When it comes to a symptom such as tinnitus, it can be especially difficult finding what the underlying cause actually is. Brain MRIs usually come back as normal (so it isn’t like you have a brain tumor or bleed). Hearing or audiology tests also usually come back as pretty close to normal … not exactly enough to cause the persistent noise in your ears. It is like having a ghost swirling around in your brain.
So when it comes to identifying the cause of tinnitus, it is instead a matter of needing to think outside the box and identify those contributing factors that are likely to be a part of the problem (but also thus the solution). In our own practice where we focus on the alignment, motion, stability, and health of the vertebrae in the upper neck, we have made an observation (and statement) for our patients for many years now that tinnitus is a problem with the temporomandibular joint or TMJ.
We had an older research paper recently brought to our attention that we thought was particularly interesting that we wanted to share. In brief, there is a ligament known as the “discomallelor ligament” that attaches directly to the inside of your TMJ and connects with one of the bones of your middle ear that, when it vibrates, produces what your brain interprets as noise.
The Link between the TMJ and Tinnitus
Let’s start with the direct linkages. First, and under normal circumstances, the ligament between the TMJ and the middle ear seems to be involved with maintaining your overall sense of equilibrium and balance. You may have had the experience of being in an airplane where you can make your ears “pop” by yawning, stretching your mouth, or chewing gum. Think of it like a reflex mechanism that allows your brain to modulate the pressure of your inner ear. Okay, so that’s the normal circumstance. However, what about abnormal circumstances? Let us consider where you may have a structural or mechanical problem with your TMJ.
Overbite (aka class II malocclusion)
Misalignment or injury of the TMJ (even if only millimetres)
In these circumstances, your TMJ will not function properly and often produces pain or other symptoms such as teeth grinding (aka bruxism), clenching, or temporal headaches. In turn, this abnormal tension may produce a pulling effect on the discomalleolar ligament, which may in turn affect your inner ear. Thus, by producing pressure in this way, it may be possible for a TMJ problem to actually produce what is known as somatosensory tinnitus. Note: This may also explain how it is that people who experience vestibular issues - specifically a syndrome that is called Meniere’s Disease - may experience intermittent episodes of hearing loss and/or tinnitus as well.
The Link between the Upper Cervical Spine and Tinnitus
Now that we’ve covered the direct linkage between the TMJ and tinnitus, let’s show how it is that a problem with the alignment, motion, and stability of your upper neck can be an underlying factor as well. In brief, the position of the vertebrae in your upper neck called the atlas (C1) and the axis (C2), affect the position of your TMJ (and visa versa). Moreover, the neurology of your spinal cord in the upper neck is what actually influences the neuromuscular control and function of your TMJ.
In effect, your upper neck affects the electrical supply to the muscles that cause your TMJ to move. Thus, if your TMJ is moving abnormally, again, there we see the potential to produce somatosensory tinnitus. What this then suggests (and as strange as it sounds) is that correcting these types of mechanical blockages in your upper neck may have the effect of improving your jaw function, which in turn may help your tinnitus.
The Blair Technique and Tinnitus
Of course, when working with such an important area as your TMJ and upper neck, precision is the key. One of the most precise methods for doing just that is what is known as the Blair technique, which is still a rare form of healthcare in Australia. The Blair technique belongs to a special division of general chiropractic that is known as upper cervical care. Unlike general spinal manipulation, the Blair technique does not use any form of neck manipulation, twisting, stretching, or cracking. It is a specific, gentle and personalised approach to healthcare that focuses on the innate healing potential of your central nervous system.
In other words, healing doesn’t occur from the outside in. It occurs from the inside out. The general process involves first a series of assessments including a physical exam, neurological exam, and specialised diagnostic imaging in order to identify the exact location, direction, and degree of misalignment in your upper neck (and/or TMJ). With this information, a Blair upper cervical chiropractor is able to provide a personalised care plan to suit your individual needs. Our practice, Atlas Health, is the leader for Blair upper cervical chiropractic care in Australia. Located in North Lakes (north Brisbane), our mission is to help people with upper neck-related disorders find long-term solutions so that they can get back to enjoying the things in life that matter most. To schedule a consultation to find out if the Blair technique may be right for you, click the Contact Us link on this page, or call us direct at 07 3188 9329.
References
Biesinger E, Reisshauer A, Mazurek B. [The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus]. [Article in German] HNO. 2008 Jul;56(7):673-7. doi: 10.1007/s00106-008-1721-2. https://www.ncbi.nlm.nih.gov/pubmed/18560742
Hölzl M, Behrmann R, Biesinger E, et al Selected ENT symptoms in functional disorders of the upper cervical spine and temporomandibular joints. HNO. 2019 Mar;67(Suppl 1):1-9. doi: 10.1007/s00106-019-0610-1. https://www.ncbi.nlm.nih.gov/pubmed/30742234
Michiels S, Van de Heyning P, Truijen S, et al. Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? Man Ther. 2016 Dec;26:125-131. doi: 10.1016/j.math.2016.08.005. Epub 2016 Aug 26. https://www.ncbi.nlm.nih.gov/pubmed/27592038
Ralli M, Altissimi G, Turchetta R, et al. Somatosensory Tinnitus: Correlation between Cranio-Cervico-Mandibular Disorder History and Somatic Modulation. Audiol Neurootol. 2016;21(6):372-382. doi: 10.1159/000452472. Epub 2017 Jan 19. https://www.ncbi.nlm.nih.gov/pubmed/28099967
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