Vertigo / Dizziness / Meniere's Disease and TMD

TMD, "The great impostor" can cause postural imbalance leading to a dizzying sensation of an individual's surroundings seeming to be moving. This is called "vertigo". What is the connection between poor jaw alignment and vertigo? Let us first look into the mechanism of balance.

Balance comes from the brain integrating information from three sources. 60% of the information comes from the vestibular system in the inner ears and the other 40% comes from visual information and the "proprioception" information from stretch receptors of muscles and joints.

Labyrinth





In each of our inner ears, there is a structure called 'labyrinth' that has three half-circles in three planes - superior, horizontal and posterior. These bony canals have fluid filled inner sacs where the sensing is accomplished by the movement of this fluid against hair like organs. Each of these canals are oriented in such a way that the fluid called 'endolymph' moves when we 1. Move the head up and down, 2. Turn the head side to side and 3. Tilt head side to side over the shoulders.

The information from each of these balance organs have to integrate with the information from what we see (vision) and what we sense in our muscles and joints (proprioception) to give us balance. So, when you get off from an amusement park ride that goes around and around fast, the endolymph within these semi-circular canals is still moving. It gives you the feeling of movement. But your visual cues and muscle spindles tell you that you are standing still. This discrepancy of messages into your brain is the reason for the dizziness and even nausea one might experience. If two out of three of these sources of information are fine, then we are OK. If you were ever on a looping roller coaster, looking out to get a visual reference and proprioceptive messages from your muscles as your body is pressed against the seat kept it thrilling. If not, one can get nauseous from such a ride.

The balance organ lies within the inner ear which, in turn, is housed in the petrous portion of the temporal bone. The glenoid fossa, which is the "socket" of the TMJ, is also part of the Temporal bone. If you put your little finger inside the ear canal and move the jaw by opening and closing, you can feel the movement of the mandible and realize how close it is to 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. This can move this temporal bone just enough to move the balance organ housed inside to be moved out of position as well.

Imagine a set of super sensitive spirit levels each with three spirit vials. The information from both of these levels has to match what the proprioception and vision is telling the brain. The brain has to be alert and not be affected by alcohol or other factors to process all this to give us balance. You can see why if one of these balance organs is knocked out of alignment even slightly, then this discrepancy leads to dizziness (vertigo).

Normalizing the jaw alignment often leads to a correction of this misalignment of the balance organs. This would be a solution to the problem instead of just masking the symptoms of vertigo with medications such as Antivert (Meclizine).

Meniere's disease is an abnormality of the inner ear causing a host of symptoms, including vertigo or severe dizziness, tinnitus or a roaring sound in the ears, fluctuating hearing loss, and the sensation of pressure or pain in the affected ear. The disorder usually affects only one ear and is a common cause of hearing loss. It is named after French physician Prosper Meniere who first described the syndrome in 1861.

Physicians believe that there is no cure for Meniere's disease. Symptoms are controlled with diet changes, stress reduction and diuretic medications. The focus is on reducing the increased pressure in the endolymph.

But why does the pressure increase? One reason is the buildup of pressure in the middle ear since there is an oval window between the inner and middle ear. Why would the pressure buildup in the middle ear? The Eustachian tube (ET) functions to equalize pressure in the middle ear and outside. Malfunction of the ET would lead to pressure buildup. As discussed under "ear symptoms", TMD can cause malfunction of ET.

The other treatments are to 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) or the more popular treatment of using medications that are ototoxic to destroy the nerve chemically.

What is striking is that every one of the symptoms of Meniere's disease are commonly found with TMD: Tinnitus, pain or pressure in the ears and dizziness. The neurologic explanations for these symptoms being caused by TMD is given here earlier. Yet when all three of them occur together, then the label from 1861 is given to the condition with no hope of a cure that returns the patient to normal health. There have been several cases of Meniere's that have been completely resolved through neuromuscular 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.


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