TMJ Disorder and Tinnitus

As noted in a previous post I have been suffering with acute tinnitus (often referred to by sufferers as simply "T") for nearly 5 months.  It started out truly debilitating, but has now gone to a manageable level and trending better.  Here is an overview for other sufferers out there, and a warning to others to make sure you don't suffer from night bruxism.

 

Doctors chased my T around as an inner ear problem for several weeks, which makes sense when dealing with phantom ringing (mine is a piercing 9 KHz and usually pulsates with my heartbeat).  T is most often a problem with the inner ear, but can also be caused by things outside the ear, such as the nerves, blood vessels or joints.

 

The Temporomandibular Joint (TMJ) is a ball-and-socket joint where your jaw comes into a receiving area in the skull.  When your jaw moves, the end of your jaw rotates around this socket.  As you can see from the image the only thing separating this socket from your inner ear is a little piece of cartilage.  And if that cartilage gets pinched or deteriorates, your inner ear gets impacted, which can cause everything from tinnitus to vertigo.

 

 

The set-up for my T started out with orthodontics 35 years ago that set my jaw too close my skull.  This crowded and removed any "guard band" for the cartilage cushion.  Over the years, day and night bruxism (grinding of the teeth) kept compressing this space until it deteriorated, causing tinnitus. 

 

Figuring all this out too two brilliant doctors, who I feel lucky to have found.  Most tinnitus comes with hearing loss, which I didn't have.  TMJ usually comes with pain, jaw clicking or other symptoms, which I didn't have. So I had T and few other concrete symptoms except: the level of T changed when I turned my head or pushed on the side or back of neck, and the T seem to come down some when I drank alcohol.

 

It took a very old, nearly retired ENT to figure out from these two symptoms I had some sort of TMJ Disorder.  It took another old, and a bit wacky, TMJ Dentist to figure out the why, and come up with a treatment plan.  The insurance companies consider TMJ Disorder a "dental problem", not medical, and there is no dental plan in the world that is going to cover all the expenses with TMJ.  People with this disorder have to dig deep into their own pockets.

 

After four months of treatments with "orthotics" (bite plates for sleeping and eating), and a few months of massage therapy around my neck and jaw, my T has gone down significantly.  The inflammation of the TMJ area, which caused the T to change when I turned my head or pushed on my neck is gone.  But now I can’t touch my back teeth any more (I haven't had anything firmer than sushi July).  Once my jaw was "relaxed" to a more natural state that took pressure off the TMJ, it didn't want to go back.  So at nearly 50 I am now back in braces to restructure my entire bite.

 

The hope is that in 12-18 months a new bite will allow me to chew again, plus allow the inner ear/TMJ area to heal completely and remove my tinnitus.  I am hopeful of the treatment plan due to the progress so far, but I know there is a good chance that I could have low-level T the rest of my life.

 

For dealing psychologically with T, that will be another post.

 

Tin"ah"tis or Tin"eye"tis it Still Sucks

I woke up with tinnitus (I say it with "eye" in the middle, both ways are acceptable) on July 16, 2016.  This began a remarkable journey to discover what I had, why I had it, and how to get rid of it.

 

For those who don't know what it is, tinnitus is a constant ringing in the ears.  You hear it at all times: when you go to sleep, when you get up, when other people are talking.  There is no escape from it.  No drug will turn it off.  It is constant and unending.  

 

To imagine a bad case of it: suppose someone attached a fog horn on each of your ears and turned them on 24-7.  You have no way of lowering the sound or turning it off.  Now imagine how long you could last knowing that there would be no relief from it for the rest of your life.

 

Many who have T at a very loud level over an extended period of time commit suicide.  Others at a high level are debilitated as it prevents conversation, sleeping, reading or any other normal activity. 

 

Tinnitus is caused in several ways:

1. Noise Induced Inner ear damage - The vast majority of T is the result of loud noises like explosions, gun shots, or even very loud music (Ozzie Osborn and other musicians have it).  It can also be caused by extended occupational noise like a jackhammer.  In these cases the ear becomes deaf only at one frequency, and the brain tries to make up for the missing signal by turning that pitch constantly "on".  In the case of sudden noise induced T (gun shots, concerts), sometimes the T will go away on its own in a matter of weeks or maybe months, but if it is chronic there is no cure.  In most cases the only relief is for the suffer to adapt, or use sound therapies such as hearing aids that pump in alternative sounds.
    
2. Drug Induced Inner Ear Damage - The inner ear is very delicate and can be can also be damaged by "ototoxic" drugs, most of which can cause permanent damage, but some are temporary (like aspirin).  In the case of permanent damage, these people are in the same category as the noise-induced sufferers above.  (Note: Be VERY careful of antibiotics, many of which can cause permanent tinnitus).
   
3. Somatic Tinnitus - This is tinnitus caused by some sort of problem surrounding the inner ear, such as problems with the blood vessels, tumors, or the temporormandibular joint (TMJ).  It is estimated about 80% of somatic tinnitus sufferers can get cured.  Sometimes somatic tinnitus pulses with the heartbeat, and gets the name "pulsatile tinnitus".  In rare cases a doctor can actually hear the tinnitus as well if it is caused by a constricted blood vessel or structure, making it "objective tinnitus" (a sound both the sufferer and another can hear), rather than "subjective tinnitus" (only the sufferer can hear).

So like "fever", tinnitus is not a condition it itself, but a symptom of an underlying problem.  And the ones I listed are just the main ones.  There are a few other rare causes and diseases of the ear (like Meniere's disease), and a huge number of people at the support site Tinnitus Talk have no clue what caused their problem, even after many years of searching.  But to address the T and find out if it is permanent, you need to figure out what is caused it. 

 

At first I didn't know what caused mine, only what it was like: a high-pitched, piercing whine at 9Khz, like the sign-off signal of TV stations way-back-when.  Most people with T experience a whine like mine, but some experience "whooshing", "crickets" or other noise.   The noise level can be so low that it can be ignored (I'll call a Level 1), to being so loud it is the only sound the person hears (Level 10).  Anything 7 or above is incredibly debilitating, and it is when it is chronic at this level that leads to suicide.  I had peaks of 7 at the beginning, but today am a 2 and hoping to get lower. 

 

I said my T started July 16, but that is actually when it was "on" all the time.  The fact of the matter is that I experienced low level tinnitus for a long time but ignored it.  Before July 16 it was either too low to notice (Level 1) so I heard it only when absolutely quiet, or it only happened in certain situations (when I yawned, when I turned my head sharply in one direction).  Like a sore joint I just thought it was apart of aging and ignored it since it didn't bother me.

 

On July 16 the T was not too low to ignore.  It was equal in volume to general conversation, Level 3-4.  And it did not go away.  In fact it seemed to be increasing in volume.   I was worried.

 

I went to the doctor and they said "swimmers ear" and gave me drops.  A week later they said I did not have swimmer's ear and that "tinnitus happens".  Don't EVER let a doctor tell you that!  Always, always get a second opinion.   

 

It took me two weeks before I could see an Ear Nose Throat Doctor (ENT), and during that time my worry and anxiety only got worse. The T continued to increase and I was convinced I was going deaf.  My T was now peaking at a 7 and I couldn't work, read or concentrate it was so loud.  I would sit across the table from my wife at dinner and see her mouth move, but all I could hear was a high pitched whine.  It was quite horrible.

 

The ENT took an audiogram (hearing test) and my hearing was perfect.  Usually when there is inner ear damage causing T, there is related hearing loss at that frequency.  So I did not have nerve damage.  It was not caused by loud noises.  I work in an office so there was no occupational issues.  The doctor was stumped as we sat and discussed it. The "ah hah!" moment came when I told the doctor that my T changed in loudness when I moved by head up, down, left or right. I also noted that the T reduced somewhat when I drank alcohol.

 

Based on these two issues, the doctor said that my T was caused by temporormandibular joint disorder, called TMD, but often referred to by just the joint name "TMJ".

 

So I had a cause, but what was the cure?  How would I get my tinnitus down?  That is for another post.