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van der Wal A1, Michiels S2, van de Heyning P3, Braem M3, Gilles A3, Topsakal V3, Visscher C4, De Hertogh W2
1Universiteit Antwerpen, Wilrijk, Belgium, 2University of Antwerp, Antwerpen, Belgium, 3University Hospital of Antwerp, Antwerpen, Belgium, 4ACTA, 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. It can cause serious problems in daily life like sleep disturbances and concentration problems. There are two types of tinnitus: objective and subjective. Objective tinnitus is rare (less than 5% of open population) and can be caused by middle ear tumors or turbulent blood flow. On the other hand, the pathophysiological mechanism of subjective tinnitus is less clear and consequently more complicated. Several risk factors such as hearing loss and noise trauma have been described.
Additionally, subjective tinnitus can be influenced by the somatosensory system, then called 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, and indicates that TMD treatment might be beneficial for patients with ST.
Purpose: To evaluate the effect of TMD treatment on tinnitus severity and intensity in patients with ST.
Methods: Patients were recruited by otolaryngologists at a tertiary tinnitus clinic. They were included when suffering from moderate to severe subjective tinnitus (Tinnitus Functional Index between 25-90 points) and TMD (based on the Diagnositic Criteria for TMD).
Patients were randomly allocated to a standard care group (SC group) or a standard care with adjuvant TMD treatment group (SCA group). The SC group received standard information and advice about tinnitus. The SCA group received standard information and advice and additional TMD treatment (physical therapy and/or occlusal splints).
The outcome measures for tinnitus severity and intensity were the Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) collected at baseline (week 0) and after therapy (week 9).
Differences in changes of the TFI and TQ between both treatment groups were compared.
Results: A sample of 10 patients was recruited (5 patients in each group). On baseline, no significant differences in both groups were found for TFI and TQ.
Averagely, patients in the SCA group scored 49,04 points on TFI and 36,50 points on TQ. The baseline scores of the SC group was 40,16 on TFI and 37,0 on TQ. After 9 weeks treatment patients in the SCA group showed a decrease of 7,84 points on TFI and 4,70 points on TQ. The SC group had a small decrease of 1,84 points of TFI and 0,40 points on TQ.
Conclusion(s): Based on this pilot study, it appears that TMD treatment can be beneficial for patients suffering from ST. Further research to confirm these data in a larger population is ongoing (NCT03209297).
Implications: The results of this pilot are of high scientific importance to substantiate ongoing RCT´s. In the meantime, TMD treatment might be carefully applied in patients with tinnitus and TMD.
Keywords: Somatosensory, tinnitus, temporomandibular disorders
Funding acknowledgements: The first and second author are funded through FWO Belgium.
Additionally, subjective tinnitus can be influenced by the somatosensory system, then called 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, and indicates that TMD treatment might be beneficial for patients with ST.
Purpose: To evaluate the effect of TMD treatment on tinnitus severity and intensity in patients with ST.
Methods: Patients were recruited by otolaryngologists at a tertiary tinnitus clinic. They were included when suffering from moderate to severe subjective tinnitus (Tinnitus Functional Index between 25-90 points) and TMD (based on the Diagnositic Criteria for TMD).
Patients were randomly allocated to a standard care group (SC group) or a standard care with adjuvant TMD treatment group (SCA group). The SC group received standard information and advice about tinnitus. The SCA group received standard information and advice and additional TMD treatment (physical therapy and/or occlusal splints).
The outcome measures for tinnitus severity and intensity were the Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) collected at baseline (week 0) and after therapy (week 9).
Differences in changes of the TFI and TQ between both treatment groups were compared.
Results: A sample of 10 patients was recruited (5 patients in each group). On baseline, no significant differences in both groups were found for TFI and TQ.
Averagely, patients in the SCA group scored 49,04 points on TFI and 36,50 points on TQ. The baseline scores of the SC group was 40,16 on TFI and 37,0 on TQ. After 9 weeks treatment patients in the SCA group showed a decrease of 7,84 points on TFI and 4,70 points on TQ. The SC group had a small decrease of 1,84 points of TFI and 0,40 points on TQ.
Conclusion(s): Based on this pilot study, it appears that TMD treatment can be beneficial for patients suffering from ST. Further research to confirm these data in a larger population is ongoing (NCT03209297).
Implications: The results of this pilot are of high scientific importance to substantiate ongoing RCT´s. In the meantime, TMD treatment might be carefully applied in patients with tinnitus and TMD.
Keywords: Somatosensory, tinnitus, temporomandibular disorders
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.
