TMJ Disorder Complaints in Tinnitus: Further Hints for a Putative Tinnitus SubType

[erik]

http://www.ncbi.nlm.nih.gov/pubmed/22723902

Abstract​

OBJECTIVE:​

Tinnitus is considered to be highly heterogeneous with respect to its etiology, its comorbidities and the response to specific interventions. Subtyping is recommended, but it remains to be determined which criteria are useful, since it has not yet been clearly demonstrated whether and to which extent etiologic factors, comorbid states and interventional response are related to each other and are thus applicable for subtyping tinnitus. Analyzing the Tinnitus Research Initiative Database we differentiated patients according to presence or absence of comorbid temporomandibular joint (TMJ) disorder complaints and compared the two groups with respect to etiologic factors.​

METHODS:​

1204 Tinnitus patients from the Tinnitus Research Initiative (TRI) Database with and without subjective TMJ complaints were compared with respect to demographic, tinnitus and audiological characteristics, questionnaires, and numeric ratings. Data were analysed according to a predefined statistical analysis plan.​

RESULTS:​

Tinnitus patients with TMJ complaints (22% of the whole group) were significantly younger, had a lower age at tinnitus onset, and were more frequently female. They could modulate or mask their tinnitus more frequently by somatic maneuvers and by music or sound stimulation. Groups did not significantly differ for tinnitus duration, type of onset (gradual/abrupt), onset related events (whiplash etc.), character (pulsatile or not), hyperacusis, hearing impairment, tinnitus distress, depression, quality of life and subjective ratings (loudness etc.).​

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CONCLUSION:​

Replicating previous work in tinnitus patients with TMJ complaints, classical risk factors for tinnitus like older age and male gender are less relevant in tinnitus patients with TMJ complaints. By demonstrating group differences for modulation of tinnitus by movements and sounds our data further support the notion that tinnitus with TMJ complaints represents a subgroup of tinnitus with clinical features that are highly relevant for specific therapeutic management.​

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I wonder what kind of therapeutic management since this is type I have....​

 

[Tinniger]

Subtyping of tinnitus seems to me to be a largely unfooted field.^

 

[Frédéric]

I found this about TMJ today.

Association Between Tinnitus and Temporomandibular Disorders: A Systematic Review and Meta-Analysis
https://doi.org/10.1177/0003489419842577

Objectives:
Tinnitus is one of the most common otological symptoms in patients with temporomandibular disorders. This study aimed to investigate the possible association between tinnitus and temporomandibular disorders.

Methods:
The online databases of PubMed, Ovid, ScienceDirect, and Web of Science were explored for all English articles published until September 2018 using the combined keywords tinnitus and temporomandibular. Cross-sectional, cohort, or case-control studies that investigated the association between tinnitus and temporomandibular disorders (TMDs) were considered. The quality of the included papers was assessed by the Crowe Critical Appraisal Tool.

Results:
Twenty-two papers met the eligibility criteria and were included in the systematic review. Meta-analysis was performed on 8 papers to investigate the possible relationship between tinnitus and TMDs by calculating the odds ratios. Odds ratios ranged from 1.78 to 7.79 in the studies related to tinnitus frequency in temporomandibular disorders and from 1.80 to 7.79 in the papers linked to temporomandibular disorder frequency in tinnitus, indicating a significant association between tinnitus and temporomandibular disorders.

Conclusions:
There was a strong relationship between tinnitus occurrence and TMDs. The findings implied the significance of exploring the signs of TMDs in patients with tinnitus as well as tinnitus in those who complain from temporomandibular disorders.

 

[Frédéric]

I found this today about TMJ and tinnitus.
The structure that connect tmj and middle ear: petrotympanic fissure. correlation between anatomy, function and aural symptoms
Impossible to copy and paste, so below is the link:
https://www.ijoms.com/article/S0901-5027(19)30968-3/abstract

 

[Greg Sacramento]

The article is inline with Science Direct.
From Science Direct.
When asked to indicate the location of pain, patients with TMJ pain typically point to a small area in front of the ear, whereas the myalgia patient will place his or her hands over the entire side of the face, Myalgia is pain originating in the muscles of mastication and differs from TMJ.

Myalgia does not cause tinnitus.

 

[Frédéric]

Autonomic and Psychologic Risk Factors for Development of Tinnitus in Patients with Chronic Temporomandibular Disorders.
https://europepmc.org/abstract/med/31247060
DOI: 10.11607/ofph.2237

Abstract
AIMS:To investigate the roles of autonomic regulation and psychologic condition in the development of tinnitus in patients with chronic temporomandibular disorders (TMD).

METHODS:In total, 55 participants (mean age 36.4 ± 12.6 years; 7 men, 48 women) were involved: 13 with no signs of painful TMD or tinnitus (CON), 15 with painful TMD without tinnitus (pTMD), and 27 with both painful TMD and tinnitus (TMDTIN). The Research Diagnostic Criteria for TMD and the Tinnitus Handicap Inventory (THI) were used to classify painful TMD and self-reported tinnitus, respectively. Measures of arterial heart rate (HR) and blood pressure (BP) were assessed at rest and in response to orthostatic challenges, cold-stress vasoconstriction, Valsalva maneuver, and psychologic stress. The sympathetic variables (BP responses to standing, cold stress, and psychologic stress) and parasympathetic variables (HR response to Valsalva maneuver [Valsalva ratio] and active standing [30:15 ratio]) were estimated.

RESULTS: Parasympathetic measures demonstrated significant differences between pTMD and TMDTIN. The period of pain duration showed significant positive correlations with BP variables during orthostatic challenges and/or cold stress in both pTMD and TMDTIN. THI scores showed significant positive correlations with results from the psychologic analysis. The range of motion of the mandible demonstrated a greater correlation with results from the psychologic analysis in TMDTIN compared to pTMD.

CONCLUSION: Dysregulated psychophysiologic interactions may affect the development of tinnitus in patients with chronic TMD.

 

[Candy]

Thanks for your interesting articles @Frédéric. I have had TMJ for years.

 

[Frédéric]

Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial

Abstract
Objective
This randomized clinical trial investigated the effects of adding cervico-mandibular manual therapies into an exercise and educational program on clinical outcomes in individuals with tinnitus associated with temporomandibular disorders (TMDs).

Methods
Sixty-one patients with tinnitus attributed to TMD were randomized into the physiotherapy and manual therapy group or physiotherapy alone group. All patients received six sessions of physiotherapy treatment including cranio-cervical and temporomandibular joint (TMJ) exercises, self-massage, and patient education for a period of one month. Patients allocated to the manual therapy group also received cervico-mandibular manual therapies targeting the TMJ and cervical and masticatory muscles. Primary outcomes included TMD pain intensity and tinnitus severity. Secondary outcomes included tinnitus-related handicap (Tinnitus Handicap Inventory [THI]), TMD-related disability (Craniofacial Pain and Disability Inventory [CF-PDI]), self-rated quality of life (12-item Short Form Health Survey [SF-12]), depressive symptoms (Beck Depression Inventory [BDI-II]), pressure pain thresholds (PPTs), and mandibular range of motion. Patients were assessed at baseline, one week, three months, and six months after intervention by a blinded assessor.

Results
The adjusted analyses showed better outcomes (all, P < 0.001) in the exercise/education plus manual therapy group (large effect sizes) for TMD pain (η 2 P = 0.153), tinnitus severity (η 2 P = 0.233), THI (η 2 P = 0.501), CF-PDI (η 2 P = 0.395), BDI-II (η 2 P = 0.194), PPTs (0.363 < η 2 P < 0.415), and range of motion (η 2 P = 0.350), but similar changes for the SF-12 (P = 0.622, η 2 P = 0.01) as the exercise/education alone group.

Conclusions
This clinical trial found that application of cervico-mandibular manual therapies in combination with exercise and education resulted in better outcomes than application of exercise/education alone in individuals with tinnitus attributed to TMD.

Source: https://academic.oup.com/painmedici...093/pm/pnz278/5609079?redirectedFrom=fulltext

 

[Frédéric]

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study

Abstract
Introduction The prevalence of tinnitus is higher in individuals with temporomandibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus.

Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus.

Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images.

Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups.

Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Full article: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0039-1688840

 

[Frédéric]

Temporomandibular joint herniation into the middle ear: A rare cause of mastication-induced tinnitus

A 75-year-old patient complained of mastication-induced clicking tinnitus on the left side, and otoendoscopic examination revealed that the left tympanic membraneTM was outwardly bulged by clenching her teeth. Temporal bone computed tomography demonstrated that the posteromedial bony wall of the glenoid was partially dehiscent, allowing herniation of soft tissue contents of temporomandibular joint into the middle ear. Increased middle ear pressure due to soft tissue herniation can induce left tympanic membrane bulging and accompanying clicking tinnitus. Herniation of temporomandibular joint soft tissue into the middle ear should be considered as a differential diagnosis when clicking tinnitus is evoked by mastication.

Source: https://www.sciencedirect.com/science/article/pii/S1930043319303590

 

[Frédéric]

Psychiatric Distress as a Common Risk Factor for Tinnitus and Joint Pain: A National Population-Based Survey

 

[Jaysterk]

Psychiatric Distress as a Common Risk Factor for Tinnitus and Joint Pain: A National Population-Based Survey

So stress can cause tinnitus but is tinnitus caused by stress reversible?

 

[Frédéric]

So stress can cause tinnitus but is tinnitus caused by stress reversible?

According to some of testimonials in this forum, it can be irreversible.

 

[Jaysterk]

According to some of testimonials in this forum, it can be irreversible.

Very alarming to hear. Do we know exactly what the stress attacks? Is it still the tiny hair cells in the Cochlea?

 

[Frédéric]

Biomarkers for Temporomandibular Disorders:
Current Status and Future Directions

Abstract: Numerous studies have been conducted in the previous years with an objective to determine
the ideal biomarker or set of biomarkers in temporomandibular disorders (TMDs). It was recorded that
tumour necrosis factor (TNF), interleukin 8 (IL-8), IL-6, and IL-1 were the most common biomarkers
of TMDs. As of recently, although the research on TMDs biomarkers still aims to find more diagnostic
agents, no recent study employs the biomarker as a targeting point of pharmacotherapy to suppress
the inflammatory responses. This article represents an explicit review on the biomarkers of TMDs
that have been discovered so far and provides possible future directions towards further research
on these biomarkers. The potential implementation of the interactions of TNF with its receptor 2
(TNFR2) in the inflammatory process has been interpreted, and thus, this review presents a new
hypothesis towards suppression of the inflammatory response using TNFR2-agonist. Subsequently,
this hypothesis could be explored as a potential pain elimination approach in patients with TMDs.

 

[Frédéric]

Temporomandibular disorders as an etiological factor for tinnitus

 

[Frédéric]

Dental disorders.

 

[Frédéric]

Relationship of TMJ Clicking with Ear Problems and Headache

Abstract This research involve 450 patients with TMDs, this study include 271 women and 179 men, concerning the age, the sample age was extended from 13years to 65 years. Data were assessed numerically by Helkimo index, the most dominant age group was 21-30 years, 314 patients were complained from clicking(69.7%). Regarding the sex, female patients with clicking were most frequently represented, whom represent 191patients (60.8 %) from the total sample. Concerning ear problems, otalgia was the most prevalent symptom which represent (164) patients followed by tinnitus(124) patients, buzzing (77) patients and subjective hearing loss (42) patients .No significant differences were found between clicking and ear problems p ≥0.001. Regarding headache 104 patients were suffering from headache, no significant differences p ≥0.001 with headache in relation to sex and clicking were found in this study.

Full article: see attached file.

 

[Frédéric]

Association between Anatomical Features of Petrotympanic Fissure and Tinnitus in Patients with Temporomandibular Joint Disorder Using CBCT Imaging: An Exploratory Study

Abstract
Mandible displacement is known to correlate with otological conditions such as pain in the ear canal, hearing loss, or tinnitus. The present work aimed to determine the association between the displacement of the condyle in a temporomandibular joint, the structure and position of the petrotympanic fissure (PTF), and comorbid tinnitus in patients affected by temporomandibular joint and muscle disorder (TMD). We enrolled 331 subjects with TMD (268 women and 63 men). The average age of women was 40.8 ± 16.8 years (range 13–88), whereas the average age of the examined men was 38 ± 14 years (range 13–74). We performed imaging studies of the facial part of the skull in the sagittal plane using a volumetric imaging method and a large imaging field (FOV) of 17 cm × 23 cm. The habitual position of the mandible was determined and used as a reference. Based on the imaging results, we developed a classification for the topography and the structure of the petrotympanic fissure. Thirty-three TMD patients (about 10% of the sample) reported having tinnitus. These patients had PTF configurations characterized by a rear (36.59%) or intracranial-cranial (63.41%) condylar displacement of the temporomandibular joint. Our findings imply that the TMJ- and tinnitus-positive group of patients possibly represents a distinct phenotype of tinnitus. We concluded that for such patients, the therapeutic approach for tinnitus should include TMD treatment.

Full article: https://www.hindawi.com/journals/prm/2020/1202751/

 

[Frédéric]

Association between Anatomical Features of Petrotympanic Fissure and Tinnitus in Patients with Temporomandibular Joint Disorder Using CBCT Imaging: An Exploratory Study

Abstract
Mandible displacement is known to correlate with otological conditions such as pain in the ear canal, hearing loss, or tinnitus. The present work aimed to determine the association between the displacement of the condyle in a temporomandibular joint, the structure and position of the petrotympanic fissure (PTF), and comorbid tinnitus in patients affected by temporomandibular joint and muscle disorder (TMD). We enrolled 331 subjects with TMD (268 women and 63 men). The average age of women was 40.8 ± 16.8 years (range 13–88), whereas the average age of the examined men was 38 ± 14 years (range 13–74). We performed imaging studies of the facial part of the skull in the sagittal plane using a volumetric imaging method and a large imaging field (FOV) of 17 cm × 23 cm. The habitual position of the mandible was determined and used as a reference. Based on the imaging results, we developed a classification for the topography and the structure of the petrotympanic fissure. Thirty-three TMD patients (about 10% of the sample) reported having tinnitus. These patients had PTF configurations characterized by a rear (36.59%) or intracranial-cranial (63.41%) condylar displacement of the temporomandibular joint. Our findings imply that the TMJ- and tinnitus-positive group of patients possibly represents a distinct phenotype of tinnitus. We concluded that for such patients, the therapeutic approach for tinnitus should include TMD treatment.

Full article: https://www.hindawi.com/journals/prm/2020/1202751/

 

[Greg Sacramento]

5. Conclusions

This study documents the association between tinnitus and TMJ. The location and type petrotympanic fissure may be a predisposing factor for tinnitus, especially in patients with TMJ(3)The type of condylar displacement of the temporomandibular joint may be essential for tinnitus induction.​

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Consideration - A deep narrow palatal or mandibular plane, wide joint space, any hyperostoses from alveolar ridge in the molar regions or cortical thickening along the surfaces of the condyles, all which can be seen on a beam reading. This is important because many with TMJ tinnitus have smooth and rounded TMJs without evidence of subchondral defects.

 

[Am92]

Interesting.

My tinnitus started after being punched on the ear/TMJ area over 4 years ago. My tinnitus started suddenly after.

I have no visible hearing loss and always assumed it was ear damage I suffered.

However I'm now starting to think could it of been my TMJ that was damaged.

Around a year ago I noticed a clicking/crunching sound everytime I bite down on my tinnitus affected side and I have a ligament/tendon feeling lump located right on my TMJ joint in front of my ear canal. I can actually feel a dislocation sort of feeling when I put my finger in my ear and open and close my mouth. I can also make my tinnitus louder by opening my mouth wide. This only happens on the side I have tinnitus.

I wonder if it could be the culprit of my tinnitus all along?

 

[Frédéric]

It is a pity that these people were not asked if they had TMJD or tinnitus.

Microscopic reconstruction and immunohistochemical analysis of discomalleolar ligament

Discomalleolar ligament represents the vestiges of the primitive lateral pterygoid muscle which penetrates in the caudal end of Meckel's cartilage; during the development of newborn, the petrotympanic fissure close almost completely leaving inside the discomalleolar ligament. After entering in tympanic cavity, some fibers of the discomalleolar ligament insert to walls of cavity, other fibers continue with the lateral margin of the anterior ligament and insert in the neck of malleus; in contrast, other Authors demonstrated that discomalleolar ligament is an independent structure inserted in proximity of the neck of the malleus. Although the discomalleolar ligament can be considered as a structure of clinical importance, it is not described by anatomy textbooks. Moreover, it is likely that important correlations between temporomandibular diseases and otological symptoms exist. We have studied discomalleolar ligament submitting the specimens to the 3D volume rendering technique, light microscopy, reconstructing a wide light microscopic fields to analyze the real connection between retrodiscal connective tissue and middle ear, and immunofluorescence methods in order to analyze the consistence of ligament. We have shown two types of connections between TMJ and ear: first, with external acoustic meatus and, second, with middle ear through discomalleolar ligament. The different insertion represents a strong support in order to demonstrate that the TMJ disorders can determine variations of tension that are transmitted on the tympanic membrane provoking tinnitus in according to clinical features. Then, we propose that it is necessary to mention, also in anatomy textbook, the discomalleolar ligament as ligament distance of TMJ.

Full article: https://www.sciencedirect.com/science/article/pii/S240584402031495X

 

[Frédéric]

Tinnitus and TMJD, study from Israel.

 

[carlover]

Hi all,

I have TMJD. I have spent thousands on treatments. I had all my teeth changed etc. No difference, just more frustration.

I can tell you I have never ever seen on any forum someone having TMJD treatment and it curing their tinnitus. You go and see someone / numerous "experts", you can be sent down so many rabbit holes and you are looking for months and months of treatment. It really is not a case of having a bite plate made and away you go.

P.S. I do know I really grind my teeth at night and it's obvious the muscles around the ear are stressed and I reckon that gives you ETD and presses on hearing bits and pieces, but having this stuff and getting rid of it is very very difficult.

 

[HootOwl]

I can tell you I have never ever seen on any forum someone having TMJD treatment and it curing their tinnitus.

I think @threefirefour managed to get it down to a very mild level with TMJ treatment.

 

[Frédéric]

Audiological Evaluation of Patients With Somatosensory Tinnitus Attributed to Temporomandibular Disorders

Abstract

Purpose
Tinnitus and temporomandibular disorders have already been associated in the literature, but despite many studies, it is still an intriguing discussion point. This study aimed to evaluate the prevalence of hearing loss among somatosensory tinnitus patients with temporomandibular disorders and to assess the influence of tinnitus on patients' quality of life.

Method
An otolaryngologist examined 585 patients in order to detect and evaluate the presence of tinnitus. Subjects were evaluated using the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders. An analysis of the somatic component of tinnitus was performed. Tinnitus was rated according to its onset (at least 6 months) and intensity with a visual analog scale. The sample was composed of 100 patients with somatosensory tinnitus divided into two groups: Group 1 (with temporomandibular disorder, n = 85) and Group 2 (without temporomandibular disorder, n = 15). The audiological evaluation was composed of pure-tone audiometry, high-frequency audiometry, tympanometry, and transient-evoked otoacoustic emissions. The impact of tinnitus on quality of life was assessed by the Tinnitus Handicap Inventory adapted and validated to Portuguese language.

Results
Pure-tone audiometry did not differ with statistical significance between groups (p = .29), neither did the high-frequency audiometry results (p = .74). Tinnitus Handicap Inventory scores also did not show any differences between Groups 1 and 2 (p = .67).

Conclusions
Subjects with somatosensory tinnitus, who also have temporomandibular disorders, do not seem to have hearing impairment. Also, they do not have a higher quality of life handicap when compared to those without tinnitus and temporomandibular disorder.

Source: https://pubs.asha.org/doi/full/10.1044/2020_AJA-20-00133

 

[just1morething]

Hi all,

I have TMJD. I have spent thousands on treatments. I had all my teeth changed etc. No difference, just more frustration.

I can tell you I have never ever seen on any forum someone having TMJD treatment and it curing their tinnitus. You go and see someone / numerous "experts", you can be sent down so many rabbit holes and you are looking for months and months of treatment. It really is not a case of having a bite plate made and away you go.

P.S. I do know I really grind my teeth at night and it's obvious the muscles around the ear are stressed and I reckon that gives you ETD and presses on hearing bits and pieces, but having this stuff and getting rid of it is very very difficult.

I have a lot of noise in my left ear and grade 5 internal derangement in my left TMJ. I guess this doctor is good.

https://www.tmjsurgery.com/