Successful
Treatment of Tinnitus
In Patients with TMJ Dysfunction
by
Ira M. Klemons, D.D.S., Ph.D.
 Editor’s
Note: Dr.
Ira Klemons is the founder and past President of
the American Academy of Cranio-facial Pain. He is
currently director of the Center for Head and Facial
Pain in South Amboy, New Jersey. His practice is
devoted to head and facial pain and temporo-mandibular
joint dysfunction.
The
condition commonly referred to as "TMD" - temporomandibular
joint disorder - is a complex dysfunction of muscles,
ligaments, and joints in the head, face, and neck.
(The temporomandibular joint, or TMJ, is the joint
in front of the ear which allows us to speak, chew,
swallow, kiss, smile, and exhibit normal facial
expressions.) TMD is typically caused by injuries
that result from falls, automobile accidents, trauma
at birth, etc. It is very common for the onset of
symptoms to be delayed for months or years. The
delay of onset occurs, in part, because these tissues
progressively degenerate.
Close
to
half the patients who have TMJ dysfunction have
tinnitus as one of their symptoms, and in these
patients, success rates in eliminating these sounds
approach 90%. Recent research has found that TMD
therapy improves tinnitus in 46-96% of patients
who have TMD and coexisting tinnitus. A survey of
patients taken two years after TMD therapy suggests
that improvement is sustained over time.
The
diagnosis of TMD requires evaluation by a dentist
or physician with advanced training and experience
in treating head and facial pain. Diagnosis begins
by taking a detailed history of the patient's (sometimes
extensive) list of complaints. Symptoms can include
headaches; pain in the face, eye, neck, or ear;
blurred vision that comes and goes; hearing loss
that comes and goes; frequent sore throats; dizziness;
ringing in the ears; pressure or blocked sensation
in the ears; difficulty swallowing; burning tongue;
and tingling or numb sensations of the arms and
hands. A physical examination of the muscles of
the head, face, neck, and shoulders is done using
manual palpation to rule out "trigger points" and
muscle spasms that can transfer pain to other areas.
Range of motion tests, x-rays, sonograms, and painless
EMG's can also help in reaching an accurate diagnosis.
Treatment
commonly employs painless procedures which help stimulate
muscles and joints to function normally, decrease
spasm, remove toxic waste products, and increase blood
flow and nutrition to the affected areas. Therapies
such as low current electrical stimulation to reduce
muscle spasm and stimulate healing, ultrasound for
deep tissue heating, hydrocollator for moist heat,
and cryotherapy (cold therapy) are used with a variety
of removable orthopedic appliances aimed to correct
the position of the condyle, or "ball", of the lower
jaw within its socket. In addition, joint mobilization
procedures, physical manipulation, and other procedures
might be employed. Eighty four percent of our last
1200 TMD patients who also had tinnitus reported that
their ear sounds were "gone" or "almost gone" after
treatment.
Treatment
time and costs vary according to the extent of dysfunction,
the simultaneous presence of related problems such
as neck injury and thyroid disorders, patient compliance,
and the patient's age. Unfortunately, for reasons
not yet explained, we have found a decreased success
rate for elimination of tinnitus in patients over
60 years of age.
Many
patients are given only home care instructions at
a single visit, while others require an average of
4-6 months of care. Still others require much lengthier
treatment and, in a small number of cases, even surgery.
Approximately 1% of our patients require TMJ surgery
and approximately 3% require radiofrequency thermoneurolysis
- a surgical procedure that uses high frequency electrical
energy to modify or eliminate pain impulses from injured
structures. This technique in particular offers enormous
promise for eliminating pain and tinnitus where other
conservative procedures have failed to bring relief.
Wright
and Bifano cite a study in which the relationship
between tinnitus and TMD therapy resulted in the following:
of 276 TMD patients who were evaluated, 101 reported
co-existing tinnitus. Ninety three of those agreed
to participate in the study. Of the 93 subjects who
were treated for TMD, 52 said that their tinnitus
had resolved, 28 reported experiencing significant
improvement, and 13 reported minimal or no improvement.
No one reported experiencing a worsening of the condition.
It's been noted that patients who have tinnitus without
any other symptoms are relatively unlikely to experience
improvement with treatment of this type.
Over
the last few decades, we have come a long way in diagnosing
and treating TMJ disorders and the accompanying symptoms
such as tinnitus. No doubt future research will provide
greater knowledge regarding the relationship between
tinnitus and temporomandibular joint dysfunction and
consequently even higher success rates than are available
at the present time.
References
1.
Wright, F., and S. Bifano: Tinnitus Improvement Through
TMD Therapy, JADA, vol. 128, pp. 1424-9, Oct. 1997.
2. Gelb, H., M. Gelb, and M. Wagner: The Relationship
of Tinnitus to Craniocervical Mandibular Disorders,
Journal of Craniomandibular Practice, vol. 15, no.
2, pp. 136-142, April 1997.
For
more information on TMJ go to http://www.tmj.org.
To find a TMJ specialist in your area go to: American
Academy of Craniofacial Pain.
|