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

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....​

 

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

 

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.

 

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

 

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.

 

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.

 

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

 

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

 

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

 

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

 

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?

 

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?

 

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.