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, and
trauma at birth, etc. It is very common for the onset
of symptoms to be delayed for months or years. The
delay in onset occurs, in part, because these tissues
progressively degenerate.
Close to half of
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 TMJ therapy improves tinnitus
in 46-96% of patients who have TMJ and coexisting
tinnitus. A survey of patients taken two years after
TMD therapy suggest 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 manually 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 electric 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 might be employed. Eighty-four
percent of our last 1200 TMD patients 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 or thyroid disorders, patient compliance,
and the patient’s age. Unfortunately, for reasons
not yet explained, we have found a decreased success
rate with respect to 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 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
cited a study in which the relationship between tinnitus
and TMD therapy resulted in the following: of 267
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.
Dr. Ira Klemons’
practice is devoted to the treatment of headaches
and facial pain and temporomandibular joint dysfunction.
He is President of the American Board of Craniofacial
Pain; and Director of The Center for Headaches and
Facial Pain in South Amboy, New Jersey. Additional
information can be obtained at www.headaches.com
