Can temporomandibular joint pain cause tinnitus in an adult without known severe neurologic disease?

Can Jaw Pain Be Related to Tinnitus?

Yes, temporomandibular joint (TMJ) disorders are a recognized cause of tinnitus, and patients with TMJ dysfunction have an increased incidence of tinnitus, though the exact mechanism remains unclear. 1, 2

The Association Between TMJ Disorders and Tinnitus

The American College of Radiology explicitly states that vertigo and tinnitus are not uncommon in patients with temporomandibular joint problems, and there appears to be a definite association between these conditions. 1 This relationship is clinically significant:

• Patients with TMJ derangement demonstrate increased incidence of tinnitus compared to the general population, suggesting a causal role of TMJ pathology in tinnitus generation and maintenance. 2, 3

• TMJ-related tinnitus represents a distinct clinical entity with specific characteristics that differentiate it from other tinnitus causes. 3

Distinguishing Features of TMJ-Related Tinnitus

Patients with TMJ disorders and tinnitus have markedly different profiles compared to tinnitus patients without TMJ involvement:

• Better hearing function (significantly better audiometric results). 3
• Younger age at presentation and at tinnitus onset. 3
• Female predominance (more frequently female). 3
• Lower subjectively perceived tinnitus loudness. 3
• Ability to modulate tinnitus with jaw or neck movements (somatosensory tinnitus) - this is a key diagnostic feature. 3, 4

Clinical Presentation to Look For

The American Academy of Otolaryngology-Head and Neck Surgery identifies specific findings that suggest TMJ syndrome as the cause of tinnitus: 2

• Sharp pain in the TMJ area that worsens with chewing and swallowing. 2
• Pain upon opening the mouth. 2
• Tenderness on palpation to the back of jaw and ear. 2
• Pain radiating down behind the ear (referred otalgia). 2
• History of gum chewing, bruxism, or recent dental procedures with malocclusion. 2
• Tenderness over the affected TMJ with possible crepitus on examination. 2

Critical Diagnostic Consideration

Before attributing tinnitus to TMJ disorder, you must rule out serious pathology. In older patients with tobacco/alcohol use history or human papillomavirus risk factors, a complete head and neck examination is mandatory to exclude upper aerodigestive tract cancer presenting as referred otalgia. 2

Evidence-Based Treatment Algorithm

First-line treatment (strongly recommended): 2

1. Cognitive behavioral therapy with biofeedback/relaxation therapy - provides the greatest pain relief with moderate certainty evidence. 5, 2
2. Therapist-assisted jaw mobilization - substantial pain reduction with moderate certainty evidence. 5, 2
3. Manual trigger point therapy - significant pain relief with moderate certainty evidence. 5, 2
4. Supervised postural exercise - important pain relief with moderate certainty evidence. 5, 2
5. Supervised jaw exercise and stretching - important pain relief with moderate certainty evidence. 5, 2
6. Usual care including home exercises, stretching, reassurance, and education. 5, 2

Second-line options (conditionally recommended): 5

• CBT combined with NSAIDs. 5
• Acupuncture. 5

Interventions to AVOID: 5, 2

• Occlusal splints alone. 5, 2
• Gabapentin. 5, 2
• Benzodiazepines. 5, 2
• NSAIDs with opioids. 5, 2
• Acetaminophen with or without muscle relaxants. 5
• Corticosteroid injections. 5

Clinical Outcomes and Prognosis

Conservative, non-invasive treatments demonstrate clinically meaningful success, with the most effective interventions providing pain relief approximately 1.5-2 times the minimally important difference compared to placebo, based on moderate to high certainty evidence from 153 trials involving 8,713 patients. 5

Important prognostic factors: 5, 2

• Depression and catastrophizing reduce treatment success. 5, 2
• Improved self-efficacy through education leads to fewer symptoms. 5, 2
• Up to 30% of acute TMD cases may progress to chronic pain, highlighting the importance of early intervention. 5, 2

Follow-Up Strategy

Reassess patients after 4-6 weeks of conservative management. If symptoms persist despite appropriate first-line treatment, refer to specialists (oral and maxillofacial surgery, TMJ specialist, or multidisciplinary pain team). 5, 2

Imaging Considerations

If TMJ pathology is suspected and clinical examination is insufficient, dedicated MRI of the temporomandibular joint may be considered. 1 However, disc displacement is the most common MRI finding in both TMJ patients with and without tinnitus, and no specific MRI findings definitively correlate with tinnitus presence. 6

Common Pitfall

Classical risk factors for tinnitus (older age, male gender, hearing loss) are LESS relevant in tinnitus patients with TMJ disorder, suggesting that TMJ pathology plays a primary causal role rather than being an incidental finding. 3 This means you should actively consider TMJ dysfunction even in younger patients with normal hearing who present with tinnitus, especially if they can modulate their tinnitus with jaw movements. 3