TMJ Mobilization for Vertigo: Tinnitus Research Insights

A randomized controlled trial published in *Scientific Reports* has found that adding temporomandibular joint (TMJ) therapy to standard vertigo treatment can significantly improve balance and jaw function. The study, led by Dilara Güler and colleagues, provides new evidence for the connection between jaw health and the vestibular system.

## The Study: Testing a Jaw-Vestibular Link

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, triggered by tiny crystals dislodged in the inner ear. The standard treatment, canalith repositioning maneuvers (like the Epley maneuver), is highly effective at moving these crystals. However, some patients continue to experience issues with dizziness perception and postural stability.

The research team from Bahçeşehir University and Alaaddin Keykubat University in Turkey theorized that musculoskeletal factors in the head and neck could play a role. The temporomandibular joint (TMJ) and its surrounding muscles have anatomical and neurological connections to the vestibular system. Previous clinical observations have linked TMJ dysfunction to dizziness, imbalance, and tinnitus, but high-quality intervention studies were lacking.

To test this, they designed a parallel-group randomized controlled trial. They enrolled 42 adults diagnosed with BPPV and randomly assigned them to one of two groups. The control group received only the standard canalith repositioning treatment. The intervention group received the same standard treatment plus a weekly session of TMJ and soft tissue mobilization for four weeks. This mobilization involved manual techniques performed by a physiotherapist to improve joint mobility and reduce muscle tension around the jaw. One participant dropped out, leaving 41 to complete the study.

## Findings: Improved Balance and Jaw Function, But Not Dizziness

The primary measure was the Dizziness Disability Inventory (DDI), which assesses how much dizziness impacts daily life. Both groups improved substantially from their baseline scores, with no significant difference between them. Standard repositioning maneuvers worked well for resolving the acute vertigo attacks.

The secondary outcomes, however, told a different story. The researchers measured temporomandibular function using standard clinical tests. Here, the intervention group showed a “significantly greater improvement” compared to the control group (p < 0.001). The manual therapy directly improved jaw mobility and comfort. The most striking finding was in postural balance. Participants were asked to perform a tandem stance (heel-to-toe) with their eyes open. The intervention group improved their balance time in this position by an average of 3.90 seconds more than the control group (95% CI 1.70-6.10; p = 0.001). This suggests that while the core vertigo was cured, underlying balance deficits linked to jaw dysfunction were better addressed with the combined therapy. ## What This Means for Patients and Clinicians The study, available with its full data via PMID: 42168393, offers practical insights for managing BPPV and related conditions.

First, it reinforces that BPPV is often more than a simple inner ear mechanical problem. For individuals whose dizziness or imbalance feels disproportionate to the BPPV diagnosis, or for those with co-existing jaw pain and tinnitus, an assessment of the TMJ by a qualified professional may be warranted. The connection between auditory, vestibular, and musculoskeletal systems is a recurring theme in hearing health research, similar to findings in studies on cochleovestibular screening in systemic diseases.

Second, it points to a specific, non-invasive adjunct therapy. For patients who continue to have balance issues after successful repositioning, a short course of physiotherapy focused on the TMJ and cervical region could be beneficial. This approach aligns with a broader shift in neuro-auditory medicine towards multimodal treatments that address overlapping neural networks, a concept also explored in tinnitus treatments inspired by neurodegenerative research.

Finally, the findings have implications beyond BPPV. They provide mechanistic support for the reported links between TMJ disorders and symptoms like dizziness and sound sensitivity. Understanding these shared pathways is critical for conditions like hyperacusis and misophonia, where sensory processing and limbic system integration are key. While the treatment is different, the principle of targeting connected neural circuits is similar to strategies using noninvasive brain stimulation and CBT for misophonia.

## A Step Toward Integrated Care

Güler and colleagues’ work demonstrates that resolving the acute vertigo of BPPV and improving the functional balance deficits that may accompany it could be two separate therapeutic goals. The standard maneuver addresses the first. Their trial suggests that manual therapy for the TMJ can effectively address the second.

This research moves the conversation from correlation to intervention. It provides a clear, evidence-based protocol that physiotherapists and otolaryngologists can consider for patients presenting with a complex of vestibular and jaw-related symptoms. For the informed patient, it offers a new avenue to explore if balance problems persist after standard vertigo care, highlighting the importance of a holistic view of head, neck, and hearing health.