Abstract
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.
Highlights
Subjective tinnitus, ringing in the ears, is a prevalent phantom sound perception that in many cases can be severe to the point of seeking medical care (McCormack et al, 2016)
The Tinnitus Sample Case History Questionnaire (TSCHQ) measures phenotypic characteristics that may be associated with tinnitus (Landgrebe et al, 2010), and question #32 “Do you suffer from temporomandibular disorder?” was adapted in Swedish to enquire about pain in the jaw muscles or problems in the jaw rather than the diagnosis itself (“Lider du av smärta i käkmuskeler eller störnig i käkfunktions?”) (Müller et al, 2016), as laymen may be unfamiliar with the medical terminology
The present study confirms previous findings from Vielsmeier et al (2012) suggesting that tinnitus patients with temporomandibular joint (TMJ) complaints may constitute a separate subtype that could benefit from specific treatment interventions targeting the TMJ
Summary
Subjective tinnitus, ringing in the ears, is a prevalent phantom sound perception (prevalence ranging from 5 to 43%) that in many cases can be severe to the point of seeking medical care (McCormack et al, 2016). The current pathophysiological models stipulate that tinnitus emerges as a failure to adapt to missing sensory information originating from the ear (Shore et al, 2016) This results in a compensatory mechanism in the brain translating into a greater neuronal activity (central gain) along the auditory pathway (Auerbach et al, 2014). The association between tinnitus and TMJ disorders was confirmed by two recent systematic reviews that reported a significant association between the two conditions in the majority of the identified studies (Bousema et al, 2018; Mottaghi et al, 2019). Both reviews assessed the quality of the included studies. We will examine the relationship between self-reported TMJ problems with tinnitus using data from the Swedish Tinnitus Outreach Project and investigate a broader range of variables that may differ in tinnitus subjects with or without TMJ complaints
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