Can TMJ cause tinnitus, dizziness, and an off-balance feeling?

Question

Hello doctor,

I have been experiencing bilateral tinnitus (ringing in both ears) along with a recurring feeling that my balance or equilibrium is off. Some days the symptoms are mild, while on other days the tinnitus becomes louder and the imbalance gradually returns or worsens.

I underwent an ENT evaluation, including:

VNG (videonystagmography): normal.
Hearing test or audiogram: normal.
I was also told there is no fluid behind my eardrums.

One physician (not an ENT) examined my ears and asked me to look right and left, which triggered a feeling of imbalance. Another physician previously mentioned that my right eardrum appeared protruding, although this was not confirmed later.

An ENT suggested the symptoms could be neurological rather than ear-related, but I continue to wonder if the inner ear is involved because the tinnitus and imbalance often worsen together.

Additional symptoms:

Ringing in both ears, fluctuating in intensity.
Intermittent dizziness or unsteadiness or off-balance sensation.
About a week ago, for the first time, my left ear felt heavy or full, though this gradually resolved.
When I open my mouth, the ringing temporarily becomes louder.
Moving my lower jaw sometimes causes a squeaking sound in the left ear.

Previously diagnosed with TMJ (temporomandibular joint disorder). Current medication is Meclizine, although I dislike the side effects and how it makes me feel.

My questions are:

Could TMJ dysfunction be contributing to both tinnitus and the off-balance sensation?
If ENT testing has been normal, what other causes should be considered (neurological, vestibular migraine, cervical issues, etc.)?
Would imaging (MRI or other scans) be reasonable given these persistent symptoms?
Are there additional tests that might help identify the cause?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

Based on everything you described, I can understand why you still feel this may be related to your ears, especially since the ringing and imbalance seem to fluctuate together. It is frustrating when symptoms are very real, but tests come back normal.

One thing that stands out is that the ringing gets louder when you open your mouth or move your jaw, combined with your history of TMJ disorder (temporomandibular joint disorder). TMJ means there is a problem with the jaw joint, which connects your lower jaw to your skull near the ears. Issues with this joint or the surrounding muscles can sometimes affect nearby nerves and structures around the ear.

Because of that, TMJ can occasionally contribute to symptoms such as:

Tinnitus is ringing, buzzing, or other noises in the ears without an outside source.
Ear pressure or fullness, feeling like the ear is heavy, blocked, or under pressure.
Dizziness or imbalance, feeling unsteady or “off balance,” even without true spinning vertigo.

The fact that your VNG (videonystagmography is a balance test that checks how the inner ear and brain work together to control balance) and hearing test were normal is reassuring. Normal results make a serious inner ear disorder less likely, although they do not completely rule out every possible cause.

Since your symptoms come and go and include balance concerns, it would be reasonable to discuss imaging, most commonly an MRI or magnetic resonance imaging (a scan that creates detailed pictures of the brain, nerves, and inner ear structures using magnets instead of radiation), with your doctor.

In situations like this, an MRI is often more helpful than a CT or computerized tomography scan. Imaging may be especially worth considering if symptoms are:

Becoming worse over time.
Happening mainly on one side.

Associated with neurological symptoms, such as:

Weakness or loss of strength in part of the body.
Numbness or reduced feeling or tingling.
Vision changes or blurred vision, double vision, etc.
Severe headaches or other new symptoms.

Your description, particularly the jaw-related changes in tinnitus and the squeaking sound with jaw movement, makes TMJ-related symptoms worth revisiting, but continuing the conversation with your doctor about whether further evaluation, including MRI, is appropriate would be reasonable.

I hope this helps.

Please revert in case of further queries.

Thank you.