus appears to be preceded or strictly linked to an underlying disorder of the musculoskeletal system rather than of the ear, it is referred to as “somatic tinnitus” or “somatosensory tinnitus”.

Recent evidence has shown that up to 69% of people with tinnitus can modulate their tinnitus by pressing on muscles of the neck and face (Rocha and Sanchez, 2012)

It is important to note that while 2⁄3 of people were able to modulate their symptoms, this was not predictive of whether they would respond to musculoskeletal of the assessed muscles. However, further analysis of the findings showed that if the participants tinnitus decreased during the assessment it was very predictive of change, they were likely to improve and 76% of improvements lasted after musculoskeletal treatment. In these patients, muscle triggerpoints (TrPs) became less painful and when they did tinnitus was relieved at the same rate.

Tinnitus and the Temporomandibular Joint

The association between tinnitus and temproromandibular disorders (TMD) has been widely reported. Epidemiological studies have shown that patients with concurrent tinnitus and TMD are more often female, younger and have better hearing function than those with tinnitus but without TMD. Furthermore, TMJ disorders were found to be the strongest predictor of tinnitus apart from headache (Rally et al, 2017). Buergers et al.reported that the incidence of tinnitus was more than 8-fold higher in patients with than without TMJ disorders. While Manfredini et al (2015) reported a tinnitus prevalence of around 30% in patients with TMD.

Improvements in tinnitus symptoms upon treatment of TMJ disorders have also been reported.Tullberg and Ernberg(2006) found that 43% of patients who were given TMJ treatment maintained a decrease in their tinnitus a whole two years after treatment. In 1997 a study by Wright and Bifano showed that tinnitus significantly improved with a combination of cognitive therapy, use of bite splints, and home exercises for the treatment of TMJ disorders.

A 2014 study showed that treatment including intraocclusal stabilization and physiotherapy (passive muscle stretching and massaging of the affected masticatory elevator muscles, thermotherapy with moist heat, traction of the TMJs, and coordination exercises) improved tinnitus symptoms in 44% of participants.

Does your tinnitus worsen when your TMJ or neck pain worsens? Is your tinnitus unrelated to hearing loss/age related auditory changes? Is your tinnitus linked to stress? Can you decrease the tone/pitch of your tinnitus with specific movements/postures?

If you are suffering from tinnitus without hearing loss and would like to find out if treatment of your neck and TMJ can help to reduce your symptoms please feel free to email us or to book an evaluation online.

At FACES Physio we are passionate about addressing the underlying causes of your symptoms, Through thorough assessment and with a combination of education, advice, manual therapy and self care exercises aim to resolve your pain and prevent its recurrence. Should onward referral be necessary we liaise with GPs, ENTs, Neurologists, Orofacial Pain Specialists etc in order to facilitate appropriate care for all of our clients.

Our treatments are tailored to each individual client’s needs and can include but are not limited to:

●  Manual Therapy

●  Intra and Extraoral Myofascial Release

●  Dry Needling and Acupuncture

●  Electrical Stimulation/ Electro-Acupuncture

●  Rehabilitation exercises for TMJ and neck range of motion and stability

●  Posture re-education

●  Self management techniques