Tinnitus, more commonly known as ear ringing or buzzing, can be a rather maddening symptom. People who suffer from tinnitus complain of difficulty falling asleep at night due to the sound. The loss of sleep can negatively impact their general health. To make matters more complicated, it can also cause problems hearing and being able to focus during conversations. This can have a negative impact on the individual's social relationships.
Tinnitus can also quickly become a problem that is costly to manage because patients aren't sure who to turn to for help. The internet is full of suggestions about noise machines, meditation programs, supplements, and medications. Some patients seek out care from an audiologist, assuming it to be a hearing problem. Others go to an Ear, Nose, and Throat (ENT) specialist seeking answers and relief. If unsuccessful there, patients sometimes read about jaw problems as a potential cause and ask their dentist for help. When other providers are unable to help, some patients ask if physical therapy might offer the answer.
The truthful answer to that question is, "It depends." Patients should always be wary of providers who promise to fix their tinnitus. It's called the "practice of medicine" for a reason; there are no guarantees in healthcare. Doctors make decisions based on statistical probabilities, and there are very few things in the world for which the probability is 100%. In fact, research is often lacking on exact statistics for what percentage of patients benefit from a given treatment. While there is evidence that physical therapy targeted to the TMJ (1, 2) and the cervical spine (1, 2, 3, 4) can improve tinnitus, there are certain patients more likely to benefit than others. In order to treat a symptom successfully, it is best to know and treat the root cause rather than cover up the symptom whenever possible.
To better understand our ears, we have to start back at the beginning. When a human embryo is developing in the womb, the same preliminary tissues will form both the ear and the jaw (5). The two structures are intimately related. You can even stick your finger in your ear and feel the condyle of your jaw moving while you open and close your mouth. Because of this close relationship, the function of your jaw can impact your ears. The muscles, bones and nerves all need to be taken into consideration.
If you use your jaw muscles for extra things beyond eating and talking, your muscles can develop inflammation and tension from overuse. People who have a tendency to clench or grind their teeth are more likely to develop jaw problems and/or tinnitus. Parafunctional oral habits such as fingernail biting, gum chewing, or smoking (6) can also increase the amount of work your jaw muscles are doing in a given day. TMJ specializing physical therapists can provide targeted manual therapy treatments for your muscles, as well as teach you exercises to help reduce the strain on your muscles. (See Choosing a PT for TMD)
If age related changes, poor posture, or past injuries have caused stiffness in the joints of either your jaw or your upper cervical spine, it can also impact your ear. The tissues in our bodies need a certain degree of flexibility to move like they should and allow forces to pass through them. The alignment of your joints can also play a role in how forces are absorbed in your body. That includes sound waves. That's why your voice sounds different in your own head than on a recording. Sound waves pass through the tissues in our skulls as they are generated by our vocal cords, so we hear them differently.
Some individuals may also experience tinnitus after a viral infection like COVID 19 (7). Viral infections can prompt your body to generate swelling and inflammation while fighting the virus. If this inflammation occurs close to a nerve, the function that nerve provides can be damaged. This can be visibly observed in conditions like Bell's Palsy, in which half of the facial muscles experience paralysis due to swelling around the facial nerve. It is possible that this can occur for the nerves that allow your jaw and ears to function. This may be why some people with tinnitus report that cardiovascular exercise can impact their symptoms. In this instance, physical therapists may utilize exercise, manual therapy treatments, or targeted treatments like dry needling to influence blood flow and inflammation responses to improve your symptoms.
Your nervous system can be strained by swelling and inflammation, but other injuries like concussions, or chronic nervous system related disorders like migraines can also influence tinnitus. The nerves that supply your inner ear and your jaw muscles are called cranial nerves, meaning that they come directly from the brain instead of taking an indirect route through the spinal cord first. Physical therapists can help patients recover from concussions and can also help with treatment of some types of migraines.
In summary, your tinnitus may benefit from physical therapy especially if:
You also have jaw pain, popping, clicking, or your jaw locks in place.
You habitually clench or grind your teeth.
You also have neck pain. (8)
Poor cervical/neck posture worsens symptoms. (8)
You have a history of concussion.
You also have headaches or migraines.
Cardiovascular exercise influences your symptoms.
This article on TMJ and tinnitus is intended for educational purposes and is not a replacement for professional medical evaluation and advice. As a word of caution, tinnitus is not well understood and can be caused by a variety of underlying conditions. It is recommended that patients do work with some of the specialty providers discussed above to rule out conditions like Meniere's disease, vascular blockages like atherosclerosis, or rare tumors like acoustic neuromas that can cause ear ringing.
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