Masseter Muscle Tinnitus: Botox Treatment Review

Masseter muscle hyperactivity has a plausible anatomical and neurophysiological link to somatosensory tinnitus. A scoping review analyzing 284 records synthesized this rationale and evaluated the potential of botulinum neurotoxin type A (BoNT/A) as a treatment, finding only four studies that directly met its eligibility criteria. Researchers Jacopo Gardellin, Marta D’Angelo, and Lorenzo Spadotto concluded that while the mechanistic link is strong, direct clinical evidence for BoNT/A in treating tinnitus remains insufficient and its use should be considered experimental.

A Scoping Review of the Muscle-Tinnitus Connection

The review team conducted a systematic search of MEDLINE and EMBASE databases, following PRISMA-ScR guidelines for scoping reviews. Their aim was to map the existing evidence linking the masseter muscle to tinnitus and to gather all available literature on BoNT/A as a potential intervention. They used three complementary search strategies, with the final search completed on May 31, 2026. From an initial pool of 284 records, the screening process was strict.

Only four studies met the full eligibility criteria. Three were identified from the search on BoNT/A and tinnitus. One came from the search on tinnitus and masticatory dysfunction. Through a manual search of references, the authors also identified a relevant 2024 protocol by Ranoux and Levine. This described cases of tinnitus improvement after BoNT/A injections in the periauricular area and splenius capitis neck muscle, with a suggestion that masseter or temporalis injections could be alternative sites.

Limited Direct Evidence, But a Strong Mechanistic Rationale

The core finding is the stark contrast between a well-supported biological hypothesis and a lack of clinical trials. The anatomical rationale is clear. The trigeminal nerve, which innervates the masseter and other jaw muscles, has connections to auditory brainstem nuclei like the cochlear nucleus and superior olivary complex. Hyperactivity in the jaw muscles could generate abnormal somatosensory signals that these central auditory pathways misinterpret as sound, thereby modulating or triggering tinnitus perception.

BoNT/A is a logical candidate based on this model. It is a well-established treatment for conditions involving muscle hyperactivity, such as bruxism and temporomandibular disorders (TMD). By chemically relaxing the masseter, BoNT/A could theoretically reduce the aberrant somatosensory input traveling to the auditory system. However, the review confirms this remains largely theoretical for tinnitus application. The authors state the evidence is currently “insufficient” to validate it as a treatment.

An Experimental, Multidisciplinary Approach

The practical implications of this review are cautious and specific. The researchers explicitly warn that BoNT/A use for tinnitus should be considered “experimental or hypothesis-based.” It is not a first-line or standalone treatment. They stress that any consideration of this approach must occur within a multidisciplinary framework. This would ideally involve collaboration between otolaryngologists, neurologists, dentists specializing in TMD, and audiologists.

Patient selection is key. The treatment might only be relevant for a subset of individuals with somatic tinnitus—those whose tinnitus changes with jaw clenching, neck movements, or who have comorbid TMD or bruxism. Before any injection, a comprehensive assessment is necessary to rule out other causes of tinnitus and to document baseline severity with standardized questionnaires.

This careful, evidence-based approach aligns with the broader understanding of how complex sensory and stress pathways interact in auditory perception disorders.

The Path Forward: Standardized Trials

The authors’ primary recommendation is for prospective, controlled clinical trials. Future studies need to standardize injection sites (e.g., masseter vs. temporalis vs. periauricular), dosages, and outcome measures to produce comparable data. They also highlight the need to better define the patient phenotype most likely to benefit—perhaps those with clear somatic modulation of their tinnitus.

Until such data is available, individuals seeking relief for tinnitus related to jaw tension should pursue established management paths. These can include sound therapy, cognitive behavioral therapy (CBT), and proper management of TMD through dental or physical therapy specialists. Some may find benefit from wearable sound therapy devices, while others might explore dietary approaches that can influence neuroinflammation and vascular health.

The review by Gardellin and colleagues provides a necessary reality check. It consolidates a compelling scientific rationale for the somatosensory tinnitus subtype while clearly demarcating the boundary between mechanistic theory and proven treatment. BoNT/A may one day become a tool in the tinnitus management toolkit, but it requires rigorous validation first.

Source: Gardellin, J.; D’Angelo, M.; Spadotto, L. Anatomical and Neurophysiological Rationale for Botulinum Neurotoxin Type A in Somatosensory Tinnitus Secondary to Masseter Hyperactivity: A Scoping Review. Toxins 2026, 18, 310.