November 4, 2025 Article by Donald R Tanenbaum, DDS, MPH

Case Study: Matt’s Experience

This past June, I evaluated Matt, a 37-year-old male referred by an otolaryngologist for fullness and ringing in his right ear. His symptoms had developed suddenly several months prior. Despite a comprehensive evaluation, including hearing tests and MRI imaging, no intracranial or ear pathology was found.

During his ENT examination, a right TMJ click was noted, and Matt shared that he had long been a nighttime tooth grinder. With medications offering little relief, his ENT referred him for evaluation of a possible temporomandibular disorder.

Tinnitus is certainly not the most common symptom reported by patients seeking consultation in our offices. When it is present, however, it can be life-disrupting, anxiety-producing, and clinically challenging, particularly when no clear ear pathology is identified. Before discussing Matt’s case further, it is important to review what tinnitus is and how, in certain situations, it may relate to the TMJ and tinnitus connection seen in select patients.

What Is Tinnitus?

Tinnitus is the perception of sound in the absence of an external acoustic stimulus. Patients often describe it as ringing, buzzing, hissing, or humming in the ears. Importantly, tinnitus is not always an ear problem; it can represent a neurological perception that may or may not have an identifiable physical cause.

In many cases, despite a thorough medical evaluation, no specific etiology is identified. This lack of a detectable cause does not lessen the patient’s experience but instead underscores the complexity of tinnitus as a symptom rather than a disease.

Common identifiable causes include:

• Noise-induced hearing loss
• Age-related hearing changes (presbycusis)
• Ototoxic medications
• Meniere’s disease
• Acoustic neuroma
• Cardiovascular conditions (particularly pulsatile tinnitus)

When these medical entities are present, management typically involves collaboration among otolaryngologists, audiologists, and, when necessary, neurosurgeons.

Is there a TMJ and Tinnitus Connection?

Many patients and healthcare providers ask if temporomandibular disorders of muscle or joint origin could contribute to tinnitus symptoms. Based on clinical experience and anatomical evidence, my answer is: it is possible, but uncommon.

The Clinical Reality

At New York TMJ and Orofacial Pain, we routinely evaluate and treat patients with temporomandibular disorders (TMDs). While many report ear pain, pressure, or fullness, tinnitus itself is notably absent in most cases and is rarely the primary complaint.

Anatomical and Neurological Pathways

Although rare, there are distinct pathways through which a temporomandibular disorder could theoretically influence auditory perception.

1. The Discomalleolar (Pinto’s) Ligament

Figure 1. The Discomalleolar (Pinto’s) Ligament connects the malleus to the TMJ disc.

First described by Pinto in 1962, this ligament connects the malleus to the TMJ disc and retrodiscal tissue via the petrotympanic fissure.

Anatomical and microscopic studies have shown that changes in tension within this ligament, such as from a TMJ disc displacement, could be transmitted to middle ear structures, potentially contributing to auditory symptoms, including tinnitus.

2. The Tensor Veli Palatini Muscle

Figure 2. The Tensor Veli Palatini Muscle and its relationship to Eustachian tube function.

This muscle regulates the opening of the Eustachian tube, ensuring middle ear ventilation and pressure balance. It is innervated by the mandibular branch of the trigeminal nerve (V3), the same nerve that supplies the jaw muscles.

Theoretically, persistent tension or hyperactivity in the jaw muscles could stimulate this nerve branch and lead to Eustachian tube dysfunction, altered middle ear pressure, fullness, or tinnitus.

In addition, the tensor veli palatini works in concert with the tensor tympani muscle, and both are trigeminally innervated. The tensor tympani helps dampen loud sounds and self-generated noises from chewing and swallowing. If it contracts excessively, symptoms such as ear fullness, pressure, and tinnitus can result as well.

3. The Muscles of Mastication

Figure 3. The primary muscles of mastication, including the masseter, temporalis, and pterygoids.

Compromise in the masseter, temporalis, and pterygoid muscles can cause pain, headaches, and restricted jaw function, but these muscles are not typically implicated in the generation of tinnitus.

The Functional Test: A Diagnostic Key

From my perspective, a temporomandibular problem should only be considered an etiologic factor in tinnitus when the tinnitus changes in pitch, intensity, or duration with jaw or postural movement. If a patient can modulate their tinnitus through chewing, opening or closing the jaw, or clenching, a relationship should be considered. This is known as somatosensory tinnitus, a subtype relevant to the broader TMJ and tinnitus connection. If no such modulation occurs, it is highly unlikely that the temporomandibular complex has anything to do with tinnitus.

Similarly, head postures and movements can influence tinnitus. If this is discerned during evaluation, then the cervical muscles may be involved as an etiologic factor.

The Role of Muscle Therapy

When tinnitus is influenced by a temporomandibular disorder or head postures and movements, treatment directed at reducing muscle hyperactivity can be effective.

Therapeutic approaches include:

• Postural correction and avoidance of muscle-fatiguing head positions
• Reduction of daytime clenching, tooth contact, or jaw-bracing behaviors
• Targeted stretching and muscle exercises
• Physical therapy, chiropractic, or osteopathic manipulation
• Trigger point injections, massage therapy, or acupuncture
• BOTOX® injections for persistent muscle hyperactivity

The mechanism of improvement may involve modulation within trigeminal-auditory brainstem pathways, which can alter tinnitus perception. Even partial improvement can reduce patient distress and improve quality of life.

Back to Matt

Further discussion with Matt revealed that four months before the onset of his tinnitus, his daily work routine had changed. As a delivery manager for a specialty food corporation, he spent hours in traffic each day, leading to neck fatigue and frequent stress-induced tooth contact, a behavior known as awake bruxism.

His jaw and neck muscles became sore and tense, and he noticed that when he opened his mouth widely, the tinnitus eased, and when he clenched his teeth, the pitch changed. Matt truly had somatosensory tinnitus.

Treatment focused on relaxation of the jaw and neck muscles, postural correction, and habit modification. Neck exercises between deliveries, along with weekly physical therapy and trigger point injections, helped restore normal muscle tone. Within two months, his tinnitus intensity had significantly improved, with occasional flare-ups during high stress.

Most importantly, Matt understood the cause and had a plan for control and long-term relief.

Conclusion

For most individuals, tinnitus is unrelated to a temporomandibular problem. However, for those with somatosensory tinnitus linked to a temporomandibular disorder, addressing jaw and neck muscle imbalance can lead to meaningful improvement.

While the connection between TMJ and tinnitus is not common, identifying somatosensory modulation helps guide accurate diagnosis and effective management across disciplines.