Monday, April 21, 2008

When You Hear Ringing, and It's Not the Phone

Temporomandibular joint disease, or TMJD, is a very common disorder that affects millions of people in this country. The most common symptoms are ear pain and headaches. Other less common symptoms that are described are ringing, buzzing, ear fullness, sound sensitivity, popping and clicking. A paper published in April, 2008 issue of Archives of Otolaryngology - Head & Neck Surgery described a relatively high incidence of theses "aural" symptom in patients seen in an academic TMJ clinic. They reiterate and agree with other authors' hypothesis that local inflammation of the jaw joint, due to it's proximity to the ear structures, can aggravate all these problems. In the end, no one really knows why these symptoms occur. As in all scientific papers, they can only show association, but never prove cause and effect.

Let me propose one possible cause for these effects: People with sleep-breathing disorders (obstructive sleep apnea and upper airway resistance syndrome) all have various degrees of nasal inflammation with ear and sinus pressure problems, TMJD, and headaches. If you have nasal inflammation with partial blockage of the tube that connects the back of the nose to the middle ear (Eustachian tube), then you can imagine that you may feel ear fullness, hearing loss, popping or clicking. If your senses are heightened due to a physiologic stress response due to inefficient breathing during sleep, then you can hear noises in your ear or be sensitive to certain sounds or voices. Neurologic stimulation of the various structures can aggravate jaw muscle stimulation and spasm, or even ear or sinus fullness. This is similar to what occurs in a migraine attack. Various papers have suggested that a migraine attack can occur in any part of the body that has nerve endings, so in theory you can have a "migraine" attack anywhere in your body.

This is one of many papers that describe observations between one specific condition and it's symptoms. Their findings and observations are accurate, but when viewed from the more holistic perspective of the sleep-breathing paradigm, you may be able to make sense of all of these various interpretations all that much more. After all, there's really no point in looking at all this research without having an overall perspective to interpret it from.

1 comment:

Becky (R.L.) Coffield said...

I completely understand the issues regarding sleep deprivation/disturbance and TMJ Disorder. Having had a terrible bout of TMJD, I am mostly in recovery, but still watch what I eat...for example, apples must be sliced, no corn on the cob, etc. What was most discouraging was how long it took for my condition to be accurately diagnosed. I was sent from doctor to doctor, from EMT's to allergists. Ultimately I figured out, through my own research, that I had TMJ Disorder. After a great deal of research and interviewing scores of people I came to realize that this condition is extremely wide spread. Most cases of TMJD do resolve on their own, however, given TIME and a SOFTER DIET. It is positively SCANDALOUS what some dentists/doctors have done to people with this condition that has caused irreversible damage. Inspired by other sufferers, I came up with an EASY-TO-COOK, EASY-TO-CHEW cookbook for people suffering from TMJD or in recovery. "You Can Conquer TMJ: Ideas and Recipes" is slowly being accepted as a healthful, natural way to come to terms with this disorder and is now being recommended by some dentists who aren't in a big rush to make up mouth guards. This extent of this disorder is grossly underestimated. The pain and resulting depression from it are enormous.