Can Temporomandibular Joint (TMJ) disorders cause hearing loss or deafness?

Can TMJ Disorders Cause Deafness?

TMJ disorders do not cause true deafness (permanent sensorineural hearing loss), but they commonly cause subjective hearing complaints and minor conductive changes in the middle ear that patients may describe as "hearing loss." 1, 2

Understanding the Hearing Complaints in TMJ Disorders

The relationship between TMJ disorders and auditory symptoms is well-established but represents functional middle ear changes rather than actual hearing loss:

• 87% of TMJ patients report otologic symptoms, with subjective hearing complaints being common, but these do not represent true deafness 3
• Objective audiometry (pure-tone testing) typically shows normal hearing in TMJ patients, despite their subjective complaints of decreased hearing acuity 1
• Multiple frequency tympanometry reveals increased middle ear stiffness in the ear ipsilateral to the TMJ disorder, representing minor alterations in conductive properties that conventional 226-Hz tympanometry cannot detect 1

What Patients Actually Experience

TMJ patients describe several ear-related symptoms that may be misinterpreted as hearing loss:

• Ear fullness (39% prevalence) is the second most common otologic symptom after tinnitus, creating a sensation of blocked hearing 3
• Tinnitus (42% prevalence) is the most common otologic complaint and may interfere with hearing perception 4, 3
• Subjective hypoacusis (decreased hearing acuity) without objective audiometric confirmation occurs frequently 2
• Tensor tympani muscle dysfunction secondary to TMJ osteoarthritis and myofascial pain may explain the sensation of ear fullness and perceived hearing loss 2

Critical Diagnostic Distinction

The key clinical pitfall is failing to distinguish TMJ-related auditory symptoms from true hearing loss requiring otologic intervention:

• Normal otoscopic examination, normal tympanic membrane, and normal pure-tone audiometry effectively rule out primary ear pathology causing actual hearing loss 5, 2
• TMJ-related auditory symptoms are characterized by: pain worsening with jaw movement (chewing, speaking), TMJ tenderness on palpation, limited mandibular range of motion, and crepitation in the TMJ 6, 2
• True sensorineural hearing loss would show abnormal audiometry and would not correlate with jaw movement or TMJ palpation 7

When to Suspect Actual Hearing Loss vs. TMJ-Related Symptoms

Red flags indicating true hearing pathology rather than TMJ-related complaints:

• Progressive unilateral or bilateral hearing loss on audiometry suggests conditions like vestibular schwannoma, Ménière's disease, or otosclerosis rather than TMJ disorder 7
• Fluctuating hearing loss with vertigo episodes indicates Ménière's disease, not TMJ disorder 7
• Sudden profound hearing loss suggests labyrinthitis, vestibular neuritis, or vascular events, not TMJ pathology 7
• Hearing loss that does not correlate with jaw function should prompt otologic rather than TMJ-focused evaluation 7

Management Implications

Treatment of TMJ disorders can resolve the subjective hearing complaints:

• A 90% improvement in ear-related symptoms (including subjective hearing loss) was achieved with TMJ-directed treatment including physical therapy, stabilization splint, and trigger point injections in documented cases 2
• Conservative TMJ management (cognitive behavioral therapy with biofeedback, therapist-assisted mobilization, manual trigger point therapy, supervised jaw exercises) addresses the underlying TMJ pathology and associated auditory symptoms 6, 5
• Ventilation tubes and other otologic interventions do not provide lasting relief when the underlying cause is TMJ disorder rather than primary ear pathology 2

Clinical Algorithm for Evaluation

When a patient presents with "hearing loss" and TMJ symptoms:

1. Perform otoscopic examination to rule out external/middle ear pathology 5, 2
2. Obtain pure-tone audiometry to objectively document any true hearing loss 1, 2
3. Assess TMJ function: jaw opening (normal >40mm), palpation tenderness, crepitation, pain with chewing 6, 2
4. If audiometry is normal and TMJ signs are present, diagnose TMJ-related auditory symptoms rather than true hearing loss 1, 2
5. Initiate conservative TMJ management rather than pursuing otologic interventions 6, 5

Population Most Affected

TMJ-related auditory symptoms predominantly affect:

• Women (more than 2/3 of cases) in their fifth decade of life 4
• Patients aged 45 years or younger show more pronounced middle ear stiffness changes on multiple frequency tympanometry 1
• Patients with advanced TMJ pathology (higher Wilkes classification stages) demonstrate stronger correlation with otologic symptoms 4