Are temporomandibular disorders and tinnitus associated?

The current study aimed to research the prevalence of temporomandibular disorders (TMD) in patients with subjective tinnitus, as compared to controls, and the association between symptoms of TMD, tinnitus, and chronic pain. Two hundred patients were divided into two groups, according to the presence (experimental) or not (control) of subjective tinnitus. The subgroups were determined according to the RDC/TMD criteria. The Pain Pressure Threshold (PPT) values of the masseter and temporalis muscles were recorded bilaterally, and a Visual Analog Scale (VAS) was used to address subjective pain. The most prevalent TMD subgroups in the tinnitus patients (p < 0.05) were myofascial pain with limited opening (39.0%), disc displacement with reduction (44.33%), and arthralgia (53.54%). The severity of tinnitus was significantly associated with the severity of chronic pain (p = .000). The PPT values were lower (p > 0.05), while the Visual Analog Scale (VAS) was statistically higher (p = .000) for the tinnitus patients. These results suggest that an association exists between TMD and subjective tinnitus.

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.

Effects of the hyaluronic acid infiltration in the treatment of internal temporomandibular joint disorders / Efeitos da infiltração de ácido hialurônico no tratamento das desordens internas da articulação temporomandibular

ABSTRACT BACKGROUND AND OBJECTIVES: The primary protocol for the control of temporomandibular disorders prioritizes reversible and less invasive measures. However, conservative treatment is sometimes ineffective. Therefore, the use of hyaluronic acid has been suggested as a therapeutic alternative to verify the effectiveness of the hyaluronic acid in patients who are not responsive to the most conservative treatments, helping them in the control of pain. This article aims to perform a literature review on the efficacy of this substance in the treatment of internal changes of the temporomandibular joint. CONTENTS: The search strategy used the Pubmed portal and the Web of Science database for the last 10 years. We included articles in English that evaluated the efficacy of the hyaluronic acid in the intra-articular disorders of temporomandibular joint, and excluded articles from literature review, clinical case reports, theses, and dissertations. Fifteen studies, classified as randomized clinical trials, prospective and retrospective studies, case-control, pilot study, and systematic reviews were selected. The hyaluronic acid is of fundamental importance in the function and lubrication of joint tissues due to its high molecular weight. When degenerative and inflammatory changes are present, their concentration and molecular weight are diminished, and the injection of this acid raises these levels, which can generate pain relief. CONCLUSION: Intra-articular therapy with hyaluronic acid is effective in the reduction of symptomatologic levels and the functional restoration of the temporomandibular joint.

RESUMO JUSTIFICATIVA E OBJETIVOS: O protocolo primário de controle das disfunções temporomandibulares prioriza as medidas reversíveis e menos invasivas. Entretanto, o tratamento conservador mostra-se, algumas vezes, ineficaz, e como alternativa terapêutica, tem sido sugerido o uso de ácido hialurônico para com isso, verificar a sua efetividade em pacientes não responsivos aos tratamentos mais conservadores e poder ajudá-los no controle da dor. O objetivo deste estudo foi rever na literatura a eficácia dessa substância no tratamento das alterações internas da articulação temporomandibular. CONTEÚDO: A estratégia de busca utilizou o portal eletrônico Pubmed e a base de dados Web of Science, nos últimos 10 anos. Foram incluídos artigos em inglês que avaliaram a eficácia do ácido hialurônico nas desordens intra-articulares da articulação temporomandibular, e excluídos artigos de revisão de literatura, relatos de casos clínicos, teses e dissertações. Foram selecionados 15 estudos, classificados como ensaios clínicos randomizados, estudos prospectivos e retrospectivos, caso-controle, estudo piloto e revisões sistemáticas. O ácido hialurônico tem importância fundamental na função e lubrificação dos tecidos articulares, devido ao seu alto peso molecular. Quando alterações degenerativas e inflamatórias estão presentes, sua concentração e peso molecular estão diminuídos, e a injeção desse ácido eleva esses níveis, o que pode gerar alívio da dor. CONCLUSÃO: A terapia intra-articular com ácido hialurônico é efetiva na diminuição dos níveis sintomatológicos e no restabelecimento funcional da articulação temporomandibular.

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report.

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

A Academia Americana de Dor Orofacial (AAOP) define anquilose da Articulação Temporomandibular (ATM) como restrição dos movimentos devido à adesão fibrosa intracapsular, alterações fibrosas nos ligamentos capsulares (fibroanquilose) e formação de massa óssea resultando na fusão dos componentes articulares (anquilose óssea). As características clínicas da Fibroanquilose são: capacidade severamente limitada de abertura bucal geralmente sem dor e sem ruídos articulares, com marcada deflexão para o lado afetado e marcada limitação de movimentos para o lado contralateral. Uma variedade de fatores pode causar anquilose da ATM, como trauma, condições inflamatórias locais e/ou sistêmicas, neoplasias e infecção na ATM. A artrite reumatóide (AR) é uma dessas condições sistêmicas inflamatórias que pode afetar a ATM e causar anquilose. O objetivo desse estudo é apresentar um caso de uma paciente, diagnosticada com Fibroanquilose da ATM bilateral e assintomática associada à AR. Esse caso ilustra a importância de um exame clínico bem realizado com exames complementares pode levar a um diagnóstico correto de Fibroanquilose da ATM e da importância do diagnóstico diferencial em casos de abertura bucal restrita.