Recovery of hearing loss in atypical Meniere’s disease after treatment with orofacial and neck massage: A case report

Abstract

BACKGROUND

A 48-year-old female presented with sudden-onset right-sided aural fullness, low-frequency hearing loss, and tinnitus. Medical history included right-sided temporomandibular joint disorder (TMJD) with crepitation, and retro-orbital headaches. The patient was diagnosed with atypical Meniere’s disease (MD) and received intratympanic steroids, prednisone, betahistine, and began a low-sodium diet; however, the patient’s symptoms worsened.

CASE SUMMARY

The patient sought physical therapy for TMJD; testing revealed reduced motion and dysfunction with vertical opening, lateral excursion of the mandible to the right, and tenderness to palpation. Treatment included soft tissue mobilization of right facial structures and temporal fossa, intraoral massage of the right pterygoid musculature, and massage of right neck structures. After 4 weeks, the patient noticed subjective improvement in hearing and decreased headaches. After 11 weeks, an audiogram showed that the hearing loss had recovered. The patient has continued the daily at-home intraoral/neck massage therapy and maintained normal hearing over 4 years to date. The temporal relationship between physical therapy and recovery of hearing loss suggests muscular or inflammatory etiology as at least partially causative of this patient’s symptoms. The mechanism of healing may have been due to decreased inflammation, improved blood flow, restored function of cranial nerves, or some combination of these and other unknown factors.

CONCLUSION

This report suggests that orofacial physical and massage therapy may be an effective treatment for the cochlear symptoms associated with MD.

Keywords: Meniere’s disease; Temporomandibular joint disorder; Cochlear migraine; Cochlear hydrops; Low-frequency hearing loss; Case report

Core Tip: A patient who experienced right-sided symptoms of Meniere’s disease (MD) with comorbid right sided temporomandibular joint disorder (TMJD) and mid-face/retro-orbital headaches experienced no relief from traditional MD treatments. The patient sought out physical therapy for TMJD, which included soft tissue mobilization of right facial structures and temporal fossa, intraoral massage, and massage of right neck structures. The patient recovered from the right-sided hearing loss and associated MD symptoms and had decreased headaches after 1 month. Physical and massage therapy for the cochlear symptoms associated with MD may be an important adjunctive treatment, though confirmatory studies are needed.