Tinnitus and the Temporomandibular Joint

Tinnitus affects roughly 30% of people, with an estimated 10% of people suffering from persistent tinnitus.

Tinnitus can be a multitude of different sounds; those reported include buzzing, whooshing, humming or even a more musical quality.
Although many of us know about tinnitus, very few are aware of how many different causes there are to this condition; not all of them being permanent. Some causes of tinnitus include:

  • Ear infections
  • Damage of the sensory hairs within the inner ear
  • Diabetes
  • Head and neck injuries
  • Rarely traumatic brain damage or tumour development

This month’s blog is going to focus on Tinnitus which has developed from TMJ (temporomandibular joint) dysfunction.

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What does the TMJ do?

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Picture1The TMJ allows for movement of the jaw during speech or chewing.

Other symptoms of TMJ dysfunction:

  • Ear ache or itching
  • Jaw clicking, locking or popping
  • Headaches or Neck pain
  • An abnormal bite
  • Grinding your teeth at night

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What can happen to the TMJ?

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Because of it’s movement requirements; the jaw can frequently suffer from overuse injuries such as:

  • Muscular strains
  • Arthritis.
  • There is also a ‘disc’ between the jaw and it’s attachment in the skull which can become ‘dislocated’.
  • The jaw can become too mobile, or not mobile enough for many reasons, including chewing patterns.

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Theories of TMJ involvement in tinnitus

  1. The chewing muscles’ approximation to the inner ear can impact on hearing if the muscles become too tense. (Temporalis, Masseter, Pterygoid). By the muscles becoming tense it may alter the size of the Eustachian tube and tympanic membrane.
  2. There is a ligament attaching from the jaw to a bone on the middle ear called the malleus. If this ligament becomes overstrained, sprained or inflamed it can impact on tinnitus.
  3. The nerve supply to the TMJ has connections with the area of the brain that interprets sound, an alteration to the TMJ’s function may inhibit the nerve function.
  4. There is also a significant link between TMJ problems and acute or chronic neck problems.

TMJ Deviation

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When you open your mouth, there is a reasonable chance that your jaw moves more to one side than the other.

This is known as TMJ Deviation. TMJ deviation has two major causes.

  • Firstly if the muscles on one side of the jaw are tighter, it can lead to the jaw being pulled to the affected side.
  • Secondly, there is a disc in-between the jaw to help reduce the friction and improve the shock absorbance between the bony aspects of the jaw. The jaw would then deviate away from the affected side.

Exercises for TMJ dysfunction

Below are some basic exercises to help with TMJ mobility and stability. Before commencing these exercises it may be worth consulting your musculoskeletal specialist or medical professional. If any of the exercises aggravate your symptoms, stop them immediately and consult with a specialist before restarting them.

If your pain is also coming from the neck, you may be provided with further exercises to target this dysfunction.

Jaw Mobility

Repeat each exercise 10 times, 2 times a day. Progress to stage 2 and 3 as you feel appropriate providing there is no aggravation of your symptoms.

Stage 1: Open mouth to roughly 1-2 cm (Tongue on roof of mouth).

Stage 2: Open mouth fully (Tongue on roof of mouth).

Stage 3: Open mouth fully (Tongue not on roof of mouth).


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Exercise 1

  1. Place one finger on your TMJ, and the other hand on your jaw.
  2. Gently push your tongue into the roof of your mouth.
  3. Keeping your tongue on the roof of your mouth, slowly open your mouth to around 2cm.
  4. Use your finger to gently push your jaw back up to the start position.
  5. Do this in front of a mirror to ensure your jaw opens straight.

Exercise 2

  1. Place one finger on either side of your TMJ.
  2. Gently push your tongue into the roof of your mouth.
  3. Keeping your tongue on the roof of your mouth, slowly open your mouth to around 2cm before slowly shutting your mouth again.
  4. Do this in front of a mirror to ensure your jaw opens straight.

 

Jaw Stabilisation (Beginner and Intermediate)

Stage 1 Exercise

Place your hand in a V shape with your forefinger and thumb either side of your jaw with your mouth closed

Gently try to push your jaw to the;

  • Left
  • Right
  • Down

Provide gentle resistance against these movements.

Hold each movement for 5 seconds, repeating 5 times. This should be done 2-3 times per day.
 

Stage 2 Exercise

Place your hand in a V shape with your forefinger and thumb either side of your jaw with your mouth open 1-2cm.

Gently try to push your jaw to the;

  • Left
  • Right
  • Down

Provide gentle resistance against these movements.

Hold each movement for 5 seconds, repeating 5 times. This should be done 2-3 times per day.

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Advanced Jaw Stabilisation

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  1. Open your jaw roughly 1-2cm wide.
  2. Place your hand in a V with your forefinger and thumb either side of your jaw.
    1. Start with your jaw moved to the left. Push your jaw gently to the right, resisting this movement with your hand.
    2. Start with your jaw moved to the right. Push your jaw gently to the left, resisting this movement with your hand.
    3. Start with your jaw in a neutral position. Gently try to open your mouth further, whilst gently resisting the movement with your hand.
  3. Hold all of these movements against the resistance for 30 seconds.
  4. Do each movement after the other and then repeat this 3 times.