Painful temporomandibular disorders, self reported tinnitus, and depression are highly associated

Association between depression and temporomandibular dysfunction in adults - a systematic review

OBJECTIVE

To critically evaluate the literature and answer the question: "Is there an association between depression and temporomandibular disorder (TMD) in adults?"

METHODS

The personalized search strategy was applied to PubMed, Embase, Web of Science, and Scopus databases. Articles were selected in two stages according to the eligibility criteria. The Joanna Briggs Institute (JBI) tool was used to analyze the risk of bias according to the type of study.

RESULTS

The included articles presented a moderate risk of bias. Based on the studies, individuals with TMD have higher levels of depression compared to the control group. There is also a direct association in that individuals with depression are more susceptible to developing TMD.

CONCLUSION

There is a probable association between depression and TMD in adults. However, more studies with high methodological quality are needed to confirm this finding.

The impact of malocclusion on the prevalence of pain-related temporomandibular disorders in children and adolescents: a systematic review

Background

The connection between occlusion and temporomandibular disorders (TMD) remains a topic of discussion, and current research does not provide a definitive answer. Pain-related TMD are the most common types of TMD. They include myalgia, arthralgia, and headaches attributed to TMD. This systematic review aims to synthesize the current scientific evidence regarding impact of malocclusion on the prevalence of pain-related TMD in individuals under 18 years.

Methods

The study was based on a searching of the PubMed, Scopus, Embase, and Web of Science databases. Selection was limited to studies that explored the link between malocclusion and pain-related TMD in young individuals. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the selected research. The certainty of evidence was assessed using the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach. A visual representation of the screening and inclusion processes was created using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. The information from the research was then summarized in a descriptive format.

Results

Out of 868 potentially relevant articles initially identified, 13 studies were selected based on the inclusion criteria. The majority of these studies were determined to be of moderate quality, according to the NOS assessment. The certainty of evidence was assessed as low, according to the GRADE approach. Most of the studies showed that malocclusion may be associated with TMD-pain signs/symptoms in children and adolescents. The most frequent relationship was found between the prevalence of pain-related TMD and posterior crossbite, Class II malocclusion, Class III malocclusion, and anterior open bite.

Conclusion

Certain types of malocclusion may have an impact on the prevalence of some TMD-pain signs and symptoms in young individuals. However, given the limited reliability of existing research and the inconsistencies observed across studies, additional well-structured, long-term investigations are necessary.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024570950.

Systematic review and meta-analysis of the correlation between tinnitus and mental health

OBJECTIVE

This paper assesses the correlation between tinnitus and mental health, including depression, anxiety, stress, insomnia, and suicide through meta-analysis.

METHODS

Web of Science, Embase, PubMed, and Cochrane databases were searched until January 2024. After article screening, data extraction, and quality evaluation, meta-analysis was performed using Stata 15.1.

RESULTS

22 papers were enrolled, including 5 case-control studies, 8 cohort studies, and 9 cross-sectional studies. Meta-analysis uncovered that tinnitus was associated with depression (OR = 1.92, 95 % CI: 1.56, 2.36), anxiety (OR = 1.63, 95 % CI: 1.34, 1.98), stress (OR = 1.17, 95 % CI: 1.01, 1.36), insomnia (OR = 3.07, 95 % CI: 2.36, 3.98), and suicide (OR = 5.31, 95 % CI: 4.34, 6.51).

CONCLUSION

A correlation is indicated between tinnitus and mental health. Therefore, it is critical to incorporate psychological interventions in tinnitus treatment and to implement a comprehensive treatment program.

The Association Between Temporomandibular Disorders and Tinnitus: Evidence and Therapeutic Perspectives from a Systematic Review

Background/Objectives: Tinnitus, often described as a ringing in the ears, affects a significant portion of the population, varying in perception and severity. Methods: This systematic review investigates the correlation between tinnitus and temporomandibular joint disorders (TMDs) within a PRISMA-compliant framework, ensuring methodological transparency and rigor. Using databases, such as PubMed, Scopus, and Web of Science, we analyzed studies from the past decade to evaluate clinical and observational evidence. Results: A significant association between TMD and tinnitus was found, with somatosensory and neuroplastic mechanisms contributing to this relationship. Key therapeutic approaches identified include manual therapy and multidisciplinary treatments, demonstrating potential clinical efficacy. Conclusions: However, the available evidence remains inconsistent, emphasizing the need for further research with standardized methodologies to improve understanding and refine therapeutic strategies. This review provides a foundation for future studies aiming to enhance tinnitus management by addressing underlying TMD-related mechanisms.

Is there a comorbid relationship between temporomandibular disorders and otologic signs/symptoms?: An umbrella review

OBJECTIVE

This umbrella review (UR) explored the possible associations between temporomandibular disorders (TMDs) and otologic signs/symptoms (OSs) and established the potential impact of TMD interventions on OSs.

METHODS

A systematic review of systematic reviews (SRs)/meta-analyses (MAs) was conducted according to the PRISMA guidelines and Joanna Briggs Institute UR protocol. Electronic search of the PubMed, Scopus, Web of Science, and Open Grey databases was conducted and the quality of the identified studies was assessed using the AMSTAR2 criteria.

RESULTS

Out of 923 and 157 articles screened for the first and second focus questions respectively, a total of 8 SRs/MAs fulfilled the eligibility criteria. The prevalence of OSs in TMD patients and contrariwise varied substantially up to 85.0-95.0%. Available evidence indicates that TMDs are associated with OSs, and TMD treatment reduced OSs.

CONCLUSION

Findings suggest that a comorbid relationship between TMDs and OSs exists, and therapeutic TMD interventions improve OSs.

The Temporomandibular Joint and the Human Body: A New Perspective on Cross Talk

Background: As a unique joint that facilitates the articulation of the upper and lower jaws, the temporomandibular joint (TMJ) is concerned with several critical functions, such as speech and mastication. Pain that can become incapacitating is a result of temporomandibular disorders (TMDs), which are complex disorders affecting the masticatory muscles and the TMJ. Several anomalies and TMDs have an interdisciplinary relationship. Complementary and concurrent disorders may be caused by occlusal anomalies, psychological disorders, and changes in spine posture. Methods: This article examines the clinical characteristics of TMDs, their classification, their etiological factors, and the impact of TMJ disorders on the human body with reference to their anatomies and histological structures. Results: The clinical picture of some TMJ pathologies may be unknown, so certain biomarkers, such as cytokines, may be useful for an accurate diagnosis as they are frequently seen in TMJ disorders. Furthermore, novel therapeutic approaches that target pro-inflammatory cytokines and treat TMDs by using tissue engineering and regenerative medicine while permitting TMJ cartilage and bone regeneration may offer numerous benefits that require clinical translation. Conclusions: Implementation of recent modalities such as microvesicles and platelet-rich plasma in growth factors may provide a promising approach to enhance bone formation. In addition, we target different biological markers that give insights into the introduction of new pharmaceutical agents for therapy.

Associations between temporomandibular disorders and tinnitus - a systematic review

OBJECTIVES

Temporomandibular disorders (TMD) and tinnitus are highly prevalent conditions, that affects about 10-30% of the adult population and seem to co-exist. The primary objective of this systematic review was to investigate any associations between TMD and tinnitus. The secondary objective was to investigate if the associations differ between painful and non-painful TMDs.

METHODS

An electronic literature search in five databases was performed, from the inception of the databases until 26th of October 2022. This was to identify clinical trials with prevalence numbers of patients with TMD, with and without tinnitus and vice versa. From 1240 studies, a total number of 32 studies were included in the meta-analysis. A risk of bias analysis was made using the Methodological Evaluation of Observational Research (MORE).

RESULTS

Seventeen studies showed low risk of bias, while fifteen studies showed some risk of bias. Among patients with TMD, 57.5% also displayed tinnitus. In contrast, among patients with tinnitus, 92.9% also suffered from TMD. There was a strong association between patients with TMD that also had tinnitus, and patients with tinnitus that also had TMD (p's < 0.001). The odds ratio for TMD-patients also having tinnitus was 1.556 (p < .05), while it for tinnitus-patients also having TMD was 2.859 (p < .05). Six studies examined the psychological status, and there was a higher degree of psychosocial distress among patients with TMD and TMD/tinnitus.

CONCLUSIONS

There is a strong significant association between TMD and tinnitus, but further research is needed to unravel the nature of this association and its clinical implication.

Anatomical variations of the lateral pterygoid plate and their implications for temporomandibular disorders: A CBCT study

OBJECTIVE

TMD is a multifaceted condition with various contributing factors, but the actual impact of the lateral pterygoid plate on the development of TMD remains uncertain. This research aims to investigate the relationship between anatomical variations of the lateral pterygoid plate (LPP), including its angle and proximity to the condyle, and the prevalence of temporomandibular disorders (TMD), to improve diagnostic accuracy and therapeutic approaches for TMD.

MATERIALS & METHODS

A retrospective analysis was conducted on 189 Cone Beam Computed Tomography (CBCT) images of individuals aged 18 to 45. Inclusion criteria were based on definitive diagnoses of degenerative joint disease, excluding individuals with orthodontic treatments, injuries, or craniofacial disorders.Participants were divided into TMD and control groups using standardized DC/TMD protocols for assessment. A radiologist, blinded to the patient's clinical status, then analyzed the CBCT images. LPP dimensions, angles, and condyle distances were measured using OnDemand 3D Imaging Software.

RESULTS

The study found a statistically significant higher average LPP length in females compared to males (right LPP p < 0,001, left LPP p = 0,004), with no significant differences in LPP-condyle distances and angles between genders. Comparing the TMD and control groups revealed a positive correlation between lateral plate angles and TMJ disorders (p = 0,044), suggesting a potential biomechanical linkage.

CONCLUSION

Conclusively, the study challenges the assumption that LPP anatomical variations significantly impact TMD while underscoring a potential link between LPP angle and TMD. The novel insight into the potential role of the LPP angle in TMD provides a new direction for research and clinical practice, emphasizing the importance of considering subtle anatomical differences in the management of TMD.

Depression and the risk of developing temporomandibular disorders in different diagnostic groups: A systematic review with meta-analysis

OBJECTIVE

To evaluate the role of depression in the development of TMD groups.

METHODS

This systematic review with meta-analysis compared the prevalence and scores of depression between TMD groups and controls.

RESULTS

The results showed that depression was a significant risk factor in the development of RDC/TMD axis I muscle disorders (group I) and arthralgia/osteoarthritis/osteoarthrosis (group III), and non-significant for disc displacements (group II). Severe depression had almost four times the risk of developing TMD as compared to moderate depression.

CONCLUSION

These findings suggest that addressing psychological factors in general, and depression in particular, in the managemenof TMD is crucial, especially in those TMD groups with higher pain levels (I and III), and the TMD pain reduction is crucial in reducing depression levels.

Comparing tinnitus, pain, psychosocial and cognitive factors between patients with tinnitus and pain: A systematic review

OBJECTIVE

Tinnitus is a multifactorial symptom, which shows similarities with the involved mechanisms in chronic pain. The aim of this systematic review is to provide an overview of studies comparing patients with only tinnitus to patients with pain (headache, temporomandibular joint (TMJ) pain or neck pain) with or without tinnitus, regarding tinnitus-related, pain-related, psychosocial and cognitive factors.

METHODS

This systematic review was written following the PRISMA guidelines. To identify relevant articles, PubMed, Web of Science and Embase databases were searched. The risk of bias was rated using the Newcastle Ottawa scale for case-control studies.

RESULTS

Ten articles were included in the qualitative analysis. The risk of bias ranged from low to moderate. Low to moderate evidence shows that patients with tinnitus experience higher mean symptom intensity, but lower psychosocial and cognitive distress, compared to patients with pain. Inconsistent results were found for tinnitus-related factors. Low to moderate evidence points to a higher severity of hyperacusis and psychosocial distress in patients with both pain and tinnitus, compared to patients with tinnitus only, as well as for positive associations between tinnitus-related factors and the presence or intensity of pain.

CONCLUSION

This systematic review shows that psychosocial dysfunctions are more clearly present in patients with pain only, compared to patients with tinnitus only and the co-occurrence of tinnitus and pain increases psychosocial distress as well as hyperacusis severity. Some positive associations were identified between tinnitus-related and pain-related factors.

Prevalence of self-reported symptoms of temporomandibular disorders and associated factors in the period of distance learning

OBJECTIVE

Assess the prevalence of self-reported TMD symptoms and anxiety and check the quality of sleep and life during the distance learning period in university students at the University of Brasilia (UnB).

MATERIALS AND METHODS

The participants were students from the Health Sciences College and Medicine College at UnB. Self-administered questionnaires were used to evaluate symptoms of TMD, quality of life, and sleep quality. One-way analysis of variance, followed by Bonferroni test, and Kruskal-Wallis test, followed by Dunn's test, were performed (P < 0.05). For qualitative data analysis, the chi-square test was applied (P < 0.05).

RESULTS

Total 156 students were included; prevalence of TMD, anxiety, sleep disturbance, and poor sleep quality was 73.1%, 84%, 12.8%, and 62.8%, respectively. A greater prevalence of painful TMD was observed in students with severe anxiety (P = 0.007). Students with symptoms of painful TMD, severe anxiety, and sleep disorders had statistically worse quality of life.

CONCLUSIONS

The implementation of distance learning in health courses to replace classroom teaching during the COVID-19 pandemic has impacted TMD prevalence, anxiety, quality of life, and sleep quality.

CLINICAL RELEVANCE

Psychological factors are directly associated with TMD symptoms and quality of life, TMD conditions are related to quality of life as well. COVID-19 pandemic and the distance learning in health courses are new situations that can lead to a great impact on mental health and in consequence to TMD conditions and quality of life.

The effects of diet and physical activity induced weight loss on the severity of tinnitus and quality of life: A randomized controlled trial

BACKGROUND & AIMS

Subjective tinnitus is the most common and manifest auditory symptom of an existing pathology in the auditory system. Although the effect of obesity on tinnitus is still uncertain, it is known that increased fat tissue increases the severity and symptoms of tinnitus. In this study, it was aimed to evaluate the effect of weight loss through diet and physical activity on tinnitus.

METHODS

Forty-six obese subjects diagnosed with tinnitus were randomized into the diet + physical activity (PA) (n = 13), diet (n = 16) and the control groups (n = 17). The anthropometric measurements, tinnitus severity scores, tinnitus handicap inventory (THI) scores and short form quality of life (SF-36) scores of the individuals were recorded and compared at the beginning and at the end of the study.

RESULTS

In the diet + PA and diet groups; body weight (diet + PA:-6.5 ± 2.6; diet: -4.1 ± 1) tinnitus severity (diet + PA:-11.0 ± 7.0; diet: -9.0 ± 8.7) and THI scores (diet + FA:-15.0 ± 9.5; diet: -14.0 ± 10.0) significantly decreased compared to the control group (p < 0.01). This decline was more in those with weight loss of ≥5.0% than those with <5.0%. SF-36 score was significantly increased in the diet + PA and diet groups (respectively 10.0 ± 5.5 and 6.0 ± 2.7) compared to the control group (p < 0.05).

CONCLUSIONS

Diet and physical activity intervention ameliorated the tinnitus severity and quality of life in obese patients with tinnitus. However to generalize this findings further studies are needed. REGISTERED UNDER CLINICALTRIALS.

GOV IDENTIFIER NO

NCT00123456.

Audiological Evaluation of Patients With Somatosensory Tinnitus Attributed to Temporomandibular Disorders

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.

Women’s oral health-related quality of life as a risk factor for TMD symptoms. A case-control study

OBJECTIVE

To investigate the association between temporomandibular disorder (TMD) symptoms and women's oral health-related quality of life (OHRQoL).Methods: An observational case-control study was performed with 765 adult women aged 21.5 years on average. Oral Health Impact Profile (OHIP-14) assessed OHRQoL and determined the selection of cases and controls matched by age and marital status at a ratio of 1:4 (153 cases: 612 controls). American Academy of Orofacial Pain's self-explanatory questionnaire assessed the TMD symptoms. The TMD symptoms' impact on OHRQoL was analyzed, estimating the odds ratio with a 95% confidence interval.

RESULTS

Of the women, 86.9% in the case group, and 69.6% in the control group presented some TMD symptoms (p< 0.05). Women with an impacted OHRQoL are 2.95 (95% CI:1.79-4.86) times more likely to report some TMD symptoms (p< 0.05).

DISCUSSION

Women with a negative impact on OHRQoL are more likely to report TMD symptoms.

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.

Temporomandibular disorders, neck disability, and oral parafunctions in tinnitus patients: A cross-sectional epidemiological study from Southern Italy

OBJECTIVE

To assess the prevalence of temporomandibular disorders (TMD) in a sample of tinnitus patients and to determine the association between tinnitus, TMD, neck disability, and oral parafunctions.

METHODS

Seventy-nine tinnitus patients were enrolled and underwent standardized clinical examination for TMD. The tinnitus severity was measured with the Tinnitus Handicap Inventory (THI). The oral parafunctions were self-reported with the Oral Behavior Checklist (OBC). The neck disability was recorded with the Neck Disability Index (NDI).

RESULTS

More than half of the sample presented TMD, and the most frequent diagnosis was TMD pain. Higher THI was observed in TMD-pain individuals, compared to TMD-free (β 18.4; 95%CI 6.7, 30.1; p = 0.002). The OBC showed a significant low-to-moderate positive correlation with the THI (rho= 0.368, p = 0.001), while the NDI did not.

DISCUSSION

Standardized assessment of TMD and oral behaviors should be integrated into the routine diagnostic evaluations of tinnitus patients.

Influence of Clinical, Physical, Psychological, and Psychophysical Variables on Treatment Outcomes in Somatic Tinnitus Associated With Temporomandibular Pain: Evidence From a Randomized Clinical Trial

OBJECTIVE

To assess the influence of clinical, psychological, and psychophysical variables on treatment outcomes after application of exercise combined with education with/without manual therapy in people with tinnitus associated with temporomandibular disorder (TMD).

METHODS

A secondary analysis of a clinical trial was performed investigating the effectiveness of including cervico-mandibular manual therapy into an exercise combined with education program in 61 subjects with TMD-related tinnitus. Clinical outcomes including tinnitus severity and tinnitus-related handicap were assessed at 3 and 6 months post-intervention. Patients were assessed at baseline for clinical (tinnitus severity, tinnitus-related handicap, quality of life), physical (range of motion), psychological (depression), and psychophysical (pressure pain thresholds [PPTs]) variables that were included as predictors.

RESULTS

The regression models indicated that higher scores of tinnitus severity at baseline predicted better outcomes 3 and 6 months post-intervention (explaining 13% to 41% of the variance) in both groups. Higher scores of tinnitus-related handicap at baseline predicted better outcome of tinnitus-related handicap (45% variance) in the manual therapy with exercise/education group. Lower PPTs over the temporalis muscle at baseline predicted poorer clinical outcomes (10.5% to 41% of the variance) in both groups. Other predictors were sex and quality of life (6.7% variance) in the manual therapy group and PPTs over the masseter muscle (5.8% variance) in the exercise/education group.

CONCLUSION

This study found that baseline tinnitus severity and localized PPT over the temporalis muscle were predictive of clinical outcomes in individuals with TMD-related tinnitus following physical therapy. Other predictors (eg, sex, quality of life) were less influential.

The discomallear ligament: anatomical, microscopical, and radiologic analysis

BACKGROUND

Several anatomic relationships between the ear and the temporo-mandibular joint have been proposed to account for the presence of tinnitus during temporo-mandibular disorders. Among the otomandibular structures, the discomallear ligament (DML) is interposed between the malleus and the retrodiscal capsular complex. The aim of present paper was to study through dissection the frequency and morphology of DML, to characterize its type of collagen, and to evaluate the DML on routine computed tomography (CT).

METHODS AND RESULTS

The study has been conducted on five un-embalmed adult cadavers, and in all cases, the DML was present (100%). It was constituted mainly by fibers of collagen I, with abundant elastic fibers. On CT exams of 40 patients with no reported pathology of the ear, on axial images, a dense structure, going from the upper end of the petrotympanic fissure to the neck of the malleus, was present in all the cases. In 90%, it showed a triangular shape, in 5% a rectangular shape, and in 5% a curved course. The mean length of the antero-medial side was 2 ± 0.6 mm and that of the antero-lateral side was 1.63 ± 0.5, and the mean area was 1.29 ± 0.83 mm².

CONCLUSION

The DML could represent an anatomical structure that joining the temporo-mandibular joint and the malleus may play a role in the otologic symptoms during temporo-mandibular disorders.

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

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.

Association Between Tinnitus and Temporomandibular Disorders: A Systematic Review and Meta-Analysis

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.

Depression in Patients with Tinnitus: A Systematic Review

OBJECTIVE

Tinnitus is a condition that causes distress and impairment across cognitive, functional, and psychiatric spectra. In the psychiatric realm, tinnitus has long been associated with depression. To better characterize the co-occurrence of depression and tinnitus, we performed a systematic review of the prevalence of depression among patients with tinnitus.

DATA SOURCES

We comprehensively examined original studies reporting the prevalence of depression in adult populations with tinnitus, as indexed in the PubMed and Web of Science databases and published from January 2006 to August 2016.

REVIEW METHODS

All identified articles were reviewed independently by 2 researchers, with a third reviewer for adjudication. Included studies were evaluated for threats to validity across 3 domains-representativeness, response rate, and ascertainment of outcome-on a 4-point modified Newcastle-Ottawa Quality Assessment Scale.

RESULTS

Twenty-eight studies were included, representing 15 countries and 9979 patients with tinnitus. Among the included studies, the median prevalence of depression was 33%, with an interquartile range of 19% to 49% and an overall range of 6% to 84%. Studies were high quality overall, with a mean score of 3.3 (SD = 0.76), and 89% utilized a validated tool to ascertain depression.

CONCLUSIONS

We conducted one of the largest contemporary comprehensive reviews, which suggests a 33% prevalence of depression among patients with tinnitus. Our review reaffirms that a substantial proportion of patients with tinnitus have depression, and we recommend that all who treat tinnitus should screen and treat their patients for depression, if present.

Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review

Movements of the neck and jaw may modulate the loudness and pitch of tinnitus. The aim of the present study was to systematically analyze the strength of associations between subjective tinnitus, cervical spine disorders (CSD), and temporomandibular disorders (TMD). A systematic literature search of the Medline, Embase, and Pedro databases was carried out on articles published up to September 2017. This covered studies in which tinnitus and CSD or TMD were studied as a primary or a secondary outcome and in which outcomes were compared with a control group. Included articles were evaluated on nine methodological quality criteria. Associations between tinnitus and CSD or TMD were expressed as odds ratios. In total, 2,139 articles were identified, of which 24 studies met the inclusion criteria. Twice, two studies were based on the same data set; consequently, 22 studies were included in the meta-analysis. Methodological quality was generally limited by a lack of blinding, comparability of groups, and nonvalidated instruments for assessing CSD. Results indicated that patients with tinnitus more frequently reported CSD than subjects without tinnitus. The odds ratio was 2.6 (95% CI [1.1, 6.4]). For TMD, a bidirectional association with tinnitus was found; odds ratios ranged from 2.3 (95%CI [1.5, 3.6]) for arthrogenous TMD to 6.7 (95%CI [2.4, 18.8]) for unspecified TMD. Funnel plots suggested a publication bias. After adjusting for this, the odds ratios decreased, but associations persisted. There is weak evidence for an association between subjective tinnitus and CSD and a bidirectional association between tinnitus and TMD.

Subtyping patients with somatic tinnitus: Modulation of tinnitus and history for somatic dysfunction help identify tinnitus patients with temporomandibular joint disorders

OBJECTIVE

Determine in a cohort of patients with normal hearing and chronic tinnitus if self-reported history for temporomandibular joint (TMJ) dysfunction and a positive modulation of tinnitus in the TMJ region could be suggestive of an underlying TMJ disorder.

PATIENTS AND METHODS

The study included 226 patients presenting to the Head and Neck Service of our University Hospital. Following audiological and somatic tinnitus evaluation, patients were divided into two groups. The study group (n = 134) included subjects that met both the following criteria: A) a self-reported history for TMJ dysfunction and B) a positive modulation of tinnitus following somatic maneuvers in the TMJ region. The control group (n = 92) included patients with similar demographic and tinnitus characteristics that did not meet the proposed criteria for somatic tinnitus. Afterwards, patients underwent clinical TMJ evaluation in the Service of Clinical Gnathology of our University.

RESULTS

One hundred thirty-one patients (57.9%) received a clinical diagnosis of TMJ disorder according to DC/TMD Axis I; 79.1% in the study group and 27.2% in the control group. Ninety-five (42.1%) patients were negative for TMJ disorders; 20.9% in the study group and 72.8% in the control group. A significantly higher number of TMJ disorders was found in patients in the study group compared to the control group (p<0.0001). Most patients had joint disorders (67.2%), followed by other (29.8%) and pain disorders (29%). Logistic regression analysis in the study group showed that female gender was more prevalent in patients with TMJ disorders.

CONCLUSION

Our findings in patients with chronic tinnitus and normal hearing suggest that self-reported history for somatic dysfunction and modulation of tinnitus, when occurring simultaneously in the TMJ region, can be useful to preliminarily identify patients with TMJ disorders.

Prevalence of signs and symptoms of temporomandibular disorders in college preparatory students: associations with emotional factors, parafunctional habits, and impact on quality of life

The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) signs and symptoms, its correlation with gender, parafunctional habits, emotional stress, anxiety, and depression and its impact on oral health-related quality of life (OHRQL) in college preparatory students at public and private institutions in João Pessoa, Paraíba (PB). The sample consisted of 303 students. Presence of TMD symptoms was determined by an anamnesis questionnaire containing questions related to the presence of parafunctional habits and emotional stress. A simplified clinical evaluation protocol was used. Anxiety and depression were determined with the Hospital Anxiety and Depression (HAD) scale and the OHRQL using the short version contained in the Oral Health Impact Profile (OHIP-14). The Chi-square, Fisher Exact, Mann Whitney, and Kruskal-Wallis tests were performed. Presence of signs and symptoms of TMD was statistically associated (p ≤ 0,05) with female gender, parafunctional habits, emotional stress, and anxiety, and represented greater impairment of the OHRQL. The physical pain domain was the most affected. The increased prevalence of signs and symptoms of TMD among college preparatory students indicates that there is a need for education and clarification among teachers and students to improve early diagnosis and to prevent the problem.

Association between temporomandibular disorders, chronic diseases, and ophthalmologic and otolaryngologic disorders in Korean adults: A cross-sectional study

INTRODUCTION

Temporomandibular disorders (TMDs) are common musculoskeletal conditions in the maxillofacial area. Although strong relationships between TMDs and other pain and diseases exist, few studies have comprehensively assessed the association between chronic diseases, ophthalmologic and otolaryngologic disorders and TMD.

METHODS

Of 25,534 individuals included in the fifth Korea National Health and Nutrition Examination Survey (2010-2012), 17,575 aged ≥20 years who completed survey items on TMD symptoms were included for cross-sectional analysis. Logistic regression analysis was performed to assess the association between chronic diseases, ophthalmologic and otolaryngologic disorders and examination findings, and TMD symptoms after adjusting for various confounding variables.

RESULTS

Out of 17,575 participants, 2,059 (11.75%) reported experience of ≥1 TMD symptom(s). Compared to individuals without chronic disease, those with asthma (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.09-1.96), migraine (1.44; 1.26-1.65), osteoarthritis (1.51; 1.20-1.89), thyroid dysfunction (1.49; 1.13-1.96), and depressive symptoms (1.51; 1.29-1.77) had higher ORs for TMD prevalence. Participants with tinnitus (1.97; 1.70-2.27), hearing difficulties (1.55; 1.29-1.87), dizziness (1.52; 1.27-1.82), rhinitis (1.46; 1.28-1.65), and xerophthalmia (1.82; 1.57-2.12) also displayed higher ORs for TMD prevalence. Patients diagnosed with chronic rhinosinusitis upon otolaryngologic examination exhibited an OR of 1.44 (95% CI 1.11-1.87) for TMD prevalence, while that for individuals with abnormal laryngoscopic results was 0.57 (95% CI 0.36-0.90).

CONCLUSIONS

These findings imply that TMDs, chronic diseases, and ophthalmologic and otolaryngologic disorders hold various correlations, suggesting the need for multitarget approaches to effectively address this phenomenon.

Somatosensory tinnitus: Current evidence and future perspectives

In some individuals, tinnitus can be modulated by specific maneuvers of the temporomandibular joint, head and neck, eyes, and limbs. Neuroplasticity seems to play a central role in this capacity for modulation, suggesting that abnormal interactions between the sensory modalities, sensorimotor systems, and neurocognitive and neuroemotional networks may contribute to the development of somatosensory tinnitus. Current evidence supports a link between somatic disorders and higher modulation of tinnitus, especially in patients with a normal hearing threshold. Patients with tinnitus who have somatic disorders seems to have a higher chance of modulating their tinnitus with somatic maneuvers; consistent improvements in tinnitus symptoms have been observed in patients with temporomandibular joint disease following targeted therapy for temporomandibular disorders. Somatosensory tinnitus is often overlooked by otolaryngologists and not fully investigated during the diagnostic process. Somatic disorders, when identified and treated, can be a valid therapeutic target for tinnitus; however, somatic screening of subjects for somatosensory tinnitus is imperative for correct selection of patients who would benefit from a multidisciplinary somatic approach.

Temporal relationship between dysthymia and temporomandibular disorder: a population-based matched case-control study in Taiwan

Background

Numerous studies have reported a relationship between depression and temporomandibular disorders (TMD), but the conclusions remain undefined. The aim of this article was to examine the temporal relationship between depression and TMD.

Methods

In this retrospective matched case-control study, we recruited all samples from a randomsample sub-dataset of one million insured individuals for the year 2005 (Longitudinal Health Insurance Database (LHID2005)). All beneficiaries were enrolled in the National Health Insurance (NHI) programme in Taiwan. We used propensity scoring and matched the case and control groups (1:1) by ten confounding factors to detect the effect of different types of depression on TMD.

Results

The positive correlative factors of TMD included the total number of times medical advice was sought for an unspecified anomaly of jaw size plus malocclusion (TTSMA-JS, p = 0.045), the total number of times medical advice was sought for an anxiety state (TTSMA-AS, p = 0.000), and the total number of times medical advice was sought for a panic disorder (TTSMA-P, p = 0.009). Dysthymia (synonymous with chronic depression) had an effect on TMD. The odds ratio (OR) of dysthymia for TMD measured by multiple logistic regression was 1.91 (p = 0.008) after adjusting for demographic factors, psychiatric comorbidities, and maxillofacial confounders.

Conclusions

This study demonstrated the established temporal relationship between dysthymia and TMD. The inclusion of a psychiatrist on the TMD management team is appropriate.

Dysthymia increases the risk of temporomandibular disorder: A population-based cohort study (A STROBE-Compliant Article)

Numerous studies have investigated the relationship between depression and temporomandibular disorders (TMD), but the conclusions remain vague. The aim of this study was to examine the causal effect between depression and TMD.The reporting of this study conforms to the STROBE statement. In this retrospective cohort study, all samples were recruited from a representative subdataset of 1 million insured persons for the year 2005 Longitudinal Health Insurance Database, who were randomly selected from all beneficiaries enrolled in the National Health Insurance program of Taiwan. We used a propensity score and stratified 926,560 patients into 2 groups (propensity1 = 588,429 and propensity2 = 338,131) and 4 cohorts (propensity1 with depression = 18,038, propensity1 without depression = 570,391, propensity2 with depression = 38,656, propensity2 without depression = 299,475) to detect the development of TMD among the depressive and nondepressive patients between 2004 and 2013.The positive correlative factors of TMD included female, total number of times seeking medical advice (TTSMA) for anxiety state, TTSMA for generalized anxiety disorder, TTSMA for mandible fracture, and TTSMA for unspecified anomaly of jaw size. The propensity2 group was represented by elder and female-predominant patients who used more psychiatric health resources. Among 3 types of depression, only dysthymia (so-called chronic depression) had a causal impact on TMD in the propensity 2 group. In the propensity 2 group, the hazard ratio of dysthymia for TMD measured by Cox's regression was 1.64 (95% confidence interval 1.28-2.09), after adjusting for demographic factors, psychiatric comorbidities, and maxillofacial confounders. The first-onset mean time of TMD as the consequence of dysthymia was 3.56 years (sd = 2.74, min = 0.08, median = 2.99, max = 9.73).This study demonstrates that dysthymia increases the risk of TMD in elderly and female-predominant patients who use more psychiatric health resources.

Reported concepts for the treatment modalities and pain management of temporomandibular disorders

Background

Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical management.

Methods

A survey was performed using the PubMed, SCOPUS and CINAHL databases for documents published between 1994 and 2014. The following search keywords were selected using MeSH terms of the National Library of Medicine in combination: TMD pain, TMD, TMJ, TMJ disorders, occlusal splint, TMD physiotherapy, TMJ rheumatoid disorders and TMJ surgery. Original articles and review papers which presented the clinical relevance and practical validity regarding the possibility of application in TMD management have been included. Authors have excluded articles without outstanding practical aspect and evidence-based background. A first selection was carried out by reviewing titles and abstracts of all articles found according to the criteria. After that the full texts of potentially suitable articles were assessed. In line with these criteria, among 11467 results the writers have included 66 papers.

Results

The most commonly reported conservative treatments are massage therapy and individually fabricated occlusal splints. In addition to massage, other popular methods include manual therapy and taping, warming/cooling of aching joints, and light and laser therapy. Drugs are also commonly used. In the most severe cases of the temporomandibular joint degeneration, surgical restoration of the joint is sometimes applied.

Conclusions

The authors concluded that conservative treatment including counselling, exercises, occlusal splint therapy, massage, manual therapy and others should be considered as a first choice therapy for TMD pain because of their low risk of side effects. In the case of severe acute pain or chronic pain resulting from serious disorders, inflammation and/or degeneration pharmacotherapy, minimally invasive and invasive procedures should be considered.

Correlation Between Tinnitus and Petrotympanic Fissure Status Among Patients With Temporomandibular Joint Dysfunction

PURPOSE

The objective of this study was to evaluate the correlation between tinnitus and petrotympanic fissure (PTF) subtypes in patients diagnosed with temporomandibular joint dysfunction (TMD).

MATERIALS AND METHODS

One hundred patients with TMD (50 with tinnitus, 50 without tinnitus) were evaluated retrospectively using cone-beam computed tomography (CBCT). CBCT images were analyzed according to PTF subtype diagnosis (types 1 to 3). PTF structure was classified as type 1 (wide tubular formation), type 2 (double conical structure), or type 3 (single conical structure).

RESULTS

Although there was a negative correlation between tinnitus and PTF type (P < .001), there was no correlation between age and tinnitus or between age and subtype of PTF. There was no significant association between gender and tinnitus or PTF type (P > .05).

CONCLUSIONS

A short, wide PTF (type 1) might be associated with an increased incidence of tinnitus in patients with TMD.