As some of you know after 8 months of ear fullness/ pain, dizziness, tinnitus, with ENT drawing a blank and coming up with nothing at all, I finally have a probable diagnosis, which is tempero mandibular joint disorder. This is a common cause of dizziness and ear problems, often over looked by ENT departments. The information I will post is most relevant to those who are an ENT 'mystery'. People who have been through tests and the tests show no damage to the vestibular nerve, or have no viral symptoms related to their labyrinthitis, or have Eustachian tube function tests which show no dysfunction, or have no history, recent or past, of headaches which could point to migraine associated dizziness. You do not have to have jaw symptoms with tmjd, sometimes it merely manifests with ear symptoms and dizziness. I stress - this is a COMMON cause of dizziness and/or ear problems, not some off the wall suggestion from someone who has this probable diagnosis. Do not be put off if you suggest this to your ENT doc and they look at you like you're mad, also your dentist, they are often ignorant about the connection btwn tmjd and the ears. If you think this diagnosis might be relevant to you, the person to see is a tmjd specialist dentist, they are the ones qualified to make the diagnosis. Also go to the tmjd board where you will find many people with ear and/or dizzy symptoms, some with jaw symptoms, some without. Here is some information on how TMJD affects the ears and causes ear symptoms and dizziness.
A list of the ear related symptoms TMJD can cause from:
The Kinnie-Funt Visual Index of Head, Neck and Facial Pain and TMJ Dysfunction:
Ear Pain, Ear Problems, and Postural Imbalances:
- hissing, buzzing, ringing, or roaring sounds
- diminished hearing
- ear pain - without infection
- clogged, stuffy, "itchy" ears, feeling of fullness
- balance problems, "vertigo", dizziness, or disequilibrium
The Tensor veli palatini is a small muscle behind your palate (also impossible to manipulate).
"The Tensor veli palatini has a number of functions, including involvement in the closing of the eustachian tubes. This tube connects the throat to the middle ear and keeps the air pressure in the middle ear the same as that of the outside atmosphere.
The Tensor veli palatini is supplied with nerve signals from a branch of the same nerve that supplies the external pterygoid muscle. When the lateral pterygoids are in spasm, the Tensor veli palatini also can go into spasm because the nerve stimuli go to both muscles. When this tiny muscle goes into spasm, it closes off the eustachian tube and produces symptoms that mimic middle-ear problems. These can include changes in hearing, earaches, buzzing, ringing or dizziness."
Cervical Spasm: Many people have spasms in their neck muscles on a constant basis that they are not aware of. This is often accompanied by a subluxation of the neck vertebrae. The neck has many proprioceptive nerves which tell the brain where the head is in space. But when the neck muscles are in spasm, these nerves don't function properly, giving the brain improper signals, thus causing the sensation of vertigo/dizziness. The jaw is often involved in that when the bite is improper, the muscle tone in the neck is elevated. Vertigo is a symptom that I cannot recall a single case in which it did not resolve.
Trigeminal Nerve Dysfunction: The trigeminal nerve, unbeknownst to the vast majority of the medical profession, innervates the blood vessels in the brain. Through this innervation and by secretion of neuropeptides from its ganglion, it has the ability to control blood flow to the brain. When the trigeminal nerve is hyperactive from jaw malalignment, this control mechanism can be abnormal, leading to low blood flow to the brain.
[This message has been edited by hbep (edited 04-11-2003).]
[This message has been edited by hbep (edited 04-11-2003).]
Feeling a bit sad, as went to dentist yesterday and asked him about TMJD, and lovely though he is ( I mean, I'd rather be sitting on his lap than in the chair!! http://www.healthboards.com/ubb/love2.gif )he said that dizzyness and vertigo is more likely to be caused by an inner ear problem, and the chances of having TMJD and an ear problem are "way out there". Buuuutttt - he did have a squeeze of my TMJ on the inside, which was painful, and he suggested some excercises to do which would help to bring my lower jaw back a bit! Actually, we had quite a giggle, as he said no-one would know I was doing them, and I said, what - like pelvic floor excercises? And he said he wouldn't know!! Tee Hee! So, he said he'd rather I went the ENT route a bit further first. Bless him!
Had a bad day yesterday - was sick when got home and couldn't lift my head for an hour or so. Veeery dizzy. Wondering if it's the jaw excercises I'm doing!!!
Thanks for your help though - I won't forget the TMJD possibility.
Hoping you're feeling better. When do you get your splint?
Thanks for your suggestion! I have already started to look into other causes for my dizziness and I just recently realized that it could be connected with that terrible burning pain in my neck and at the back of my head I have been having for quite some time now. Funny, it's only on one side of my body! Anyways, I think sometimes I'm going nuts or maybe just don't want to accept the inner ear diagnosis but anyways...! I am going for an ENG on the 17th which could bring some answers.
Once again, your research is impressive! I am with you 100%. As a long term sufferer of TMJ there's a pretty good chance that my dizziness is a result of TMJ. The only unfortunate thing is that I've been treating my TMJ for years and developed dizziness while treating it. Hmmm, lucky me. Hopefully this NTI will make a difference. At the 7 month mark I am now definitely on the road to recovery. My life is now interrupted very little by my dizziness which is still constantly there, but at low enough levels to not cause depression.
How is your search for an NTI going? Will your swedish trained dentist fit one?
The excercises involved rolling my tongue back towards my throat, thus moving my lower jaw backwrads - and at the same time, closing my jaw until it's at the point just before you bite. The biting point!! Bit like a clutch, but you don't take off like in a car!! Anyway - my lovely dentist said no-one would know I was doing them, but I thought I'd see what this looked like in the mirror, and I actually look like a turtle!! Maybe I look like a turtle anyway!! No-one has ever mentioned this before!! Anyway - hope this helps. I suppose really you should check with your dentist first, because I've found my jaw is more painful since starting the excercises (and it's only been a day!!)
Sorry to have been a bit absent, brother and his girlfriend were visiting this weekend. Nice but tiring. Hey Spaced Out, loved the icon you used for your dentist LOL. Emsybobs, the long winded answer to the question you asked under another topic is contained below.
Anyway, some info that might be interesting to you all. Saw my friend who had lab for over a year (or so he thought) the other day. He had 2 ENG/caloric tests which show whether or not you have damage to the vestibular nerve. Both times the tests showed no damage. By the time he saw the neuro oto 10 months in, he was so improved she merely gave him more specific VRT to do and said if he didnít recover fully theyíd investigate further. When we met I told him about tmjd, which he didnít know about. Turns out, throughout the course of this he had constant pain/tension in his neck, back, face and jaw, (which also constantly clicks) so much so that he sought out massage therapy for his jaw/neck/back all the way through his illness. Massage therapy is one of the treatments for tmjd. I guess he may never know for sure what caused his dizziness, but the good news is he is almost 100% better. Also, as a source of comfort to those who still have very bad dizziness, his dizzies were appaulingly bad, every horrible type of dizziness I've heard described here he had.
I have since read a balance therapist say that if you have lab /vestibular neuritis then you will definitely show nerve damage on an ENG. It made me think that all those who are worried about whether this is lab/VN or something else, should insist on an ENG/caloric test. It does seem that this will provide a definite answer as to whether itís a virus caused inner ear problem, or whether you need to look elsewhere. Was specifically thinking of you, Emsybobs, and the question you asked re subluxations. I never had an ENG, but then I never had vest nerve damage type dizziness. I did, however, have further Eustachian tube function tests recently, as I considered the only other feasible diagnosis to be ETD. They came back clear, this helped me deduce that this is almost certainly tmjd.
In terms of what can be done about tmjd, the answers are a mouth guard or splint, (the correct one for you from a tmjd specialist ) this relieves the pressure on the jaw muscles/joint. Some people try chiros or cranial osteopaths, massage therapy can be very effective. Sometimes it will clear up on its own. There is no one definitive answer, although apart from in the most severe cases involving extreme jaw symptoms, surgery should not be considered, and extensive re alignment splint/orthodontal work to re align a bad bite should be approached with caution. And yes, you can do exercises, although I can't remember if the same exercises will help everyone, saw someone recommend a book of self help for tmjd over on the tmjd board, I'll have a look and post it. Anyone who is interested in this possibility , check out the tmjd board, thereís loads of info. Try putting Ďearsí or Ďdizzinessí in to the search engine once youíre in the board and have a read.
Jen, Spaced Out, in answer to your questions, I am going to see a tmjd dentist who favours the NTI splint tomorrow, see if Iím a suitable candidate. Jen, Iím so happy to hear about your improvements. Wonder if this is because of all the VRT, although itís interesting that your improvements seemed to coincide with the new NTI splint. They do say a lot over on the tmjd board that the right splint that works for you can make all the difference, and the wrong one can actually exacerbate the problem. Iím also much better, but as we all know, much better isnít completely well, and so my quest continues.
Hope youíve all had a good weekend.
[This message has been edited by hbep (edited 04-13-2003).]
Thanks Hbep. I never had an ENG as I went privately and the ENT said the cost just wasn't worth it. Doubt my Doc would refer me on the NHS now. I think I have decided to go to my Chiropractor and ask for one treatment. I guess if that doesnt help, then I know sublixations. I am a bit worried about whether it may make it worse too. Do you think I should try it? I am also worried it may bring the headaches back! Agh! It's so difficult to know what to do! xxx
Yeah, it could be the NTi, but I also started acupuncture at the time I started to feel better, and I've never given up on the VRT. And then again, it could just be that it's been SEVEN MONTHS. Aaaaaaaaaaaaaaaaaaaaaargh.
I will never know, but as long as I keep improving, I don't care!!
Let us know whether you're the lucky owner of a new NTI.
Yup, I am now the lucky owner of an NTI. Very happy about this. Saw the tmj dentist, he felt around my face, jaw, said the knots in the muscles were pretty obvious, he had me clench whilst he squeezed one, ouch. I asked about X Rays etc... He said let's see how you're doing with the splint first, I go back in 2 weeks. He is very against any type of surgery and also said even if I did want my jaw re aligned (which he isn't in to either) with my type of cross bite the only option would be to crack my jaw. Yuck. That's not going to happen, LOL.
Anyway, I will start wearing it tonight. Just had an answer from the audiologist who is currently visiting this board - he said that eustachian tube dysfunction will only show on tests when the dysfunction is actually happening and this can wax and wane. Which means I still don't know if Eustachian tube probs set off the tmjd or whether it's been tmjd all along. I'm hoping it's the latter and that the splint works. Anyway, I am going to try wearing the splint, if I really make no headway I will finally take the oral steroids I was prescribed by the otologist. Now I suspect I have tmjd I am not keen to take these unless I need to - steroids are not a pleasant drug. Thanks for the tip off about the NTI - fingers crossed it makes a difference.
Yup, earache, deep inside the ear, like someone's been in there with a carrot grater. Not all the time, off and on. Probably shouldn't be writing as am very despondent this morning. Apologies. Used the NTI last night and my jaw feels worse/tighter this morning, there is more clicking than there usually is, and my ears were more blocked but seem to be calming down again. Am worried as I know certain splints only work for certain people. The NTI can work wonders for some, but I fear already that I may be one of the people it doesn't work for. Splints are an expensive hit and miss thing. I am seeing the dentist who fitted it again in two weeks, I'll probably wear it once more tonight then leave it till I see him again. He said if my jaw felt worse to stop.
My dentist told me to try the dental hospital again. I went ahead and saw the NTI bloke as I am so desperate to get things moving. As I explained, last time I was at the dental hosp they said to finish with ENT then come back after that (July) but to phone if my jaw got worse. I've phoned. Basically they are free on the NHS, if the NTI isn't right for me I'm hoping they will make me a splint. I got an ansaphone but am hoping they phone back soon. I don't have insurance as you're meant to get free healthcare in England (Yeah right, after you've waited months and months to see someone) As you can see, I am not in the best of moods, just want help and am sick of searching and searching to find it and then paying through the nose. Am going to tell my acupuncturist tomorrow that I can't see her much anymore as this is all just costing me too much. The NTI was expensive. The irony is that I have never felt less like taking on a lot of work, because I'm ill, (I'm freelance) but need a lot of work to pay for all this stuff. I think I am now going to stop all treatment, apart from maybe taking the steroids ENT gave me, and wait for the dental hospital. Big apologies again that this is so down beat, but I'm so tired of it all today.
Thought I'd write something slightly more cheerful to make up for the total misery of my last message - sorry about that, was just hit by a wave of weariness. Got through to the dental hospital, they can see me in 3 wks. Very happy about this - my dentist assured me that I could trust them with regard to tmjd ( I had my doubts) so if I get nowhere with the NTI, I think I'll just put myself in their hands. I'll try the NTI again tonight - see what I think about continuing with it tomorrow. I see him the NTI bloke again in 2 wks, so I'll know what he has to say before I see the dental hosp. I am much improved but do feel I've hit an impasse - for wks now I have stayed the same. Delighted the worst of the dizziness has gone but fed up with the blocked ears, jaw discomfort and the out of it feeling/ concentration problems that go with it. Glad I now have a plan again.
Hope you're all doing ok, and apologies for all the moaning.