Monday, November 28, 2016

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.