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TMJ and the Ear

Timothy C. Hain, MD   Page last modified: July 19, 2010

See also: Dizziness and dental work

TMJ stands for the temporomandibular joint. The TMJ is located just below the Eustachian tube.

Location of the Eustachian Tube. The TMJ is just below the ear and ET tube.

Because the TMJ is a joint, it can become arthritic. Because people use it all the time (to talk and eat), arthritis is very common. Because it is close to the ear, pain in the TMJ can feel as if it is coming from the ear.

With all of that background aside, the TMJ is blamed for an immense number of human ailments. One dentist, apparently trying to drum up business, sent me a circular claiming that TMJ causes:

Supposed consequences of TMJ

Some of these are reasonable -- jaw joint aching for example. Some are extremely implausible. I have also been contacted by a group of dentists who were upset that I questioned the association between TMJ and a myriad of other symptoms. I asked them for data in the form of peer reviewed publications. These were not forthcoming.

Literature

Dr. Cox (2008) recently investigated ear related symptoms in persons with TMD (temporomandibular dysfunction - -same as TMJ). He reported much higher occurrence of the following symptoms:

Symptom Relative Risk
warm and/or fluid sensation 38
stuffy 14
loud noise sensitivity 6.2
pressure or fullness 6.2
cold air/wind sensitivity 4.4
brief dizziness spells 3.5
ringing or other noises 2.8
muffled hearing 2.4

Some of these symptoms could simply be related to focusing of attention on the painful ear. If one's ear is hurting, it seems reasonable to also start to pay more attention to symptoms that might be due to the ear - -such as ringing, dizziness, or pressure. These symptoms could also be caused by the TMD.

It seems very unlikely to us, however, that any substantial dizziness is caused by TMJ/TMD, and it also seems highly unlikely to us that TMD causes any organic changes in auditory processing. Rather, we think that these associations are probably psychological in origin, and related to a redirection of attention.

Treatment:

There is an amazing repertoire of treatments for TMJ -- dental appliances, orthodontic work, physical therapy, surgery, botox injections. A common feature of most of these treatments seems to be that they are expensive. A rather simple "bite guard", often provided by dentists -- costs about $300-500 in Chicago. MRI or CT of the TMJ, followed by orthodontic appliances is at least an order of magnitude more expensive.

Some of these treatments seem to help -- for example,

Bottom line:

Be careful when you see TMJ specialists - -get a second opinion.

References

Copyright March 24, 2014 , Timothy C. Hain, M.D. All rights reserved. Last saved on March 24, 2014