Can bruxism (teeth grinding) affect hearing?

Bruxism and Its Effects on Hearing

Bruxism (teeth grinding) can potentially affect hearing through its association with temporomandibular joint (TMJ) disorders, which may cause referred otalgia (ear pain) and tinnitus, but there is no strong evidence that it directly causes hearing loss.

Relationship Between Bruxism and Hearing

Temporomandibular Joint Connection

Bruxism is a common condition characterized by grinding or clenching of teeth, which can occur during sleep (sleep bruxism) or while awake (awake bruxism) 1. The condition is often associated with temporomandibular joint (TMJ) disorders, which can manifest as referred pain to the ear region 2.

Potential Mechanisms Affecting Hearing

Several potential mechanisms may explain the relationship between bruxism and hearing-related symptoms:

1. Referred Otalgia: TMJ disorders can cause referred pain to the ear region without actual ear pathology 2.

2. Tinnitus Association: Research has shown a higher prevalence of tinnitus in patients with sleep bruxism. A study found that 54% of sleep bruxism patients reported tinnitus, with significant correlations to:

   • Chronic facial pain
   • Myofascial pain in masticatory muscles
   • Higher number of painful areas in masticatory and cervical muscles
   • Higher levels of depression
   • Tooth absence without prosthetic replacement 3

3. Anatomical Proximity: The close anatomical relationship between the TMJ and the ear structures may explain how dysfunction in one area can affect the other 2.

Clinical Implications

Assessment and Diagnosis

When evaluating patients with both bruxism and hearing complaints:

• Consider bruxism as a potential contributing factor to tinnitus, especially in patients with other TMJ symptoms 3
• Evaluate for myofascial pain in masticatory and cervical muscles 3
• Assess for signs of tooth wear, mobility, and hypertrophied masticatory muscles 4
• Rule out other causes of hearing symptoms, including sensorineural hearing loss 5

Management Approaches

For patients with bruxism who report hearing-related symptoms:

1. Occlusal Splints: Protective devices to reduce the impact of grinding and clenching 1, 4

2. Stress Reduction Therapy: Since stress is a common factor in bruxism 1, 4

3. Physical Therapy: Specialized physiotherapy can improve tension, pain, and restricted movement 1

4. Audiologic Evaluation: For persistent hearing complaints, especially if hearing loss is suspected 2

5. Relaxation Exercises: Can improve bruxism symptoms 1

6. Botulinum Toxin: May reduce subjective complaints during its period of action 1

Important Considerations

Differential Diagnosis

When evaluating ear symptoms in patients with bruxism, consider other potential causes:

• Otitis externa or media 2
• Sensorineural hearing loss 5
• Other causes of referred otalgia (dental pathology, tonsillitis, etc.) 2

Monitoring and Follow-up

Regular follow-up is important to:

• Assess the effectiveness of bruxism management
• Monitor for changes in hearing symptoms
• Evaluate for progression of TMJ disorders

Conclusion

While bruxism has been associated with tinnitus and referred ear pain through its relationship with TMJ disorders, there is no strong evidence that it directly causes hearing loss. Management should focus on addressing the underlying bruxism and TMJ issues while appropriately evaluating any persistent hearing complaints.