Orthotown January/February 2021 - 22

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to continuing aligner therapy or rescanning. I'm too impatient and will simply add build-ups to
re-establish proper posterior contact.
This is also an amazing treatment option for female patients who begin having TMJ " clicking "
during aligner therapy. I am happy to talk further about this issue with you. ■
11/6/2020

below
Member Since: 08/07/09
Post: 5 of 7

Seems like Dr. H is saying that the cause of the tinnitus is premature occlusion on the 7s and
Dr. M is saying that the cause is lack of occlusion on the posterior teeth and suggesting build-ups
on the 7s to cause a premature occlusion on the 7s. I am confused.
Just so that we do not get tunnel vision on this, here is part of an article from Byung In Han,
MD, Ho Won Lee, MD, Tae You Kim, MD, Jun Seong Lim, MD, and Kyoung Sik Shin, MD.
[Editor's note: Visit this message board online to view the links.]
Tinnitus does not represent a disease itself but instead is a symptom of a variety of underlying
diseases. Otologic causes include noise-induced hearing loss, presbycusis, otosclerosis, otitis, impacted
cerumen, sudden deafness, Meniere's disease, and other causes of hearing loss. Neurologic causes
include head injury, whiplash, multiple sclerosis, vestibular schwannoma (commonly called an
acoustic neuroma), and other cerebellopontine-angle tumors. Infectious causes include otitis media
and sequelae of Lyme disease, meningitis, syphilis, and other infectious or inflammatory processes that
affect hearing. Tinnitus is also a side effect of some oral medications, such as salicylates, nonsteroidal
anti-inflammatory drugs, aminoglycoside antibiotics, loop diuretics, and chemotherapy agents (e.g.,
platins and vincristine). Temporomandibular-joint dysfunction and other dental disorders can also
cause tinnitus. However, in many cases no underlying physical cause is identifiable. For many years,
hearing loss has been understood to be the most common cause of tinnitus, and population-based data
indicate that excessive noise exposure represents the second most common cause of tinnitus. However,
about 40% of patients cannot identify any cause associated with tinnitus onset.
My understanding is that the vestibulocochlear nerve does not really run in an area where the
actual nerve can be damaged by the TMJ. It does seem, however, that if the TMJ disc is displaced
medially and posteriorly due to the aligners causing joint separation then that medial-posterior
displacement could cause pressure/inflammation and trauma to the ear canal/inner ear resulting
in tinnitus (upon closing).
Not sure how to avoid the thickness of the aligners causing this. Maybe put them in braces
after recapturing the disc and plan for Hawley retainers. This all being said if indeed this is the
cause. Based on the article above, there can be a multitude of other causes. ■
11/17/2020

davidharnick
Member Since: 08/28/02
Post: 6 of 7

Hi. I didn't particularly talk about ringing in the ears. I have had some luck by sectioning the
second molars and cutting off the distal half for a variety of problems with aligners during treatment.
Pretty simple thing to try. I think it beats rearranging the entire occlusion for a first attempt. ■
11/20/2020

below
Member Since: 08/07/09
Post: 7 of 7

Thank you for the clarification, Dr. H. May I ask what the variety of problems that you
encounter with aligners are that can be taken care of with sectioning the distal half of the 7s on
the aligners? Thank you. ■
11/23/2020

Discuss-and solve-your clear aligner challenges
Clear aligner therapy has never been more popular, and with millions of new cases each year
comes a wide spectrum of patient concerns and potential complaints. Check out the rest of
this conversation and see what other clear aligner tips and considerations Townies are discussing. Go to orthotown.com/messageboard and search " ringing in ears " to find this thread.

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Orthotown January/February 2021

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