TMD Treatment for Vertigo/Meniere's Disease

Have you ever had the sensation of feeling like the room is spinning, tilting, or swaying?

Have you been to the doctor because of ear aches and dizziness only to be told that you don't have an ear infection but are put on antibiotics anyway?

Have you been told you have Meniere's Disease and that there is no cure for it so you have to take medications to control it?

These could just be symptoms of TMD!

TMD treatment is something we handle frequently at Cobb Center for Advanced Dentistry. Our patients have seen amazing results!

How Ears Work

Our brain determines balance from three sources: 60% of the information comes from the vestibular portion of the inner ears and the other 40% comes from visual information from our eyes and the "proprioception" information from stretch receptors of muscles and joints. That's why if you stand up and close your eyes you feel like you are moving.

In each of our inner ears, there is a structure called the semicircular canal that are three half-circles in three planes (superior, horizontal, and posterior) housed in the Temporal bone. These bony canals have fluid-filled inner sacs where the sensing is accomplished by the movement of this fluid against hair-like organs. The inner ear pressure is also regulated with the outside pressure through the oval window, middle ear, and the Eustachian tube which is a tube that connects the middle ear to the naso-pharyx. This is why when we go up in an airplane our ears feel blocked until we swallow, causing the pressures to balance out. The Eustachian tube also serves to drain away accumulated secretions, infection, and/or debris from the middle ear. The Eustachian tube opens upon swallowing or yawning by contraction of the Tensor Veli Palatini which is the muscle that also causes the roof of the mouth to close when we swallow so we don't get food or liquid up our nose.

 The "socket" of the TMJ, is part of the Temporal bone which also houses the balance organ of the inner ear. When the mandible is poorly aligned to the upper jaw, which is part of the skull, then there are excessive pressures in the joint that is transmitted to the socket and therefore to the bone. This can move this temporal bone just enough to move the balance organ out of position as well.

Vertigo/Meniere's Disease

Vertigo/Meniere's disease is named after French physician Prosper Meniere who first described the syndrome in 1861. According to the medical definition, it is a problem of the inner ear thought to be caused by the buildup of fluid and changing pressure in the inner ear, which can cause episodes of vertigo as well as ringing in the ears and hearing loss in one or both ears.

Physicians believe that there is no cure for Meniere's disease. Symptoms are controlled with diet changes, stress reduction, and diuretic medications (water pills) to reduce the pressure within the ear. The focus is on reducing the increased pressure in the inner ear.

But why does the pressure increase?

One reason is the buildup of pressure in the middle ear and therefore the inner ear as well as through the oval window between the inner and middle ear. A malfunction of the Eustachian tube would lead to pressure buildup. This can be due to inflammation or infection, or a muscle spasm of the muscle that controls the opening of the Eustachain Tube, the Tensor Veli Palatini. The nerve that controls the contraction of this muscle is called the Medial Pterygoid nerve which is part of the Mandibular nerve which controls the muscles that determine the way we bite. If the Medial Pterygoid muscle is in spasm (as in TMD) then the Tensor Veli Palatini muscle would also spasm resulting in a blockage of the Eustachian tube. The resulting effect, along with the increased pressure on the temporal bone, could lead to vertigo and other symptoms of TMD. Thankfully, Dr. Patel is highly experienced in past and current TMD treatment options.

 Treatments for Vertigo/Meniere's Disease:

  • Eliminate the balance organ. This is done with surgical removal of a balance organ (along with hearing), cutting off the nerve to the balance organ (with surgical risks).
  • Medications that are ototoxic to destroy the nerve chemically.
  • Medications that relieve symptoms such as nausea and motion sickness, steroids to reduce swelling, or a diuretic (water pill) to reduce the pressure.

These treatments all serve to control or mask the symptoms of the disease, however, they don't treat the underlying cause of the problem.

There have been several cases of Meniere's that have been completely resolved through neuromuscular TMD treatment to align the jaw properly. This led to the relief of stress on the socket of the TM Joint which in turn allowed the balance organs, which are extremely close to the socket, to go back to normal as well. By neuromuscular aligning of the jaw, the muscles are placed into their relaxed and resting position thereby preventing muscle spasms and the pressure buildup in the ear.