Stand on any train platform or wander any high street, and you will see people listening to something on their phones. The widened accessibility to smartphones, earphones and apps has meant that many are frequently listening to music, podcasts, radio programmes, or even learning a new language on the go. Listening has never felt so important in our daily lives, but it also feels like it’s taken for granted.
In the UK, hearing loss is a growing problem. Eighteen millionadults are either deaf, losing their hearing or have tinnitus – that equates to one in three adults. This has a colossal monetary impact: the UK economy loses an estimated £25bn a year in unemployment and lost productivity because of hearing loss. For dental practitioners, hearing loss may not be a priority when treating patients. However, the association between temporomandibular joint disorder (TMD) and hearing loss demands a greater awareness, allowing practitioners to better help at-risk patients.
A strange symptom
Temporomandibular joint disorder symptoms usually focus on masticatory muscle pain, restrictions in opening the oral cavity and clicking noises in the temporomandibular joint (TMJ). Whilst these are more recognisable signs and symptoms for patients to be aware of, it is the less obvious connections like headaches and hearing loss that must be highlighted too, giving practitioners and patients a greater understanding of the condition and also the body as an interconnected whole.
Aural symptoms such as tinnitus, otalgia, dizziness or vertigo, hyperacousia or hypoacousia can be associated with TMD, with their incidence reaching 85 per cent among TMD patients. As such, research has found that delivering TMD treatments to patients with aural fullness reduces their symptoms, with 90.2 per cent of affected patients having significant improvements to their aural fullness, emphasising that TMD was a major factor. One explanation is that patients with clenching habits may have dysfunctional masticatory and tensor tympani muscles, leading to aural fullness and hearing problems. However, it is uncertain what the actual cause of the connection between TMD and hearing loss is because the aetiology of hearing loss is often hard to define.
Too close for comfort
The TMJ is a synovial joint that allows for hinge and sliding movements. Its proximity to the ear means that when the jaw is moving, be that for speaking, mastication or bruxism, the disposition of the joint disc increases pressure in the Eustachian tube. This connects the middle ear, used for transmitting soundwaves, with the nasal-sinus cavity. The Eustachian tube drains fluid away from the middle ear to balance the pressure – this is felt when the ears pop whilst changing altitude, for instance. When the equilibrium of pressure is altered by the disposition of the joint disc, the Eustachian tube cannot properly drain the fluid, blocking the middle ear and inhibiting hearing.
Similarly, the close location between the TMJ and the ear can also explain the connection through an immunobiological lens: TMD can cause facial swelling due to arthritis or, in cases of trauma, retrodiscitis. The inflammation and swelling easily affect nearby tissues and structures, including the ear.
Problem and solution
Left unchecked or untreated, hearing loss can lead to other problems, such as social isolation, depression, reduced quality of life, and loss of independence and mobility. An inability to hear will also push the brain to work harder to process sounds, affecting memory. The relationship between dementia and hearing loss is noticeable: patients with untreated mild hearing loss are twice as likely to develop dementia, whereas those with severe hearing loss are up to five times more likely to develop dementia. Dental practitioners can help avoid these outcomes by encouraging a greater awareness of TMD and its impact on the whole body, as well as helping TMD patients receive the treatment they need as early as possible.
For an excellent home therapy treatment option, the OraStretch Press Jaw Rehab System from Total TMJ is a simple yet effective way of restoring strength and function to the jaw. User-operated, a squeeze of the handles opens the patient’s jaw, stretching the orofacial tissues and mobilising the TMJ. With a range of rehabilitation protocols for practitioners to recommend, the system can help a variety of TMD patients on the road to recovery, reclaiming a better quality of life.
For many, listening is an invaluable part of everyday life. Without it, many of life’s joys can pass by unheard. To give patients a better chance at reducing the risk of hearing loss, utilise an interdisciplinary approach when treating TMD patients and combat the condition together.
References available on request.
For more information email info@totaltmj.co.uk