Successful
Treatment of Tinnitus
In Patients with TMJ Dysfunction
by
Ira M. Klemons, D.D.S., Ph.D.
 Editor’s
Note: The following article first appeared
in Quiet Times in February, 2002. Since that time
Arches' President Barry Keate has spoken with
hundreds of people who suffer from tinnitus in
which TMJ dysfunction is a principal or contributing
factor. We believe highlighting this article again
may prove very useful to many more people.
Dr.
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: http://www.aacfp.org
|