MYOFASCIAL DRY NEEDLING OF THE MASTICATORY MUSCLES AS A NOVEL INTERVENTION FOR TREATING TEMPOROMANDIBULAR JOINT RELATED TINNITUS: A CASE STUDY

¹University of Birmingham, Centre of Precision and Rehabilitation for Spinal Pain, Birmingham, United Kingdom

Background: A recent systematic review suggested that otological symptoms are highly prevalent in adults with Temporomandibular Disorders (TMD) with tinnitus being one of the most common (Porto de Toledo et al, 2017). Studies have shown a causal role of TMD in generating and maintaining tinnitus which is linked to the close proximity of the cochlea and the surrounding nerve connections to the Temporomandibular Joint (TMJ). This interaction between the somatosensory and auditory system is known as somatosensory tinnitus. It has been proposed that in the presence of tinnitus without any otological basis, a detailed examination of the TMJ is warranted. Existing literature on proposed treatments for TMJ related somatosensory tinnitus is limited to splint therapy and exercises with low efficacy.

Purpose: To investigate the effectiveness of Myofascial Dry Needling to the masticatory muscles when treating a patient with TMJ related somatosensory tinnitus.

Methods: The subject was selected from a convenience population of a secondary care community clinic and had received prior medical screening from an ENT consultant who identified no apparent otological dysfunction, hence was referred for physiotherapy assessment and treatment. The subject was a 47-year old female, with a 6 month history of persistent R sided tinnitus severely affecting her lifestyle. On physical examination, TMDs were clearly identified. Her mouth opening was limited and painful on the R sided TMJ. Active myofascial trigger points of the R sided primary masticatory muscles (masseter, lateral pterygoid and medial pterygoid) were identified on palpation. Localised twitch responses of these muscles were noted whilst the trigger points were deactivated using long and thin needles with a diameter of 0.25x30 mm for the superficial muscles and 0.25x40 mm for the deeper ones. The patient received 4 dry needling treatment sessions (one session per week for 4 consecutive weeks - 7 days interval). Maximal Mouth Opening (MMO) using a millimetre scale ruler was measured pre and post treatment in each session and at 3 months from last session to evaluate jaw function in relation to treatment. Due to their psychometric properties, Tinnitus Functional Index (TFI) and Tinnitus Handicap Inventory (THI) questionnaires were used as outcome measures to evaluate functional limitations and tinnitus severity respectively. Responses were measured (total score) before the first session and at 3 months after treatment completion.

Results: MMO was improved by 16 mm at the end of the last treatment session with improvement reducing at 11 mm after 3 months (cut off > 6.5 mm for clinically meaningful difference). TFI and THI decreased from 68 to 14 (cut off > 48) and 76 to 16 (cut off > 58) respectively.

Conclusions: Myofascial Dry Needling as an intervention for treating TMJ related somatosensory tinnitus was associated with improvement in jaw function and a substantial decrease in tinnitus severity and functional limitations at 3 months follow up.

Implications: Physiotherapy in the form of myofascial dry needling can be beneficial for a sub-group of tinnitus sufferers. Further research, including high quality randomised controlled trials, is needed to fully explore the potential of this novel intervention in treating TMJ related tinnitus.

Funding acknowledgements: This study was not funded.​

Keywords:
Myofascial Dry Needling
Somatosensory Tinnitus
Temporomandibular Disorders

Topics:
Musculoskeletal
Musculoskeletal: upper limb
Pain & pain management

Did this work require ethics approval? Yes

Institution: University of Birmingham, United Kingdom

Committee: Ethics Committee of the University of Birmingham, United Kingdom

Ethics number: Not available