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Middle-Ear Symptoms and Vertigo

I began to think I had allergies to everything.
—a 28-year-old writer

The headaches aren't as frightening as the dizziness.
—a 30-year-old artist

It's often difficult to understand how such symptoms as ringing or buzzing in the ears, earaches, altered hearing, or even vertigo (dizziness) can be connected to a muscle-spasm problem originating with the teeth. The connection is a small muscle called the tensor veli palatini.

A SMALL MUSCLE

The Tensor veli palatini has a number of functions, including involvement in the closing of the eustachian tubes. This tube connects the throat to the middle ear and keeps the air pressure in the middle ear the same as that of the outside atmosphere. Normally this happens without our knowing it, but in certain cases, such as flying in an airplane, this change is noticeable.

The Tensor veli palatini is supplied with nerve signals from a branch of the same nerve that supplies the external pterygoid muscle. When the Lateral pterygoids are in spasm, the Tensor veli palatini also can go into spasm because the nerve stimuli go to both muscles.

When this tiny muscle goes into spasm, it closes off the eustachian tube and produces symptoms that mimic middle-ear problems. A patient may see a physician about changes in hearing, earaches, buzzing, ringing, or dizziness. The patient may have no signs of infection or a cold, and when the problem is not resolved in a short time, allergies are often suspected.

ALLERGIES SUSPECTED

Mary Washington was a patient who'd been told numerous times that she had allergies because of the intermittent ear symptoms. It was assumed that milk was a culprit, because an allergy to milk will produce middle-ear symptoms in some patients. However, avoiding dairy products didn't make Ms. Washington's problem disappear.

Ms. Washington experienced dizziness along with the ringing and stuffiness in her ears. Dizziness has the same cause—the closing of the eustachian tube by the tensor veli palatini. Other patients have reported being put on antibiotics because of these middle-ear symptoms. The symptoms mimic infection and colds, and even when an infection isn't apparent, the symptoms are often treated with antibiotics. This group of symptoms is mysterious because the cause is almost never suspected to be TMJ.

This group of symptoms may exist with other TMJ symptoms or alone. A patient may have just buzzing or ringing and no dizziness or pain around the ear. Again, like the other symptoms, there is no way to predict which are going to occur and which will never appear.

Patients with middle-ear symptoms should realize that their problems could be caused by TMJ alone or along with other conditions such as allergy. Anyone experiencing these symptoms should look for other causes first. Ms. Washington had been on antibiotics before the allergies were suspected. It was when allergies were subsequently ruled out that TMJ could be considered. If a patient seeks TMJ evaluation and has a positive finding, it is likely that the middle-ear symptoms will be resolved during treatment. If a patient has TMJ and allergies, TMJ treatment will eliminate the component caused by that condition. The allergies or other ear problems can then be treated more effectively.

It turned out that Ms. Washington did in fact have allergies to a number of substances. However, until the TMJ was treated, there was no effective way to correlate her exposure to certain foods or environmental substances with her symptoms. She would avoid a particular food and be fine for a period of time. Then the middle-ear symptoms would return and confuse the determination of what she was allergic to. At one point she was experiencing these symptoms every day for weeks. She concluded that she was allergic to practically everything she was eating, wearing, and breathing.

DIZZINESS

Dizziness is sometimes blamed on stress. When no other cause can be found for various symptoms, stress is often blamed. One patient, Elizabeth Andersen, experienced dizziness many times a day. It came and went with no apparent cause. Ms. Andersen went through a series of tests, including an electroencephalogram (EEG), a CAT scan, and blood work, in order to determine the cause of these dizzy spells. Ultimately, stress was blamed.

Ms. Andersen tried to find ways to manage stress more effectively, but her dizzy spells continued to come and go mysteriously. More symptoms of TMJ began to appear— some neck stiffness, pain around her ears, and finally headaches. She sought help for the headaches without realizing that the dizziness could have the same ultimate cause. She was referred by a chiropractor who had become knowledgeable about TMJ. She mentioned the dizziness as separate from the other symptoms, but shortly after beginning treatment, that symptom began to disappear.

REFERRED PAIN

Pain in or around the ears can be referred pain from other places on the head or face. When the source of the pain is discovered to be TMJ and the condition is treated, the pain will disappear. But ear pain should never be ignored, and medical causes should be investigated.

When a person experiences dizziness, buzzing or ringing in the ears, or ear pain or stuffiness, and a diagnosis is made, a treatment plan should result. If the symptoms go away and don't recur immediately, then it is likely these symptoms are not connected to TMJ. But, as with other symptoms, many people are told that no cause can be found. They often are left with the impression that they must learn to live with the problems. People who have had this group of symptoms repeatedly investigated, receiving only tentative or descriptive diagnoses, should consider having an evaluation for TMJ.