van der Wal A1, Michiels S1, van de Heyning P2, Braem M2, Gilles A2, Topsakal V2, Visscher C3, De Hertogh W1
1University of Antwerp, Antwerpen, Belgium, 2University Hospital of Antwerp, Antwerpen, Belgium, 3ACTA, Amsterdam, Netherlands
Background: Tinnitus or ringing in the ears, is a common symptom with a prevalence ranging from 10 to 15 % in an open population that can cause serious problems in daily life like sleep disturbances, concentration and communication problems.
One specific type of tinnitus can be influenced by the somatosensory system, then called somatic or somatosensory tinnitus (ST). ST is pathophysiologically explained by activity in connecting fibers between the dorsal cochlear nucleus (DCN) and the somatosensory nuclei which are located in the medulla. Through these fibers, altered cervical and temporomandibular somatosensory information can increase spontaneous firing rates of the DCN, causing tinnitus or altering an existing tinnitus. This mechanism can explain the greater prevalence of tinnitus in patients with temporomandibular disorders (TMD) (30.4% to 64%), compared to the prevalence in the general population (10% to 15%). The effect of TMD treatment on tinnitus severity has been shown in case studies and case series, but currently no information is available on the type of masticatory dysfunctions present in patients with ST. Likewise, no data are available on masticatory disfunctions in patients with other types of tinnitus.
Purpose: The aim of this study is to define the differences in the clinical characteristics of patients with TMD and tinnitus and patients with other types of tinnitus.
Methods: Patients were recruited by otolaryngologists at a tertiary tinnitus clinic. All patients were assessed based on medical history, Ear-Nose-Throat (ENT) examination with audiometry and brain MRI (Magnetic Resonance Imaging). Based on this information two groups were created, one group with TMD-related ST and a second group with other types of tinnitus.
The following parameters were compared: age, gender, tinnitus duration, measuring tinnitus loudness using VAS, tinnitus severity using Tinnitus Functional Index TFI and presence of bruxism, arthralgia of the temporomandibulair joint and myalgia of the masticatory muscles.
Results: In total 47 patients with tinnitus attributed to TMD and 99 patients with other types of tinnitus were included. No significant differences were found for age, gender, tinnitus duration, TFI score and VAS mean loudness.
However, in the TMD group bruxism was reported more frequently. Of this group 87% has bruxism compared to 12% in the other group. Similar percentages of myalgia were diagnosed in both groups. In the TMD group 16% was diagnosed with arthralgia compared to none in the other group.
Conclusion(s): Based on these results, there were no significant differences in tinnitus parameters between both groups. This means that it is difficult to identify ST or another type of subjective tinnitus based on tinnitus parameters.
On the other hand, bruxism, myalgia and arthralgia were far more prevalent in the TMD group. These parameters should be further investigated.
Implications: These data are clinically important because questioning TMD parameters during history taking can help to identify ST.
Keywords: Temporomandibular disorders, tinnitus, clinical characteristics
Funding acknowledgements: The first and second author are funded through FWO Belgium
One specific type of tinnitus can be influenced by the somatosensory system, then called somatic or somatosensory tinnitus (ST). ST is pathophysiologically explained by activity in connecting fibers between the dorsal cochlear nucleus (DCN) and the somatosensory nuclei which are located in the medulla. Through these fibers, altered cervical and temporomandibular somatosensory information can increase spontaneous firing rates of the DCN, causing tinnitus or altering an existing tinnitus. This mechanism can explain the greater prevalence of tinnitus in patients with temporomandibular disorders (TMD) (30.4% to 64%), compared to the prevalence in the general population (10% to 15%). The effect of TMD treatment on tinnitus severity has been shown in case studies and case series, but currently no information is available on the type of masticatory dysfunctions present in patients with ST. Likewise, no data are available on masticatory disfunctions in patients with other types of tinnitus.
Purpose: The aim of this study is to define the differences in the clinical characteristics of patients with TMD and tinnitus and patients with other types of tinnitus.
Methods: Patients were recruited by otolaryngologists at a tertiary tinnitus clinic. All patients were assessed based on medical history, Ear-Nose-Throat (ENT) examination with audiometry and brain MRI (Magnetic Resonance Imaging). Based on this information two groups were created, one group with TMD-related ST and a second group with other types of tinnitus.
The following parameters were compared: age, gender, tinnitus duration, measuring tinnitus loudness using VAS, tinnitus severity using Tinnitus Functional Index TFI and presence of bruxism, arthralgia of the temporomandibulair joint and myalgia of the masticatory muscles.
Results: In total 47 patients with tinnitus attributed to TMD and 99 patients with other types of tinnitus were included. No significant differences were found for age, gender, tinnitus duration, TFI score and VAS mean loudness.
However, in the TMD group bruxism was reported more frequently. Of this group 87% has bruxism compared to 12% in the other group. Similar percentages of myalgia were diagnosed in both groups. In the TMD group 16% was diagnosed with arthralgia compared to none in the other group.
Conclusion(s): Based on these results, there were no significant differences in tinnitus parameters between both groups. This means that it is difficult to identify ST or another type of subjective tinnitus based on tinnitus parameters.
On the other hand, bruxism, myalgia and arthralgia were far more prevalent in the TMD group. These parameters should be further investigated.
Implications: These data are clinically important because questioning TMD parameters during history taking can help to identify ST.
Keywords: Temporomandibular disorders, tinnitus, clinical characteristics
Funding acknowledgements: The first and second author are funded through FWO Belgium
Topic: Musculoskeletal
Ethics approval required: Yes
Institution: University of Antwerp
Ethics committee: Ethics committee universiteit Antwerpen
Ethics number: B300201730825
All authors, affiliations and abstracts have been published as submitted.
