Can bruxism cause hearing problems?

Bruxism and Hearing Problems: The Connection

Yes, bruxism can cause hearing problems, particularly tinnitus, through its effects on the temporomandibular joint and surrounding structures. Research evidence demonstrates a significant association between sleep bruxism and tinnitus, with higher prevalence of tinnitus in patients who grind their teeth 1.

Mechanisms Linking Bruxism to Hearing Problems

Bruxism can affect hearing through several pathways:

1. Temporomandibular Joint (TMJ) Proximity:

   • The TMJ is anatomically close to the ear structures
   • Excessive grinding and clenching creates pressure and inflammation that can affect nearby auditory structures

2. Muscle Tension Pathway:

   • Bruxism causes hypertrophy and tension in masticatory muscles
   • This tension can extend to muscles around the ear and Eustachian tube
   • Altered muscle function may affect middle ear pressure regulation

3. Neurological Connection:

   • The trigeminal nerve (involved in jaw movement) and auditory pathways share connections
   • Chronic stimulation from bruxism may create neural cross-talk affecting auditory processing

Clinical Evidence

A clinical study found that among patients with sleep bruxism 1:

• 54% reported tinnitus symptoms
• Patients with bruxism and tinnitus had significantly higher rates of:
  • Chronic facial pain (p = 0.0007)
  • Myofascial pain in masticatory muscles (p = 0.0003)
  • More painful areas in masticatory and cervical muscles (p = 0.0032)
  • Higher depression indices (p = 0.0234)

Diagnosis Considerations

When evaluating patients with both bruxism and hearing complaints:

• Assess for bruxism signs:

  • Tooth wear and mobility
  • Tender or hypertrophied masticatory muscles
  • TMJ tenderness or dysfunction 2

• Evaluate hearing symptoms:

  • Type of hearing problem (tinnitus, hearing loss, ear fullness)
  • Timing relationship between bruxism episodes and hearing symptoms
  • Other ear-related symptoms (pain, pressure)

• Rule out other causes:

  • Recurrent or persistent otitis media, which can cause hearing loss 3
  • Cerumen impactions, which can obstruct the ear canal 3
  • Other conditions that may mimic or coexist with bruxism-related symptoms

Management Approach

For patients with bruxism and associated hearing problems:

1. Address the bruxism:

   • Occlusal splints to protect teeth and reduce muscle tension 4
   • Stress reduction techniques and relaxation exercises
   • Specialized physiotherapy for tension, pain, and restricted movement 4

2. Audiological evaluation:

   • Comprehensive hearing assessment to determine the type and extent of hearing issue
   • Audiologic testing as recommended in guidelines for hearing assessment 3

3. Multidisciplinary approach:

   • Dental evaluation for bruxism management
   • Otolaryngology consultation for persistent hearing symptoms
   • Consider psychological support, especially with comorbid depression 1

Special Considerations

• Monitoring progression: Regular follow-up to assess both bruxism and hearing symptoms
• Medication considerations: Some medications for bruxism may impact hearing function
• Comorbid conditions: Address sleep disorders, anxiety, and depression that may worsen both conditions

Prevention Strategies

• Regular dental check-ups to monitor for signs of bruxism
• Early intervention for bruxism to prevent progression to hearing problems
• Stress management techniques to reduce bruxism intensity

The relationship between bruxism and hearing problems highlights the importance of considering dental conditions when evaluating auditory symptoms. Proper management of bruxism may help alleviate associated hearing complaints, particularly tinnitus.