111 N. Wabash Ave Suite 2011 • Chicago, IL 60602
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
—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.
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 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
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.