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I deliberated long and hard before penning this article, given the intricate nature of the explanation. However, the severity and debilitating nature of this problem compelled me to move forward.

While some aspects of this article may seem a bit “Dusty,” I implore those who suffer from this condition to continue reading, as I may be able to provide some assistance. Before I go any further, let me assure you that this is not some half-baked idea I conjured up – it is rooted in solid medical fact.

What Is Tinnitus?

Tinnitus stems from the Latin word “tinnitus,” which means “ringing.”

It refers to the perception of sound within the human ear when there is no corresponding external sound present. Tinnitus is not a disease itself, but rather a symptom. When questioned, approximately 1 in 5 people report experiencing it.

Causes (aetiology) (etiology)

If you consult a medical textbook or conduct an online search, you’ll find an exhaustive list of potential causes. However, the most common culprits include:

• Past exposure to loud noise, such as music
• Ear wax
• Inflammation of the ear drum
• Overdose of Aspirin

If none of these apply to you and you’ve sought the expertise of an ENT specialist who couldn’t identify a specific cause, it’s highly likely that your jaw joint, known as the Temperomandibular Joint (TMJ), holds the answer. Many people are familiar with TMJ Dysfunction, but few realize that it can actually cause Tinnitus. So the question becomes, “How is this possible?”

Anatomy

Unfortunately, we must delve into the anatomy of the ear and TMJ in order to fully comprehend the underlying mechanics at play. But before we do that, I encourage you to stand in front of a mirror. Gently place a finger in front of your ear and open and close your mouth. You may need to slightly adjust the position of your finger to locate the joint, but once you do, you’ll feel its movement. Take note of how closely your ear and jaw joint are positioned.

This proximity is not coincidental. During embryonic development, the lower jaw (mandible) and a significant portion of the ear originate from the same tissue known as “Meckel’s Cartilage.” Due to this shared origin, remnants remain that physically connect the middle ear to the mandible. But more on that later…

The Ear

The ear consists of three main parts:

The External Ear – this includes the visible portion and the ear canal, which terminates at the ear drum.

The Middle Ear – a small, air-filled chamber containing three tiny bones, or ossicles, named “Malleus,” “Incus,” and “Stapes.” These bones are interconnected and transmit vibrations from the ear drum to…

The Inner Ear – responsible for relaying the vibrations detected by the ear drum to the brain, where they are interpreted as familiar sounds, such as speech or music. The inner ear also plays a role in maintaining balance.

Summing it up:

Sound waves travel through the ear canal, causing vibrations in the ear drum. These vibrations are then transmitted across the middle ear by the three ossicles to the inner ear and ultimately to the area of the brain responsible for hearing.

The Temperomandibular Joint (TMJ)

The TMJ is a small yet intricate joint. It is ginglymoarthrodial in nature, which means it allows for rotation, like most joints, but also sliding, which is where complications can arise.

The joint is comprised of:

The “Condyle,” which resembles a ball and is part of the lower jaw.

The “Glenoid Fossa,” which takes the form of a depression and is part of the skull. The Condyle fits snugly into the Glenoid Fossa.

Sitting between these two components is the “Disc,” which serves to separate them, provides some cushioning, and reduces friction. Finally, the entire assembly is encompassed by the “Capsule,” which helps maintain the joint’s stability.

TMJ Dysfunction

Under normal circumstances, when the upper and lower teeth come together, the Condyle sits nicely in the Glenoid Fossa, separated by the Disc. As the mouth begins to open, the Condyle rotates, and as the opening continues, the Condyle starts to slide forward and downward. Simultaneously, the Disc moves backward over the top of the Condyle. The reverse process occurs when the mouth closes.

During periods of rest, when we are not speaking or eating, there should be a slight space, a few millimeters, between the upper and lower teeth. This allows the jaw muscles to recover from their exertions. However, if you constantly grind or clench your teeth or have a misalignment of your bite, the muscles continue to overwork and eventually go into spasm, akin to experiencing cramps while swimming.

These muscle spasms can cause abnormal positioning of one or both Condyles, placing additional stress on the muscles themselves and exacerbating the spasms further.

So how does all this tie in with Tinnitus?

Earlier, I mentioned the shared embryological origins of the ear and TMJ, as well as the remnants that still persist. There are two such remnants that are pertinent:

1. Disco-Malleolar Ligament (DML) – also known as Pinto’s ligament.
2. Anterior Ligament of Malleus (ALM)

While many TMJ specialists believe the DML to be the key contributor to the onset of Tinnitus, H.J. Kim et. al., in the journal “Surgical and Radiologic Anatomy,” conclusively demonstrated that it is the ALM that plays the crucial role.

The ALM is a minuscule ligament that connects the Malleus (the first ossicle in the middle ear, situated against the ear drum) to the Disc within the TMJ. If the Disc is not properly positioned within the TMJ, it can stretch the ligament, exerting excessive tension on the three ossicles, as well as other important muscles in and around the ear, and even the ear drum itself. It is this tension and strain that give rise to Tinnitus.

Cure

The good news is that the solution to this problem is relatively straightforward and aligns with standard TMJ treatment protocols.

In the majority of cases, disengaging the teeth (separating them from contact with one another) proves highly effective.

A night guard, worn while sleeping, offers a convenient means of achieving this, as it doesn’t interfere with daily activities. Typically crafted from pliable plastic, these guards fit over either the upper or lower teeth, positioning the TMJs into a neutral state, along with their accompanying discs. This, in turn, helps reduce excessive stresses on the three auditory ossicles via the ALM.

Conclusion

Tinnitus afflicts a sizable portion of the population, and at its worst, this condition is truly distressing, a plight that I, as a non-sufferer, can only begin to fathom. Standard TMJ treatment can provide relief to Tinnitus sufferers whose medical professionals have ruled out organic or obvious causes.

It’s worth noting in passing that many other aural issues are linked to TMJ Dysfunction.

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Ihab Salloum