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Michigan Head & Neck Institute

Hearing Loss and TMD

I first learned about how TMD causes ear problems in the 1970’s.  An 8-year-old girl came in to my office, and after reading the forms that her parents filled out, I learned that she had lost her hearing.  Her ENT (Ear, Nose & Throat Specialist) had no idea why, as her structural anatomy was perfect.  Her previous dentist had extracted an upper baby tooth, and because that upper tooth had nothing to bite against, it grew downward and was longer than all of her other teeth. This caused an uneven bite (malocclusion), so I evened out the bite. I was just practicing dentistry, I was not thinking about her hearing loss.  About a month later, her mom came in with a cake and said her daughter’s hearing came back. I said, “I have no idea why, but thanks for the cake.”

I thought, “I’m going to find out why.”  So I went to the hospital library and found an ENT textbook, which of course is obsolete by the time it’s published. It said “The TMJ and ear maculas (patches of sensory cells) comes from a tiny piece of cartilage, and as a child or adult, they are both innervated (supplying an organ with nerves) by the same nerve pathway, and therefore they confuse each others symptoms.”  At the same time, I saw Bob Seger 5 nights in a row at a local concert venue in Michigan and I had muffled hearing. That was well known back then – loud noises can impair hearing. The tensor veli palatini (a broad, thin, ribbon-like muscle in the head that tenses the soft palate) muscle pulls on the eardrum to protect it from all the noises. That’s what happened with that little girl – she had a TMJ problem.

One of the most frustrating effects of a TMJ disorder is hearing loss. While there are many causes of hearing loss, most people have no idea that TMJ disorder is one of them. Consequently, this problem often goes unresolved.  People who suffer from TMD may struggle for months or even years with clogged ears, tinnitus, earaches, and vertigo in addition to hearing loss. They may see a number of specialists including an ENT who tells them that their ear looks healthy, and they may blame it on allergies.  Alternatively, they are diagnosed them with Meniere’s disease or prescribed hearing aides.  Or, they simply go on living with it lacking an explanation.

There are different types of hearing loss including conductive hearing loss, sensorineural hearing loss and mixed hearing loss.

Conductive hearing loss – caused by any condition or disease that impedes the conveyance of sound in its mechanical form through the middle ear cavity to the inner ear.  This results in reduction of intensity (loudness), so the energy reaching the inner ear is lower or less intense than originally intended.

Sensorineural hearing loss – caused by inner ear or auditory nerve dysfunction. This may result from an inability of the hair cells to stimulate the nerves of hearing or a metabolic problem in the fluids of the inner ear. It can also result from damage to the inner ear organs.

Mixed hearing loss – a combination of the above 2 types, where in addition to some irreversible hearing loss caused by an inner ear or auditory nerve disorder, there is also a dysfunction of the middle ear mechanism that makes the hearing worse than the sensorineural loss alone.

Location alone is one reason that jaw joint irritation transfers easily to the ear.  The presence of structures that connect the middle ear with the temporomandibular joint and the common innervation of the masticatory muscles tell us why 85% of TMD patients report aural symptoms.

The TMJ is adjacent to the ear, so swelling and inflammation often has a direct effect on the ear/s. Inflammation can cause blocked Eustachian tubes, and if the fluid in these tubes cannot drain properly, hearing is almost always affected (stuffiness, clogging, pain and/or hearing loss).

 

The following is an example of the sequence of events in the body:

 

  1. Nerves send a message to the brain that there is TMJ pain
  2. The pain message crosses through the inner ear canal
  3. The brain receives the pain message from the ear and TMJ
  4. The ear reacts by contracting craniofacial muscles (ie: medial pterygoid)
  5. Bones become misaligned due to frequent contractions
  6. The tensor palatini muscle (mentioned above) pulls on the eardrum and leads to Eustachian tube malfunction

If you are suffering from ear pain, stuffiness, hearing loss or vertigo, and you think it may be related to your jaw dysfunction, please call our office.  Dr. Klein is someone who understands the relationships of these diseases and disorders, and he is here to help. His years of practice will allow him to find the best course of treatment for each patient.  To schedule your consultation, please call us at (586) 573-0438.

 

References

Axelsson R, Tullberg M, Ernberg M, Hedenberg-Magnusson B.  Symptoms and signs of temporomandibular disorders in patients with sudden sensorineural hearing loss.  Swed Dent J. 2009;33(3):115-23.

Kempf HG, Roller R, Mühlbradt L.  Correlation between inner ear disorders and temporomandibular joint diseases.  HNO. 1993 Jan;41(1):7-10.

Ramírez LM, Ballesteros LE, Sandoval GP.  Otological symptoms among patients with temporomandibular joint disorders.  Rev Med Chil. 2007 Dec;135(12):1582-90.

Ciancaglini R, Loreti P, Radaelli G.  Ear, nose, and throat symptoms in patients with TMD: the association of symptoms according to severity of arthropathy.  J Orofac Pain. 1994 Summer;8(3):293-7.

Kaygusuz I, Karlidağ T, Keleş E, Yalçin S, Yildiz M, Alpay HC.  Ear symptoms accompanying temporomandibular joint diseases.  Turk Jour of ENT. 2006;16(5):205-8.

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The contents of this website, such as text, graphics, images, and other materials are for informational purposes only. While there are many commonalities among multiple TMD and sleep apnea cases, each patient is unique. Information on this website should be used to educate the reader about what they should discuss with their doctor if they are suffering from the listed symptoms. The information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or you may call our office with any questions you may have regarding TMD or sleep apnea. If you think you may have a medical emergency, call your doctor or 911 immediately.