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Original Research

Open Access

Aural Symptoms in Temporomandibular Disorder Patients Attending a Craniofacial Pain Unit

  • David K. Lam1
  • Herenia P. Lawrence2,*,
  • Howard C. Tenenbaum1,2

1Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

2Discipline of Community Dentistry, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

DOI: 10.11607/jofph.15203 Vol.15,Issue 2,June 2001 pp.146-157

Published: 30 June 2001

*Corresponding Author(s): Herenia P. Lawrence E-mail: herenia.lawrence@utoronto.ca

Abstract

Aims: To determine (1) the prevalence of aural symptoms in orofacial pain patients and (2) a potential association between temporomandibular disorders (TMD) and aural health, while controlling for covariates known to be associated with TMD or auditory dysfunction. Methods: In a retrospective study, health questionnaires, medical histories, clinical findings, diagnoses, and treatments were systematically retrieved from the charts of 776 patients. The dates of initial assessment ranged from May 1987 to June 1999. Of the included subjects, 39.7% were female; the median age was 39 years; 16.4% displayed only aural symptoms (otalgia, tinnitus, vertigo, or perceived hearing loss); 26.4% had both TMD and aural symptoms; 17.8% had TMD but no aural complaints; and 39.4% had neither TMD nor aural symptoms. Results: Of the 344 subjects who had TMD, 59.9% complained of aural symptoms, versus 29.2% of the 432 patients without TMD. Of the subjects with otalgia, tinnitus, vertigo, or perceived hearing loss, 67%, 64.1%, 65.2%, and 62.2% had TMD, respectively. Subjects with aural symptoms were significantly more likely to be female; to consider themselves in poor health; to smoke; or to have TMD, orofacial pain, headaches (temporal, occipital, or frontal), neck and shoulder pain, altered vision and sensation, sleep disturbances, loss of appetite, memory loss, or low energy. Clinical findings indicated that pathognomonic signs of TMD were associated with an increased risk of aural complaints in this patient population. A significantly greater negative impact on normal life functions was found in subjects exhibiting aural symptoms versus those who only had TMD complaints. Conclusion: These findings indicate that TMD is significantly correlated to aural health, although no cause-and-effect relationship has yet been demonstrated. Aural symptoms were also found to have a measurable impact on the subjects’ quality of life.

Keywords

temporomandibular disorders; otalgia; tinnitus; vertigo; perceived hearing loss; quality of life

Cite and Share

David K. Lam,Herenia P. Lawrence,Howard C. Tenenbaum. Aural Symptoms in Temporomandibular Disorder Patients Attending a Craniofacial Pain Unit. Journal of Oral & Facial Pain and Headache. 2001. 15(2);146-157.

References

1. Myrhaug H. Clicking ear and pharyngeal tic associated with functional disturbances of the jaw. Acta Otolaryngol Suppl 1958;188:430–433.

2. Posselt U. The temporomandibular joint syndrome and occlusion. J Prosthet Dent 1971;25:432–438.

3. Ciancaglini R, Loreti P, Radaelli G. Ear, nose, and throat symptoms in patients with TMD: The association of symptoms according to severity of arthropathy. J Orofac Pain 1994;8:293–297.

4. Keersmaekers K, De Boever JA, Van Den Berghe L. Otalgia in patients with temporomandibular joint disorders. J Prosthet Dent 1996;75:72–76.

5. Kuttila S, Kuttila M, Le Bell Y, Alanen P, Jouko S. Aural symptoms and signs of temporomandibular disorders in association with treatment need and visits to a physician. Laryngoscope 1999;109:1669–1673.

6. Coles RRA. Epidemiology of tinnitus: (1) Prevalence. J Laryngol Otol 1984;(Suppl 9):7–15.

7. Rubinstein B. Tinnitus and craniomandibular disorders: Is there a link? Swed Dent J 1993;95(Suppl):1–46.

8. Chan SWY, Reade PC. Tinnitus and temporomandibular pain-dysfunction disorder. Clin Otolaryngol Allied Sci 1994;19:370–380.

9. Parker WS, Chole RA. Tinnitus, vertigo, and temporomandibular disorders. Am J Orthod Dentofac Orthop 1995;107:153–158.

10. Cooper BC, Alleva M, Cooper DL, Lucente FE. Myofascial pain dysfunction: Analysis of 476 patients. Laryngoscope 1986;96:1099–1106.

11. Chole RA, Parker WS. Tinnitus and vertigo in patients with temporomandibular disorder. Arch Otolaryngol Head Neck Surg 1992;118(8):817–821.

12. Dolowitz DA, Ward JW, Fingerle CO, Smith CC. The role of muscular incoordination in the pathogenesis of the temporomandibular joint syndrome. Laryngoscope 1964;74:790–801.

13. Bernstein JM, Mohl ND, Spiller H. Temporomandibular joint dysfunction masquerading as disease of ear, nose, and throat. Trans Am Acad Ophthalmol Otolaryngol 1969;73:1208–1217.

14. Koskinen J, Paavolainen M, Raivio M, Roschier J. Otological manifestations in temporomandibular joint dysfunction. J Oral Rehabil 1980;7:249–254.

15. Toller MÖ, Juniper RP. Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg 1993;21:2–8.

16. Baldursson G, Blackmer ER. Temporomandibular joint symptoms in patients with midfrequency sensorineural hearing loss. Ear Hear 1987;8:63–67.

17. Vernon J, Griest S, Press L. Attributes of tinnitus that may predict temporomandibular joint dysfunction. Cranio 1992;10:282–288.

18. Costen JB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhinol Laryngol 1934;43:1–15.

19. Sicher H. Temporomandibular articulation in mandible overclosure. J Am Dent Assoc 1948;36(2):131–139.

20. Shapiro HH, Truex RC. The temporomandibular joint and the auditory function. J Am Dent Assoc 1943;30:1147–1168.

21. Pinto OF. A new structure related to the temporomandibular joint and middle ear. J Prosthet Dent 1962;12(1):95–103.

22. Komori E, Sugisaki M, Tanabe H, Katoh S. Discomalleolar ligament in the adult human. Cranio 1986;4:300–305.

23. Loughner BA, Larkin LH, Mahan PE. Discomalleolar and anterior malleolar ligaments: Possible causes of middle ear damage during temporomandibular joint surgery. Oral Surg Oral Med Oral Pathol 1989;68:14–22.

24. Manni A, Brunori P, Giuliani M, Modoni M, Bizzi G. Oto-vestibular symptoms in patients with temporomandibular joint dysfunction. Electromyographic study [in Italian]. Minerva Stomatol 1996;45:1–7.

25. Alkofide EA, Clark E, El-Bermani W, Kronman JH, Mehta N. The incidence and nature of fibrous continuity between the sphenomandibular ligament and the anterior malleolar ligament of the middle ear. J Orofac Pain 1997;11:7–14.

26. Rodríguez-Vásquez JF, Mérida-Velasco JR, Mérida-Velasco JA, Jiménez-Collado J. Anatomical considerations on the discomalleolar ligament. J Anat 1998;192:617–621.

27. Arlen H. The otomandibular syndrome: A new concept. Ear Nose Throat J 1977;56:60–62.

28. Arlen H. The otomandibular syndrome. In: Gelb H (ed). Clinical Management of Head, Neck and TMJ Pain and Dysfunction.Philadelphia: Saunders, 1985:171–180.

29. Miller DA, Wyrwa EB. Ear pain: A dental dilemma. Compend Contin Educ Dent 1992;13:676–684.

30. Sessle BJ, Hu JW, Amano N, Zhong G. Convergence of cutaneous, tooth pulp, visceral, neck and muscle afferents onto nociceptive and non-nociceptive neurons in trigeminal subnucleus caudalis (medullary dorsal horn) and its implications for referred pain. Pain 1986;27:219–235.

31. Sessle BJ. Acute and chronic craniofacial pain: Brain stem mechanisms of nociceptive transmission and neuroplasticity and their clinical correlates. Crit Rev Oral Biol Med 2000;11:57–91.

32. Erlandsson SI, Rubinstein B, Carlsson SG. Tinnitus: Evaluation of biofeedback and stomatognathic treatment. Br J Audiol 1991;25:151–161.

33. Kempf H-G, Roller R, Mühlbradt L. Correlation between inner ear disorders and temporomandibular joint diseases [in German]. HNO 1993;41:7–10.

34. Morgan DH. Dysfunction, pain, tinnitus, vertigo corrected by mandibular joint surgery. South Calif Dent Assoc J 1971;39:505–534.

35. Morgan DH. Temporomandibular joint surgery. Correction of pain, tinnitus, and vertigo. Dent Radiogr Photogr 1973;46(2):27–39.

36. House LR, Morgan DH, Hall WP, Vamvas SJ. Temporomandibular joint surgery: Results of a fourteen-year implant study. Laryngoscope 1984;94:534–538.

37. Steigerwald DP, Verne SV, Young D. A retrospective evaluation of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus. Cranio 1996;14:46–54.

38. Williamson EH. The interrelationship of internal derangement of the temporomandibular joint, headache, vertigo, and tinnitus: A survey of 25 patients. Cranio 1990;8:301–306.

39. Principato JJ, Barwell DR. Biofeedback training and relaxation exercises for treatment of temporomandibular joint dysfunction. Otolaryngology 1978;86:766–769.

40. Rubinstein B, Carlsson GE. Effects of stomatognathic treatment on tinnitus: A retrospective study. Cranio 1987;5:254–259.

41. Wright EF, Bifano SL. Tinnitus improvement through TMD therapy. J Am Dent Assoc 1997;128:1424–1432.

42. Bush FM. Tinnitus and otalgia in temporomandibular disorders. J Prosthet Dent 1987;58:495–498.

43. Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW. The functional neuroanatomy of tinnitus: Evidence for limbic system links and neural plasticity. Neurology 1998;50:114–120.

44. Pinchoff RJ, Burkard RF, Salvi RJ, Coad ML, Lockwood AH. Modulation of tinnitus by voluntary jaw movements. Am J Otol 1998;19:785–789.

45. Grossi ML, Goldberg MB, Locker D, Tenenbaum HC. Reduced neuropsychological measures as predictors of treatment outcome in patients with temporomandibular disorders. J Orofac Pain (in press).

46. Dworkin SF, LeResche L. Research Diagnostic Criteria for Temporomandibular Disorders: Review, Criteria, Examinations andSpecifications, Critique. J Craniomandib Disord 1992;6:301–355.

47. Gelb H, Calderone JP, Gross SM, Kantor ME. The role of the dentist and the otolaryngologist in evaluating temporomandibular joint syndromes. J Prosthet Dent 1967;18:497–503.

48. Dao T, Reynolds WJ, Tenenbaum HC. Comorbidity between myofascial pain of the masticatory muscles and fibromyalgia. Alpha Omegan 1998;91(2):29–37.

49. Türp JC, Kowalski CJ, Stohler CS. Generic pain intensity scores are affected by painful comorbidity. J Orofac Pain 2000;14:47–51.

50. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes ofHealth, 2000.

51. LeResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291–305.

52. Ash CM, Pinto OF. The TMJ and the middle ear: Structural and functional correlates for aural symptoms associated with temporomandibular joint dysfunction. Int J Prosthodont 1991;4:51–57.

53. Branch MA, Carlson CR, Okeson JP. Influence of biased clinician statements on patient report of referred pain. J Orofac Pain 2000;15:120–127.

54. Lawrence HP, Garcia RI, Essick GK, Hawkins R, Krall EA, Spiro III A, et al. A longitudinal study of the association between tooth loss and age-related hearing loss. Spec Care Dent (in press).

55. Wright EF. Referred craniofacial pain patterns in patients with temporomandibular disorder. J Am Dent Assoc 2000;131:1307–1315.

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