Ear Pain & Tinnitus
Ear Pain and Tinnitus
Why does my ear hurt, or even give me a similar noise disturbance to tinnitus? It is because of the close positioning of the ear and the jaw, side by side.
The rear portion of the jaw joint is separated from the front wall of the external ear canal by a thin plate of bone. Both the ear and the jaw receive nerves from the same branch (trigeminal nerve, which becomes the auriculotemporal nerve).
An inflamed jaw joint or displaced jaw joint (due to disc injury/degeneration) can be displaced backwards into the ear canal (Selesnick et al 1995) In some people there may be an absence of this thin plate of bone, thus more noise is heard in the ear from the vibration or noises of the jaw joint.
Or, it can be due to pain from the throat (tonsils, larynx, pharynx), in this case the ear pain occurs after swallowing
Or, neck muscles closely inserting near the ear, most commonly the sternocliedomastoid muscle.
Often described by clients that their hearing has a feeling ‘fullness’ or ‘pressure’. (Simons et al 1990)
Resources: American Tinnitus Association and Tinnitus today magazine
Tinnitus has no identifiable cause. Causes anxiety, depression, difficulty sleeping, difficulty concentrating. TMJ and neck problems can exacerbate tinnitus.
Imaging not needed unless pulsatile tinnitus or hearing loss
Latest info from a conference in 2021 by Dr Wright and Dr Ken Grandfast, following Treatment guidelines American academy of Otolaryngology – Head and Neck Surgery.
(Any mistakes are mine in the taking of the lecture notes on the zoom meeting).
12-30% of population. Subjective tinnitus – most common. Somatic /somatosensory tinnitus
- Modulated by physical contact or movement
- Presents in 36-43% of patients with subjective tinnitus
Associated with Tinnitus & Cervical spine disorders = strong. Associated w Tinnitus, Cervical spine, TMJ = stronger, more muscle diagnosis. Rule out dental disorder, touch teeth, percuss teeth, if increases tinnitus – possibly tooth related. Common areas to palpate – splenius capitus – often ref to ear and jaw, + periauricular area, + TMJ area.
Tinnitus increases with the age of the patient. Tinnitus;
- Occurs for short duration, began when TMD began, worse when TMD worse, worse when stressed, occurs when clench teeth, not related to noise, related to medication as side effects, thus with age more meds, so more tinnitus. Pain usually on one side. Hearing is normal.
Primary locations that reproduces tinnitus; 1/3 masticatory, 1/3 Cervical spine, 1/3 both.
Tinnitus and TMD symptoms - Break parafunctional habits, Relaxation, Splint and cognitive awareness techniques, Splint therapys - ? hard acrylic top with soft on bottom for tinnitus. Tricyclic anti depressant with minimum drowsiness eg desipramine. Can be related to snoring and sleep apnoea.
If TMD is the cause = -tinnitus is one one side, associated pain in affected ear, history of bruxism, use of ear buds with blue tooth, past history of TMD, click, tenderness.
Treatment; Tinnitus maskers – not sure if effective, Sound generators – better than radio. Meds – prescription not helpful, maybe melatonin, vitamins not helpful. Tinnitus retraining therapy with psychologist is most helpful. Biomedical device – starting to look effective. It hooks onto the tongue. Jaw Physio for TMJ and cervcial spine triggers.
Pathophysiology; Cochlea – auditory cortex – dorsal cortex – lateral meniscus – temporal lobe. Dorsal cochlea nucleus is probably site of dysfunction. So sound is perceived, even though no sound coming through. (and has connections with trigeminal nerve), from cervical spine, caudal trigeminal nucleus.
COVID – produces tinnitus, hearing loss and vertigo
New – near infra red spectroscopy is being developed to assess and recognise onset of tinnitus.
Another, older theory from 2019;
The oto-mandibular ligaments are the discomalleolar ligament (DML), which arises from the malleus (one of the ossicles of the middle ear) and runs to the medial retrodiscal tissue of the TMJ, and the anterior malleolar ligament (AML), which arises from the malleus and connects with the lingula of the mandible via the sphenomandibular ligament. The oto-mandibular ligaments may be implicated in tinnitus associated with TMD. A positive correlation has been found between tinnitus and ipsilateral TMJ disorder. It has been proposed that a TMJ disorder may stretch the DML and AML, thereby affecting middle ear structure equilibrium “It thus seems that otic symptoms (tinnitus, otalgia (ear pain), dizziness and hypoacusis) corresponding to altered ossicular spatial relationships (such as conductive middle ear pathologies) can also be produced from masticatory system pathologies.” (Taken from the Pysiopedia).
Most commonly caused by age, or side effects to medication. Thus with age, more meds, more tinnitus
It is thought that chronic tinnitus is more related to how the brain interprets feedback from the rest of the body – ie our nervous system. We know people who have busy minds, ie with traces of anxiety, worry, depression etc develop tinnitus. It’s now thought to be a less mechanical reason. Ie less likely to be something wrong with your ear.
Usually it is a loud ringing in the ears and may keep you awake at night. It may interfere with your ability to hear. It does reduce as your body finds a way to cope, and starts to only be noticeable if you stop and listen for it or are tired / fatigued or distressed. It is likely to fade with time.
Going to bed at night with gentle/soft music (classical is the best type, or nature sounds) can help you adapt, and get to sleep. Playing white noise for a few months can help reset the nervous system to lower the tinnitus noise Apple app = Noizes has nature sounds.