The Association Between Temporomandibular Disorders and Tinnitus: Evidence and Therapeutic Perspectives from a Systematic Review
Gianna DipalmaAlessio Danilo InchingoloCarmela PezzollaRoberta SardanoIrma TrilliDaniela Di VenereFrancesco InchingoloAndrea PalermoAngelo Michele Inchingolo
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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.Objective:To investigate the characteristics of sudden sensorineural hearing loss (SSHL) patients with tinnitus.Method:Two-hundred and seventy two SSHL patients with tinnitus underwent evalution through Tinnitus Handicap Inventory(THI) and Tinnitus Questionnaire(TQ).Demographic data and tinnitus characteristics were analyzed.Result:In 272 patients,41.6% of patients suffered from low frequency tinnitus,2.0% with medium frequency tinnitus,56.4% with high frequency tinnitus.There were 79% patients whose tinnitus were continous,while 21% were intermittent;From the view point of daily life compromising,37.4% were minor,44.8% were moderate,17.8% were serious.The most important factors that deteriorate tinnitus were bad sleep,noise,life pressure and tiredness.Conclusion:There were individual differences among patients with sudden deafness and tinnitus.Enough evaluation should be made to decrease the infection of tinnitus.
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Individuals with tinnitus and co-occurring psychological conditions typically rate their tinnitus as more disturbing than individuals without such comorbidities. Little is known about how tinnitus self-efficacy, or the confidence that individuals have in their abilities to successfully manage the effects of tinnitus, is influenced by mental or psychological health (PH) status. The purpose of this study was to examine the influence of psychological state on tinnitus perceptions and tinnitus self-efficacy in individuals with chronic tinnitus.Observational study. Three groups (N = 199) were examined and included: (1) those with tinnitus without a concurrent psychological condition (tinnitus-only; n = 103), (2) those with tinnitus and concurrent PH condition other than post-traumatic stress disorder (PTSD; tinnitus + PH; n = 34), and (3) those with tinnitus and PTSD (tinnitus + PTSD; n = 62). The Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) was administered. Responses on the SETMQ were compared among the groups, as well as to other indicators of tinnitus perception such as (1) the percentage of time tinnitus was audible (tinnitus awareness), (2) the percentage of time tinnitus was distressing/bothersome, (3) tinnitus loudness, (4) tinnitus handicap inventory scores, (5) subjective ratings of degree of hearing loss, and (6) subjective ratings of sound tolerance problems.The tinnitus + PTSD group reported significantly poorer tinnitus self-efficacy levels on average than the tinnitus-only group on all SETMQ subscales and poorer self-efficacy levels than the tinnitus + PH group for most subscales (except for routine management and devices). Tinnitus self-efficacy levels were similar between the tinnitus + PH and tinnitus-only groups except for the emotional response subscale in which the tinnitus-only patients reported higher self-efficacy on average than both the other groups. Group differences were not seen for tinnitus loudness ratings nor for the amount of time individuals were aware of their tinnitus. Group differences were observed for the percentage of time tinnitus was distressing/bothersome, self-reported degree of hearing loss, sound tolerance problems ratings, and responses on the tinnitus handicap inventory (THI). In general, the group differences revealed patient ratings for the tinnitus-only group were least severe, followed by the tinnitus + PH group, and the tinnitus + PTSD group rated tinnitus effects as most severe. With all patient responses, the tinnitus + PTSD group was found to be significantly more affected by tinnitus than the tinnitus-only group; in some cases, the responses were similar between the tinnitus + PTSD and tinnitus + PH group and in other cases, responses were similar between the tinnitus + PH group and the tinnitus-only group.Tinnitus self-efficacy, along with other self-assessed tinnitus characteristics, varied across groups distinguished by PH diagnoses. In general, individuals with tinnitus and concurrent PTSD reported significantly poorer tinnitus self-efficacy and more handicapping tinnitus effects when compared to individuals with other psychological conditions or those with tinnitus alone. The group differences highlighted the need to consider tinnitus self-efficacy in intervention strategies, particularly for patients with tinnitus and concurrent PTSD as the results reiterated the unique ability of PTSD to interact in powerful and disturbing ways with the tinnitus experience and with patients' coping ability.
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Tinnitus is one of the Ménière's disease clue symptoms, but by far less studied than vertigo or other types of dizziness. The typical Ménière's tinnitus is a low pitched fluctuating one. Although controversial, cochlear Ménière's disease may account for a tinnitus subtype, a fact that may impact on tinnitus diagnosis and treatment. Further studies focused on tinnitus are necessary to clarify at which extent Ménière's disease may have a role in some types of chronic tinnitus.
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Comparison of search strategies in systematic reviews of adverse effects to other systematic reviews
Abstract Background Research indicates that the methods used to identify data for systematic reviews of adverse effects may need to differ from other systematic reviews. Objectives To compare search methods in systematic reviews of adverse effects with other reviews. Methods The search methodologies in 849 systematic reviews of adverse effects were compared with other reviews. Results Poor reporting of search strategies is apparent in both systematic reviews of adverse effects and other types of systematic reviews. Systematic reviews of adverse effects are less likely to restrict their searches to MEDLINE or include only randomised controlled trials ( RCT s). The use of other databases is largely dependent on the topic area and the year the review was conducted, with more databases searched in more recent reviews. Adverse effects search terms are used by 72% of reviews and despite recommendations only two reviews report using floating subheadings. Conclusions The poor reporting of search strategies in systematic reviews is universal, as is the dominance of searching MEDLINE . However, reviews of adverse effects are more likely to include a range of study designs (not just RCT s) and search beyond MEDLINE .
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Many TMD patients with coexisting tinnitus find TMD therapy improves or resolves their tinnitus in conjunction with their TMD symptoms (Table I). Forty TMD patients rating their tinnitus as moderate or severe, were asked questions and participated in clinical tests. Upon completion of TMD therapy, 21, 12, 7 and 0 reported their tinnitus was resolved, significantly improved, unchanged and worse, respectively. The subjects' ages, question results and clinical test results were statistically evaluated for an association with their tinnitus change. The following were identified as significantly associated with tinnitus improvement when the patient reports: they are younger in age, their tinnitus is moderate rather than severe, their hearing is normal, their tinnitus began approximately when their TMD symptoms began, their tinnitus is worse when their TMD symptoms are worse, their tinnitus is related to stress, their tinnitus is unrelated to loud noise and their tinnitus is reproduced or intensified from one minute of maximum voluntary clenching on their posterior teeth. These findings may help forecast which tinnitus patients with concomitant TMD may obtain tinnitus improvement through TMD therapy.
Temporomandibular disorder
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Three hundred and sixty-three outpatients with tinnitus in 1987 were studied.Sex distribution was approximately equal in both sexes. The incidence of tinnitus increased with age and the greatest incidence was the sixth decade.About the side of tinnitus, tinnitus of one ear accounted for 62.5% (1t>rt), tinnitus of bilateral ear accounted for 36.4%, and tinnitus originating from head accounted for 1.1%.According to our classification of primary diseases, tinnitus with presbyacusis and nohearingloss tinnitus acounted for 40-50%.
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There is increasing evidence of associations between the presence of temporomandibular joint (TMJ) disorders and tinnitus. It has been recently proposed that tinnitus patients with TMJ complaints could constitute a subtype, meaning a subgroup of tinnitus patients responsive to specific treatments. Tinnitus patients with TMJ complaints are often young women with somatosensory features of their tinnitus. Here, we investigate the socio-economic factors, phenotypic characteristics and psychological variables of tinnitus subjects from the Swedish Tinnitus Outreach Project, with (n=486) or without (n=1,996) TMJ complaints. The prevalence of TMJ complaints was greater in tinnitus subjects with severe tinnitus (36%) when compared to those with any tinnitus (19%), strongly indicating the contribution of TMJ problems to the severity of tinnitus. Comparing subgroups with or without TMJ complaints in the whole sample, differences were found regarding a large number of socioeconomic, phenotypic and psychological characteristics. Subjects with TMJ complaints were more often women, more often reported stress as the cause of tinnitus, were more severely affected by tinnitus, scored worse in measures of psychological well-being and life quality, and were more often affected by problems tolerating sounds, headache, vertigo/dizziness, and neck pain. In addition, they more often reported pulsating and tonal tinnitus, somatic modulation of tinnitus, and aggravation of tinnitus by loud sounds and stress. When focusing the analysis in subjects with tinnitus as a big problem using the Tinnitus Functional Index cut-off ≥ 48, or with severe tinnitus according to the Tinnitus Handicap Inventory cut-off ≥ 58, the impact of somatosensory modulations and stress on tinnitus were greater in subjects with TMJ complaints in comparison to those without. In light of these results, we hypothesize that stress could contribute to the co-occurrence of TMJ problems and tinnitus and also to the development of severe tinnitus. Our study supports the need of involving dental care and stress management in the holistic treatment of patients with severe tinnitus.
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