Temporomandibular Joint Tinnitus: What It Is and How To Treat It

Tinnitus is often linked to several underlying conditions and factors such as age-related hearing loss, loud noise exposure, ear infections or blockages, head injuries, and more. The buzzing or ringing sounds are typically connected with inner ear issues, but another less-known cause is problems with the temporomandibular joint (TMJ).

This correlation, called temporomandibular joint tinnitus, links issues with the jaw to tinnitus symptoms. Studies have confirmed the connection between temporomandibular disorder (TMD) and tinnitus after treatment for TMD and characteristics of tinnitus showed significant relevance.

Understanding this connection further can help you find effective treatments, alleviate tinnitus perception, and improve your quality of life. This article defines TMJ, identifies its causes and connection to tinnitus, explores treatments, and how an audiologist can help. Read on.

What Is the Temporomandibular Joint (TMJ)?

The temporomandibular joint (TMJ) is the hinge-like structure that connects your jaw to your skull, enabling essential functions such as opening and closing your mouth, chewing, and speaking. This joint is crucial for everyday activities, from eating to talking.

It’s common to confuse “TMJ” with the disorder itself, but in reality, TMJ refers specifically to the joint. The proper term for issues affecting this joint is temporomandibular joint disorder (TMD). Everyone has two TMJs—one on each side of the face—located just in front of the ears. These joints work in tandem to allow smooth movement of the jaw.

However, TMJ disorders can cause problems like jaw pain, neck pain, and even headaches, due to its complex nature and proximity to the ear and head.

TMDs refer to a group of more than 30 conditions that affect the TMJ, as well as the muscles and tissues surrounding it. Problems with the TMJ can lead to pain, discomfort, or limited movement, often due to injury, arthritis, or stress on the joint from clenching or grinding teeth. If left untreated, these issues can impact your ability to perform daily functions like chewing or speaking without discomfort.

While some TMDs are temporary and resolve on their own, others may become chronic and require medical intervention, including therapies, medications, and even non-conservative methods.

What Causes Disorders of the TMJ?

Various factors that affect the joint itself can trigger TMDs, such as the muscles that control jaw movement, or the surrounding tissues. It can be through inflammation or irritation from strain or injury.

Here are some common factors causing temporomandibular joint dysfunction.

1. Jaw Injury or Trauma: Direct injuries to the jaw or head, such as a blow, whiplash, or a heavy fall, can damage the temporomandibular joint or the muscles supporting it, leading to pain and dysfunction.

2. Arthritis: Osteoarthritis or rheumatoid arthritis can affect the TMJ, causing inflammation, cartilage breakdown, and limited jaw movement.

3. Teeth Grinding and Clenching (Bruxism): Excessive grinding or clenching of teeth, especially at night, puts constant pressure on the TMJ, which can cause inflammation, muscle fatigue, and eventually pain.

4. Stress: High stress levels can lead to clenching or tightening of the jaw muscles, contributing to TMD symptoms. This unconscious behaviour can strain the joint over time.

5. Poor Jaw Alignment: Misalignment of the teeth or jaw (malocclusion) can lead to an uneven bite, which puts stress on the TMJ during activities like chewing and speaking.

6. Joint Overuse: Overuse of the TMJ, such as excessive chewing (gum or tough foods), nail-biting, or even repetitive talking, can strain the joint and lead to dysfunction.

7. Connective Tissue Disorders: Certain conditions can affect the TMJ function and stability (e.g. Ehlers-Danlos syndrome or other connective tissue disorders).

8. Degenerative Disc Disorders: Like other joints in the body, the TMJ contains a disc that cushions movement. Degeneration or displacement of this disc can cause joint pain and restricted movement.

9. Hormonal Factors: Research suggests that hormones, particularly estrogen, may play a role in the higher prevalence of TMDs in women. Hormonal changes may affect the joint and surrounding muscles.

10. Cervical Spine Disorders: Misalignment or muscle tension in the neck can contribute to TMJ disorders due to the close anatomical and functional relationship between the neck, jaw, and TMJ. Tension or issues in the cervical spine can lead to poor posture and increased strain on the jaw muscles, exacerbating TMJ dysfunction. Additionally, shared nerve pathways between the cervical spine and TMJ can lead to referred pain, further linking neck issues to TMJ-related symptoms.

These causes can act individually or in combination, and the specific reason for TMD can vary from person to person. Early diagnosis and treatment are essential to managing symptoms and preventing the condition from worsening.

When any of these issues arise, they can trigger other symptoms, including ear pain and tinnitus.

What Is Tinnitus?

Tinnitus refers to the sensation of hearing sounds like ringing, buzzing, or whooshing when no external noise is present. It varies in tinnitus pitch and intensity, causing distress for many sufferers. In some cases, it can result from hearing impairment or damage to the inner ear.

The primary symptom of tinnitus is hearing a sound that isn’t present externally. This may manifest as:

• Ringing – The most common sound people report is ringing in the ears.

• Buzzing, Humming, or Hissing – Other common perceptions include buzzing, hissing, or humming sounds.

• Roaring – Some may hear roaring sounds, which can be distracting or distressing.

• Clicking or Pulsing – In cases of pulsatile tinnitus, individuals may hear rhythmic pulsing, often in sync with their heartbeat.

• Intermittent or Continuous Noise – Tinnitus can be intermittent, occurring in short bursts, or continuous, lasting for extended periods.

• One or Both Ears – Tinnitus can affect one ear (unilateral) or both ears (bilateral).

• Fluctuations in Loudness – The perceived sound may fluctuate in volume, becoming louder during times of stress or silence.

• Difficulty Concentrating – Persistent tinnitus can make it hard to focus or hear external sounds clearly, especially in quiet environments.

If you’re unfamiliar with tinnitus sounds, we recommend our article “What Does Tinnitus Sound Like”.

What Is the Connection Between TMJ and Tinnitus?

The relationship between the TMJ and tinnitus is rooted in the anatomical proximity and the shared nerve pathways between the jaw joint, the middle ear, and the brain. When there is dysfunction or inflammation in the TMJ, these closely linked structures, especially the ear, can be indirectly affected. This condition is known as somatic tinnitus or somatosensory tinnitus, where disturbances in other parts of the body, such as the jaw, alter auditory perception, causing the individual to experience tinnitus.

The primary cause of TMJ tinnitus is misalignment or dysfunction in the jaw joint, which irritates the surrounding nerves and tissues. This irritation can lead to tinnitus symptoms, especially if the trigeminal nerve is involved, which connects the jaw to the ear. Other contributing factors include:

• Chronic pain in the jaw or neck

• Jaw muscle tension

• Changes in blood flow near the ear

• Direct pressure on the jaw joint

These issues can affect how your brain processes sound, leading to tinnitus and TMJ symptoms.

Let’s dive into it deeper below.

What Causes Temporomandibular Joint Tinnitus?

Shared Nerve Pathways

One of the primary reasons for the connection between TMJ disorders and tinnitus lies in the trigeminal nerve, a major nerve that provides sensation to the face and controls the muscles used for chewing. The trigeminal nerve also has branches that are closely linked to the ear, including the tensor tympani, a muscle within the middle ear that helps dampen sounds such as chewing or your own voice.

Dysfunction in the TMJ, such as inflammation or misalignment, can affect the trigeminal nerve and irritate these ear muscles, leading to abnormal auditory sensations, including tinnitus.

Additionally, the facial nerve, which controls muscles in the face and also innervates the ear, is closely involved with both jaw function and hearing. Issues in the TMJ can irritate or compress these nerve pathways, which may disrupt the normal function of the middle ear, contributing to the onset of tinnitus.

Shared Blood Supply

The TMJ and the ear also share common blood vessels that supply both structures. When there is inflammation in the TMJ, the increased blood flow to the area can impact the nearby ear structures. This can alter pressure and fluid levels within the ear, potentially leading to tinnitus. This close anatomical relationship explains why people with TMJ disorders often report symptoms like ear pain, a feeling of fullness in the ear, or tinnitus.

Muscle Tension and Tinnitus

Muscle tension is another key factor that links TMJ disorders and tinnitus. The muscles involved in jaw movement—such as the masseter, pterygoid, and temporalis—are located close to the ear. When these muscles become tense or overworked, as can happen with TMJ disorders, they can exert pressure on the structures in and around the ear, leading to tinnitus.

For example, people who clench or grind their teeth (bruxism), often a result of TMJ dysfunction, may develop muscle tension that aggravates or causes tinnitus.

Moreover, myofascial pain syndrome, a condition where trigger points in the muscles cause referred pain in other areas, is often associated with TMJ disorders. Trigger points in the jaw muscles can refer pain to the ear, leading to tinnitus-like symptoms.

Misalignment and Tinnitus

Another mechanism connecting TMJ disorders and tinnitus is jaw misalignment or malocclusion. When the teeth or jaw are not aligned correctly, the TMJ can become strained during activities like chewing or speaking. This strain may put pressure on the surrounding nerves and muscles, which, in turn, can affect auditory function. In some cases, correcting jaw alignment with dental appliances or orthodontic treatment has been shown to alleviate tinnitus, highlighting the importance of the jaw’s positioning in contributing to this condition.

Altered Auditory Perception: Somatic Tinnitus

Somatic tinnitus refers to tinnitus that is influenced or exacerbated by physical movement, particularly of the head, neck, or jaw. In cases of TMJ dysfunction, patients may notice that certain jaw movements, such as opening or closing the mouth, can change the loudness or pitch of the tinnitus sound. This is due to the interconnectedness of the TMJ, jaw muscles, and the auditory system. When the TMJ is inflamed or the muscles surrounding it are tight, they can alter the perception of sound by affecting the way the auditory system functions.

Somatic tinnitus is unique in that it can often be modulated by changing the posture or position of the jaw or neck. Patients with TMJ-related tinnitus might find that moving the jaw from side to side, clenching the teeth, or pressing on certain areas of the face or neck can influence the sound they hear. This suggests a mechanical connection between the jaw and the auditory system, supporting the theory that TMJ dysfunction can be a direct contributor to tinnitus.

How To Treat Temporomandibular Joint Tinnitus

The treatment for temporomandibular joint tinnitus often begins with addressing the root cause: the TMJ disorder. Since TMJ dysfunction is closely linked to tinnitus, improving the health and function of the jaw joint can help eliminate or reduce tinnitus symptoms. A comprehensive treatment plan targeting both TMJ-related complaints and tinnitus severity can provide significant relief. Here’s a breakdown of the most common approaches.

Physical Therapy

Physical therapy helps manage TMJ disorders and their associated tinnitus. A customized program that focuses on reducing muscle tension and improving the function of the jaw, neck, and surrounding areas. Techniques used in physical therapy may include:

Jaw Exercises

These exercises aim to strengthen and stretch the jaw muscles, helping to improve alignment and reduce strain on the TMJ. Consistent exercise can lead to greater flexibility, which can ease jaw movement and reduce irritation of the joint.

Neck and Shoulder Relaxation

Since the jaw and neck muscles are interconnected, physical therapists also work on relieving tension in the neck and shoulders. Loosening tight muscles in these areas can ease the stress on the jaw and reduce TMJ-related tinnitus.

Manual Therapy

Techniques like myofascial release, trigger point therapy, and gentle massage help alleviate pain, reduce inflammation, and improve blood flow to the affected areas, often reducing both TMJ pain and tinnitus.

Physical therapy not only improves the functionality of the jaw but can also directly reduce the intensity of tinnitus by addressing the muscle tension that aggravates the auditory system.

Exercise Treatment

Specific exercises designed to target the jaw muscles can significantly improve TMJ dysfunction and reduce tinnitus.

Increasing Jaw Mobility

Gentle stretching exercises help improve the range of motion in the jaw, making it easier to open and close the mouth without pain or discomfort. This reduces the strain on the TMJ and, consequently, the tinnitus symptoms.

Strengthening the Jaw Muscles

Strengthening the muscles that support the TMJ helps to stabilize the joint, minimizing irritation. Exercises like opening the mouth against resistance or lateral jaw movements can improve muscle tone, preventing overexertion that could contribute to both TMJ pain and tinnitus.

Posture Correction

Poor posture, especially in the neck and upper back, can place additional strain on the TMJ, exacerbating both jaw pain and tinnitus. Exercises that promote better posture help realign the jaw and neck, alleviating stress on the TMJ and decreasing tinnitus intensity.

Regularly performing these exercises, under the guidance of a healthcare professional, can significantly reduce TMJ-related tinnitus over time.

Splint Therapy or Mouthguards

For individuals who suffer from bruxism (teeth grinding or clenching), splint therapy or the use of custom-fitted mouthguards can be highly effective. Bruxism puts excessive strain on the TMJ, often worsening tinnitus. Here’s how splint therapy can help.

Reducing Nighttime Grinding

Wearing a mouthguard at night protects the teeth and jaw from the damaging effects of grinding, relieving pressure on the TMJ. This reduces muscle tension around the jaw and ear, which can alleviate tinnitus.

Improving Bite Alignment

Splints or other oral appliances can also help realign the jaw, promoting a more balanced bite. A properly aligned bite reduces stress on the TMJ, minimizing irritation of the nerves and muscles that are connected to tinnitus.

By addressing both teeth grinding and bite misalignment, splint therapy helps create a more relaxed jaw environment, which can directly reduce TMJ-induced tinnitus.

Bite Realignment

TMJ disorders are often linked to malocclusion, or improper alignment of the teeth and jaw. A misaligned bite can place uneven pressure on the TMJ, leading to discomfort and exacerbating tinnitus symptoms. Treatment options for bite realignment include the following:

• Orthodontic treatment using braces or aligners to help reposition the teeth into their proper alignment, reducing strain on the TMJ.

• Dental restorations using crowns, bridges, or veneers. These may be necessary to restore the proper alignment of the teeth, which can help balance the jaw’s function and reduce tinnitus.

• Surgical options in severe cases of TMJ disorder, where the misalignment is causing chronic pain and severe tinnitus. Corrective jaw surgery (orthognathic surgery) may be recommended to reposition the jaw properly.

Bite realignment addresses the root cause of the strain on the TMJ, making it a key factor in reducing tinnitus that stems from jaw misalignment.

Magnetic Resonance Imaging (MRI)

In cases where the underlying cause of TMJ-related tinnitus is not clear, magnetic resonance imaging (MRI) can provide a detailed view of the TMJ and its surrounding structures. An MRI helps in assessing the condition of the joint disc, muscle and ligament health, and joint inflammation or degeneration.

The disc inside the TMJ acts as a cushion between the jawbone and the skull. Displacement or degeneration of this disc can lead to jaw dysfunction and tinnitus.

The MRI can reveal inflammation or tears in the ligaments or muscles surrounding the TMJ, which may contribute to tinnitus.

MRI can also detect arthritis or other degenerative changes in the TMJ, which may cause both pain and tinnitus.

Pain Management Techniques

Pain management is crucial for alleviating TMJ disorders and reducing the associated tinnitus. Several techniques can help manage TMJ-related discomfort.

Massage Therapy

Gentle massage of the jaw muscles and surrounding areas can relax tight muscles, improve blood flow, and reduce tension that worsens tinnitus. Regular massage therapy can relieve the pain and stiffness in the TMJ and lessen the perception of tinnitus.

Heat Therapy

Applying heat to the jaw area can help relax tight muscles, reduce inflammation, and promote healing. Heat therapy can be particularly effective when muscle tension contributes to tinnitus.

Medications

Over-the-counter anti-inflammatory medications, such as ibuprofen or aspirin, can reduce TMJ inflammation and alleviate pain, potentially reducing tinnitus. In more severe cases, muscle relaxants or corticosteroid injections may address chronic inflammation or muscle spasms.

These pain management techniques not only improve the comfort of the jaw but also have a direct impact on reducing the severity of TMJ-related tinnitus.

Somatic Modulation

Somatic modulation refers to the phenomenon where changes in body posture or jaw movement can influence tinnitus. This occurs when the TMJ and its surrounding muscles, nerves, or ligaments affect the auditory system. Patients with TMJ-related tinnitus may notice that opening or closing the mouth, moving the jaw from side to side, or clenching the teeth can alter the loudness or pitch of the tinnitus sound. This indicates that the TMJ plays a direct role in influencing auditory perception.

Poor posture, particularly in the neck and shoulders, can increase strain on the TMJ, worsening tinnitus symptoms. Improving posture, such as maintaining a straight spine and relaxed shoulders, can help reduce TMJ stress and alleviate tinnitus.

Understanding how somatic modulation works can help tailor treatment strategies, such as physical therapy or exercises, to minimize TMJ strain and reduce tinnitus.

How Your Audiologist Can Help

While TMJ treatments address the underlying jaw problems, audiologists play a key role in managing tinnitus-related distress. Tinnitus patients can benefit from specialized care such as:

• Tinnitus counselling to manage the emotional impact of the condition

• Hearing aids that can mask or minimize the perception of tinnitus

• Specific treatments to alleviate hearing problems and improve communication

Bloor Hearing Clinic provides treatment and consultation for tinnitus-related conditions. Here’s what a tinnitus consultation looks like:

• A detailed conversation involving the patient’s history and onset of tinnitus

• Hearing test and tinnitus mapping

• Discuss hearing test results and the best possible treatment

Your audiologist may also collaborate with dentists or TMJ specialists to create a comprehensive treatment plan that targets both TMJ disorders and tinnitus. This approach can significantly improve tinnitus patients’ daily experiences by addressing the root cause and providing tailored solutions to alleviate symptoms.

Temporomandibular joint tinnitus can be frustrating, but understanding the close relationship between TMJ and tinnitus offers hope for targeted treatment. Addressing the jaw joint and TMJ disorder helps many patients experience relief from tinnitus and see an improvement one day at a time.