Monday, 20 December 2010

Temporo Mandibular Joint Disorder and Dizziness

I am going to jump in and start talking about the relationship between Temporo Mandibular Joint Disorder (TMJ) and Dizziness. Many people who have Dizziness and start to research the internet always come up with overlaps between dizziness and another physical complaint. Temporo Mandibular Joint Disorder (TMJ) is one, Bruxism is another. The sort of stuff you read about sounds like this;

Ear pain: About 50% of patients with a TMJ disorder notice ear pain and do not have signs of ear infection. The ear pain is usually described as being in front of or below the ear. Often, patients are treated multiple times for a presumed ear infection, which can often be distinguished from TMJ disorder by an associated hearing loss or ear drainage (which would be expected if there really was an ear infection). Because ear pain occurs so commonly, ear specialists are frequently called on to make the diagnosis of a TMJ disorder.

Sounds: Grinding, crunching, or popping sounds, medically termed crepitus, are common for patients with a TMJ disorder. These sounds may or may not be accompanied by increased pain.

Dizziness: Of patients with a TMJ disorder, 40% report a vague sense of dizziness or imbalance (usually not a spinning type vertigo). The cause of this type of dizziness is not well understood.
Fullness of the ear: About 33% of patients with a TMJ disorder describe muffled, clogged, or full ears. They may notice ear fullness and pain during airplane takeoffs and landings. These symptoms are usually caused by eustachian-tube dysfunction, the structure responsible for the regulation of pressure in the middle ear. It is thought that patients with TMJ disorders have hyperactivity (spasms) of the muscles responsible for regulating the opening and closing of the eustachian tube.

Ringing in the ear (tinnitus): For unknown reasons, 33% of patients with a TMJ disorder experience noise or ringing in the ears (tinnitus). Of those patients, half will have resolution of their tinnitus after successful treatment of their TMJ disorder.

For someone with Vestibular Presenation this is too close to what might be a solution not to considered, especially after months maybe years of misery. I have seen about 3 Maxillofacial Surgeons (maybe even 4). I have a CT Scan and a medical report which says, yes I have TMJ.

So is there a link? Yes, but TMJ whilst common in people with Dizziness is not the trigger of the symptoms. I can assure you of this based after I personally harrassed some of the top Maxillofacial Consultants in London.  I will develop the reasoning behind this statement later since I want to keep the developing of the ideas behind dizziness inline with how I developed my understanding of the disorder. The key point made share by each consultant is that TMJ is generally caused my pyschological triggers and that treating the underlying pyschological component would stop the development of the TMJ presentation (in me). Everyone ruled out surgery, instead opting for splints and diet changes (soft food) combined with stress management.

This is important for 2 reasons:

  1. It establishes a link between a disorder closely associated with dizziness being triggered by  pyschological factors. TMJ is not the source of dizziness, TMJ and Dizziness are simply triggered by similar pyschological factors and are therefore common in people who have in those with pyschological presentations.
  2. Plenty of Maxillofacial establishments which will profess to help those with Vestibular Symptoms because of the known but yet unexplained associated symptoms between the TMJ and Dizziness. (You will start to see the important interference between Money and Medicine Opinion as I keep blogging and how it is so destructive in helping those get treatment for dizziness).

  2. Medical Report

Right TMJ- Closed

The condylar head is stightly irregular with a veqy early osteophyte formation in the most antaior surface.The disc is situated in the normal position betwcen the condylar hear and the glenoid fossa. The glenoid fossa and articular eminence appear normal. No evidence of joint effusion noted.

Right TMI - Open

There is a good range of movement with the disc remaining in the normal position.

Left TMJ- Closed
Similar appearamce of the condylar head is noted where there is a very early ostcophyte formation. The disc is tcthered antcriorly but also rnedially displaced.

Left TMJ- Open

There is a good range of movement and the disc returns to a normal position. This is anterior and medial displacement of the disc with reduction.


Anterior but also medial disc displacement of the left temporomandibular joint with reduction with noevidence of joint effiusion bilateralty.

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