Clicking Sound Research Articles

An assessment of auditory-guided locomotion in an obstacle circumvention task.

This study investigated how effectively audition can be used to guide navigation around an obstacle. Ten blindfolded normally sighted participants navigated around a 0.6 × 2 m obstacle while producing self-generated mouth click sounds. Objective movement performance was measured using a Vicon motion capture system. Performance with full vision without generating sound was used as a baseline for comparison. The obstacle’s location was varied randomly from trial to trial: it was either straight ahead or 25 cm to the left or right relative to the participant. Although audition provided sufficient information to detect the obstacle and guide participants around it without collision in the majority of trials, buffer space (clearance between the shoulder and obstacle), overall movement times, and number of velocity corrections were significantly (p < 0.05) greater with auditory guidance than visual guidance. Collisions sometime occurred under auditory guidance, suggesting that audition did not always provide an accurate estimate of the space between the participant and obstacle. Unlike visual guidance, participants did not always walk around the side that afforded the most space during auditory guidance. Mean buffer space was 1.8 times higher under auditory than under visual guidance. Results suggest that sound can be used to generate buffer space when vision is unavailable, allowing navigation around an obstacle without collision in the majority of trials.

ID 383 – On the impact of stimulus intensity on vestibular evoked potentials (VestEPs)

Objective Recently published studies describe neural correlates of vestibular stimulation by means of evoked potentials. While some groups use loud click sounds or taps to the forehead we use passive body movements to study vestibular evoked potentials (VestEPs). Here, we investigated the impact of the acceleration intensity on the latency and amplitudes of the previously discovered VestEPs. Methods The EEG of eleven healthy subjects was recorded while they were seated in a racing chair mounted on a motion platform (hexapod). During the experiment the platform performed 216 translational movements using three different acceleration intensities. The EEG was analyzed in order to study the evoked potentials and the scalp topographies. Results We could replicate the characteristic potentials of vestibular stimulation as observed by our group in previous experiments. Additionally, we could show that the amplitudes of the VstEPs increased with higher accelerations. Conclusions Our data revealed that as in other sensory systems, e.g., the auditory, the stimulus intensity modulates the VestEPs amplitudes. Acknowledgements The work was supported by Deutsche Stiftung Neurologie, Graduate School for Systemic Neuroscience (GSN) and the German Federal Ministry of Education and Research (BMBF Grant code 01EO1401 ).

54. Fibrinolytic therapy and polyvalvular heart disease in pediatric patient

Introduction Novel therapy for a stuck mechanical heart valve in pediatric patient with multiple prosthetic valves. Not much is known with the use of anticoagulation and fibrinolysis in multiple mechanical valves in pediatric patients. Case presentation 10 year, Saudi, male with poly-valvular disease with tricuspid, mitral, and aortic, and pulmonary valve regurgitation. Initially, he had repair of all his valves in June 2008. He required Mitral valve replacement #21, and repeat poly-valvar repair in July 2008. Eventually, tricuspid valve was replaced by CM #27, aortic valve was replaced by St.Jude #19 mm, and pulmonary valve replaced by Jan 2012. He presented to cardiology clinic on March 2014 in which found to have stuck disc of the tricuspid valve prosthesis on echo with increasing gradients of six mmHg, despite therapeutic INR with warfarin. Immediate fluoroscopy confirmed diagnosis. Physical exam positively mild tachypnea and liver of three cm below costal margin, with mechanical cardiac click sounds. Immediate admission to the intensive care for observation and planning starting the tPA with heparin infusion. TPA stated as a dose of 0.5 mg/kg/h over 6 h then repeated fluoroscopy done after 4 h of the completion of tPA showed mobile tricuspid disc. He was observed for a few days in ward with therapeutic INR and discharged home. Conclusion As growing surgical skills we are facing many pediatric cases with prosthetic valves with stuck valves. Which tPA dose should be used? Is streptokinase better? How long do you wait before considering surgery?

V19. Neural correlates of otolith stimulation: Results of an EEG study

Introduction The otolith organs sense the head's translational motion and its orientation relative to gravity. Signals proportional to head acceleration are carried by otolith afferents from the vestibular endorgan to the brain. fMRI studies revealed the insula, the inferior parietal lobule as well as the superior/middle/transverse temporal gyri as regions involved in the processing of otolith input (Schlindwein et al., 2008). However, due to the poor temporal resolution of the BOLD signal knowledge on the temporal processing and the interaction between the distinct brain areas is sparse. Recent EEG studies using loud click sounds (McNerney et al., 2011; Todd et al., 2014) reported reliable evoked potentials observable on the scalp. Though, the used stimuli resulted in a superposition of auditory and vestibular signals. Aim of the current study was to avoid this superposition by the use of passive translational body movements for otolith stimulation. Methods The EEG of thirteen healthy, right-handed subjects was recorded while they were seated on a motion platform. Subjects were seated in a padded racing seat mounted on the platform. In order to mask motion related sounds by the platform subjects wear head phones by which white noise of 90dB (SPL) was presented. During the experiment the platform performed translational movements along the interaural (IA) axis, the dorsoventral (DV) axis and the nasooccipital (NO) axis. The EEG was analyzed to visualize the potentials evoked by the onset of the movement. Results We identified a series of potentials evoked by this stimulation. In particular we found a positive component peaking about 40ms after acceleration onset, a negative component after about 80ms, followed by another positive component after approximately 200ms (Fig. 1). Voltage maps showed strongest activity in electrodes over the parietal, occipital lobes and at electrode Cz (Fig. 2). Source localization estimated the inferior parietal lobe, the superior frontal gyrus, and the insula as potential generators of these components. Discussion These potentials are in line with the previously published EEG studies on otolith stimulation using loud click sounds. Additionally, the estimated generators nicely fit the locations reported in several previous imaging studies on the stimulation of the vestibular system. We conclude that recording EEG during passive body movements is a feasible way to shed some light on the temporal processing of vestibular otolith input and the interaction between the involved brain areas. Acknowledgements The work was supported by Deutsche Stiftung Neurologie, Graduate School for Systemic Neuroscience (GSN) and the German Federal Ministry of Education and Research (BMBF grant code 01 EO 0901).

A method for estimating lingual cavity volume in click consonants

A method for estimating lingual cavity volume in click consonants is presented. The upper edge of the lingual cavity is estimated from stone palate casts, which were scanned using a Polhemus 3D Digitizer. The floor of the midline of the lingual cavity was estimated using 114 fps mid-sagittal ultrasound traces of the tongue collected with the CHAUSA method (Miller and Finch 2011). The width of the cavity from front to back was estimated by measurements of the cavity width at six different locations in linguograms. Changes in lingual cavity volume for the four coronal click types in Mangetti Dune !Xung are estimated by changing the mid-sagitttal ultrasound trace that corresponds to one of five stages in click production. 3-D images of the changes in cavity volume for each of the four coronal click types recognized by the IPA (2006) are presented.

Agonistic sounds and swim bladder morphology in a malapterurid electric catfish

AbstractSeveral catfish families possess an elastic spring apparatus (ESA) morphology that is assumed to function as a swim bladder drumming sound production mechanism. Although they have an ESA, drumming sounds in the electric catfish (Malapteruridae) have not been described. We have recorded several different sound types in Malapterurus beninensis and we examined the morphology of the swim bladder, the ESA and the ultrastructure of the protractor muscle. The protractor muscle contains small rounded muscle fibers with abundant mitochondria, narrow myofibrils, elaborated sarcoplasmic reticula and sometimes sarcoplasmic cores. Contractions of the protractor muscle should pull the Müllerian ramus (MR) and attached swim bladder anteriorly. Further, the MR possesses an anterior fulcrum that abuts upon the vertebral complex. Several sound types were elicited during agonistic interactions in the laboratory. We observed ratchet, click train and mouth sounds. Mouth sounds are single event, low‐frequency (mean dominant frequency 176 Hz) sounds that coincide with a bite‐like motion. Ratchet and click sounds are high‐frequency (mean dominant frequency 1568 and 3739 Hz, respectively) and occur in trains. Ratchet and click train sound characteristics are not indicative of a muscle‐driven drumming sound predicted by ESA morphology. We propose several hypotheses for these sound production mechanisms. Click sounds, in particular, could result from gas movement through the neck between the anterior and posterior swim bladder chambers.

Essential Palatal Tremor Managed by Cognitive Behavioral Therapy.

Background. Essential palatal tremor is a disorder of unknown etiology involving involuntary movement of the uvula and soft palate. Treatment attempts including drugs or surgery have been conducted to cease the rhythmical movement. Case Report. A 55-year-old female visited our department complaining of a sudden, noticeable, intermittent, and rhythmical clicking noise in her throat for five years. Oral examination revealed rhythmical contractions of the soft palate with clicking at the frequency of 120 per min. Magnetic resonance imaging (MRI) examination of the brain performed after consulting with the department of neuropathic internal medicine showed no abnormalities. Thus, essential palatal tremor was diagnosed. The symptoms improved with cognitive behavioral therapy without drugs or surgical treatments. The patient is now able to stop the rhythmical movement voluntarily. Discussion. Cognitive behavioral therapy might be suitable as first-line therapy for essential palatal tremor because the therapy is noninvasive.

Imaging dynamic lingual movements that we could previously only imagine

Pioneering lingual ultrasound studies of speech demonstrated that almost the entire tongue could be imaged (McKay 1957). Early studies contributed to our knowledge of tongue shape and tongue bracing in vowels (Morrish et al. 1984; Stone et al. 1987). However, until recently, lingual ultrasound studies have been limited to standard video frame rates of 30 fps, which are sufficient only for imaging stable speech sounds such as vowels and liquids. High frame rate lingual ultrasound (&amp;gt;100 fps) allows us to view the production of dynamic speech sounds, such as stop consonants, and even click consonants. The high sampling rate, which yields an image of the tongue every 8–9 ms, improves image quality, by decreasing temporal smear, allowing even tongue tip movements to be visualized to a greater extent than was previously possible. Results from several high frame rate ultrasound studies (114 fps) of consonants that were collected and analyzed using the CHAUSA method (Miller and Finch 2011) are presented. The studies elucidate (a) tongue dorsum and root gestures in velar and uvular pulmonic consonants; (b) tongue coronal, dorsal, and root gestures in four contrastive click consonants; and (c) lingual gestures in pulmonic fricatives.

Asymmetric transfer of sound localization learning between indistinguishable interaural cues

Learning in perceptual tasks is typically highly specific to the trained stimulus parameters. However, can learning be specific to a stimulus parameter that is perceptually indistinguishable from another? We assessed this question using a perceived sound location task in which the perceived sound location was created through either an interaural time difference (ITD) cue or an interaural level difference (ILD) cue. We used the same transient, broadband sound (clicks) for both cues, and after training on one of the cues, listeners switched cue mid-session. This allowed us to assess cue specificity or transfer when the subjectively unnoticed cue switch occurred. One group of listeners improved their ITD performance as a function of training, but deteriorated in performance when switching to ILD in mid training session. Another group of listeners started with ILD training; their improved performance level did not deteriorate as they switched to the ITD cue. This transfer asymmetry was not hypothesized, and we therefore extended our study with a second data collection. Both the training effect and the transfer asymmetry remained after the second data collection. Our results indicate (a) listeners can improve both their ITD and ILD performance for click sounds, extending previous findings on tones; (b) learning can be specific to a stimulus parameter that is indistinguishable from another, as ITD learning did not transfer to ILD performance; but (c) ILD learning can transfer to ITD performance. This transfer asymmetry may have occurred because of how ITD and ILD are coded in early brainstem areas.

Fibrosarcoma of the temporomandibular joint area: benefits of magnetic resonance imaging and computed tomography

Here, we report a case of primary fibrosarcoma in the mandible of a 33-year-old woman with symptoms and radiologic signs mimicking temporomandibular disorder. We also present a literature review of fibrosarcomas in the jaw. CASE REPORT A 33-year-old woman presented with a 1-year history of trismus associated with a clicking noise in the left temporomandibular joint (TMJ). Her chin shifted to the right side when she opened her mouth (Figure 1). Panoramic radiographs (Figure 2, A, B) and magnetic resonance imaging (MRI) scans (Figure 3, A-H) of the TMJ regions showed signs of temporomandibular disorder (TMD), so conventional treatment for TMD was prescribed, including occlusal splints, mouth-opening exercises, and a muscle relaxant for 6 months. When the MRI scout images were analyzed retrospectively, the findings of 2 of 5 scout images were suggestive of tumor (see Figure 3, A, E). The patient was referred again 6 months after the initial visit for investigation of insomnia caused by spontaneous pain in the left TMJ area. She also had paralysis of the lower lip and left chin. She had herpes labialis and gastroenteritis caused by stress. Given the suspicion of malignancy, both MRI and computed tomography (CT) were performed. MRI showed a round, inhomogeneous mass in the pterygomandibular portion of the masticator space, which caused minimal medial narrowing of the left parapharyngeal space (Figure 4, A, B). CT found significant bony erosion of the inner cortex of the left ramus of the mandible (Figure 5). The patient was referred to another hospital for further management because the tumor grew toward the pharyngeal arches. An incisional biopsy was subsequently performed, and the initial diagnosis was a sarcoma based on the histopathologic examination of the biopsy. A definitive histologic diagnosis was reached by exclusion. The tumor was diagnosed as a grade 3 (poorly differentiated) fibrosarcoma using the FNCLCC (Federation Nationale des Centres de Lutte Contre le Cancer) grading system. Histopathologic examination found that the tumor contained spindle cells arranged in compact fascicles that were intersected by various amounts of delicate thin to dense keloid-like collagen. Cell bundles were arranged at acute angles to each other, whereas the presence of fascicles was subtler in other areas. A prominent storiform pattern was not seen (Figure 6). The fibrosarcoma was resected followed by postoperative radiotherapy and chemotherapy. The tumor was removed, along with the left ramus of the mandible, a portion of the left maxilla, a deep part of the parotid gland, and lymph nodes located superior to the omohyoid muscle. The cheek mucosa was reconstructed using a free anterolateral thigh flap (Figure 7). The patient recovered and got married afterward; however, lung metastasis with Fig. 1. Facial photograph. The patient’s chin shifted to the right side when she opened her mouth.

Accurate Assessment of Aortic Stenosis

Aortic valve (AV) stenosis is one of the most common valvular diseases and is the third most common cardiovascular disease in developed countries. It occurs in ≈2.8% of patients ≥75 years of age and can occur because of degenerative calcification and congenital valvular defects such as bicuspid AVs or rheumatic disease.1–3 Calcific aortic stenosis (AS) is associated with increased leaflet stiffness and a narrowed AV orifice, resulting in increased pressure gradients across the valve. The presence of a bicuspid AV significantly increases the risk of AS.4 The natural history of AS is a prolonged asymptomatic period, with progressive reduction of the AV orifice area due to sclerosis initially, culminating in calcific AS. This is accompanied by a corresponding increase in the transaortic pressure gradient (Δ P ) and myocardial pressure overload. Through the preload reserve, the left ventricle (LV) compensates for the increased workload until the sarcomeres stretch to their maximum diastolic length. Once the preload reserve is exhausted, increases in afterload are accompanied by a reduction in stroke volume (SV), resulting in afterload mismatch. Ultimately, this causes LV hypertrophy, associated with an enlargement of cardiac myocytes and increased LV wall thickness.5 Initial diagnosis of AS typically occurs during routine physical examination with the presence of a heart murmur, click, or other abnormal sounds, but undiagnosed patients may experience the onset of severe symptoms such as angina, syncope, and heart failure. Without intervention, patient mortality typically occurs within 5 years of the onset of symptoms.6–11 Multiple studies and reviews have focused on the clinical aspects of this disease, including disease progression, markers of disease severity, treatment guidelines, and outcomes.1–3,6,12–16 Very few reviews have focused on the hemodynamic principles underlying AS and on comparing data obtained across different …

Auditory steady-state response audiometry in children with severe to profound sensorineural hearing loss

Objective The aim of the study was to find out the predictive value of single monotic auditory steady-state response (ASSR) for hearing threshold estimation in children with severe to profound sensorineural hearing loss (SNHL). Methodology Forty-eight children (96 ears) with severe to profound SNHL were included in the present study, with age range 1-10 years. They were subjected to age-based audiological evaluation to estimate the behavioral thresholds. Single monotic ASSR was performed for all children using test signals of 250, 500, 1000, 2000, and 4000 Hz, modulated in both ears at high rates of 67, 74, 81, 88, and 95 Hz, respectively, using GSI Audera-evoked potential system. ASSR thresholds were obtained and analyzed according to the equipment default criteria. Results The number and percentage of ASSR detected were highest at 1000 Hz then 500 Hz followed by 2000 Hz and were the least at 4000 and 250 Hz in all children. The ASSR thresholds obtained were statistically correlated with the behavioral pure tone audiometry thresholds at 500, 100, and 2000 Hz. A considerable number of ears with no sound field thresholds or click auditory brainstem response responses showed ASSR. Conclusion Single monotic ASSR, with high modulation frequencies, has proven to be a reasonable method for estimating hearing sensitivity in the mid-conventional audiometric frequencies in children with severe to profound SNHL. Recommendations All children with no behavioral hearing threshold and/or absent click-evoked auditory brainstem response should be tested by ASSR at 500, 1000, and 2000 Hz to give information about the presence of useful residual hearing. ASSR can provide important information for use in the cochlear implant selection process

Severe Metallosis Following Polyethylene Dislocation in a Mobile-Bearing Medial Unicompartmental Knee Replacement

Metallosis is a rare cause of failure after unicompartmental knee replacement (UKR) and has only previously been reported when there has been abnormal metal-on-metal contact. We present a case report of a 67-year-old woman who was admitted to our department with a 5-month history of a painful right knee. There was no history of trauma and her past medical history was unremarkable. She had undergone a primary mobile bearing medial UKR of her right knee 5 years ago. During the preceding 5 months, the patient complained that the knee was becoming unstable, was painful, and was making frequent clicking noises associated with metallic friction. Plain radiographs of the right knee showed dislocation of the polyethylene bearing and the patient was taken to the operating room for revision of the implant. Intraoperatively, severe evidence of metallosis was found in the periprosthetic soft tissues. The tibial component was found to be loose and the polyethylene bearing was dislocated posteriorly. The implants were revised. Postoperative recovery was uneventful. Microscopic examination revealed findings consistent with metallosis. At the latest follow-up, the patient had a good clinical and radiological outcome. In conclusion, such a complication of UKR requires early diagnosis and treatment as it can result in implant loosening and metallosis.

When Source is Also Receiver

Musicians (and low budget acousticians) often judge the acoustics of a venue by clapping, shouting or making other kinds of more or less impulse-like sounds. In such situations, the source and the receiver are (almost) at the same position. This is a different situation than for standard measurements of room acoustics, where there is a (long) distance between the sound source (loudspeakers, pistols, balloons and musical instruments) and the receiver (microphone, ear). The sonic experience must be totally different, but still we trust our clapping and our ears. We probably “recalculate” so that reverberation times etc. judged in such a way “by ear”, are often quite correct. How can this be? And: Can we learn from how a blind person uses click sounds made with the mouth in order to “see”/echolocate surfaces and objects by the ears? In both situations the position of the source and the receiver are (almost) the same. In this paper we compare the results from room acoustic measurements taken from “in-ear”-recordings of own hand claps with more standardised measurements in three types of rooms: A big, reverberant foyer, a concert hall and a small living room/music room.

No evidence for impaired multisensory integration of low-level audiovisual stimuli in adolescents and young adults with autism spectrum disorders

Abrupt click sounds can improve the visual processing of flashes in several ways. Here, we examined this in high functioning adolescents with Autism Spectrum Disorders (ASD) using three tasks: (1) a task where clicks improve sensitivity for visual temporal order (temporal ventriloquism); (2) a task where a click improves visual search (pip-and-pop), and (3) a task where a click speeds up the visual orienting to a peripheral target (clock reading). Adolescents with ASD were, compared to adolescents with typical development (TD), impaired in judgments of visual temporal order, but they were unimpaired in visual search and orienting. Importantly, in all tasks visual performance of the ASD group improved by the presence of clicks by at least equal amounts as in the TD group. This suggests that adolescents and young adults with ASD show no generalized deficit in the multisensory integration of low-level audiovisual stimuli and/or the phasic alerting by abrupt sounds.

Multisensory integration compensates loss of sensitivity of visual temporal order in the elderly

Here, we examined sensitivity of visual, auditory, and audiovisual temporal order in five age-groups (20 to 70 years old). We also measured multisensory integration (MSI) using a phenomenon known as "temporal ventriloquism," in which click sounds improve sensitivity of visual temporal order. Results showed that sensitivity of visual, auditory, and audiovisual temporal order declined from 50 years on. However, there was no corresponding decline in MSI as the click sounds actually compensated the loss of sensitivity of visual temporal order in the elderly. Sensitivity of audiovisual temporal order did not correlate with MSI, suggesting that well-preserved explicit judgments about cross-modal temporal order are not required for MSI to occur.

Dental malocclusion is not related to temporomandibular joint clicking: a logistic regression analysis in a patient population

To assess the association of several dental malocclusion features with temporomandibular joint (TMJ) click sounds in a population of temporomandibular disorder (TMD) patients. Four hundred forty-two TMD patients (72% female; 32.2 ± 5.7 years, range 25-44 years) were divided into a TMJ clicking and a no-TMJ clicking group, based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) assessment. Seven occlusal features were recorded for each patient: (1) posterior crossbite, (2) overbite, (3) open bite, (4) overjet, (5) mediotrusive and (6) laterotrusive interferences and (7) retruded contact position to maximum intercuspation (RCP-MI) slide length. A logistic regression model was created to estimate the association of occlusal features with TMJ clicking. The difference between the groups as for the prevalence of the various occlusal features was generally not statistically significant, with minor exceptions. Mediotrusive interferences (P = .015) and RCP-MI slide ≥2 mm (P = .001) were the two occlusal features that were associated with the probability of having TMJ clicking, even if the adjusted odds ratios for TMJ clicking were low for both variables (1.63 and 1.89, respectively). Moreover, the amount of variance in the prevalence of TMJ clicking that was predicted by the final model was as low as 4.5% (R(2) = 0.045). Findings from the present investigation suggested that in a population of TMD patients, the contribution of dental malocclusion features to predict TMJ click sounds is minimal with no clinical relevance.

Characterization of Yellow Seahorse Hippocampus kuda feeding click sound signals in a laboratory environment: an application of probability density function and power spectral density analyses

Do the sounds generated by different-sized fish of different sexes differ from each other in temporal, spectral or intensity patterns? Such differences would enable the development of passive acoustic techniques to locate seahorses in open water bodies. On the basis of this perspective, we characterize and present in this study Yellow Seahorse Hippocampus kuda (Syngnathidae) feeding click sounds, recorded in a controlled laboratory environment. The characterization involved analysis of the “probability density function” (PDF) and the “power spectral density” (PSD) of the seahorse feeding click sound signals of different sizes and sexes. The PDF describes the general distribution of the magnitude of a random process, and such analysis, using recorded seahorse clicks, points towards a multimodal statistical distribution, which is the existence of more than one fitting component for the majority of seahorse click signals above the tank ambient noise level. This fact has been appraised towards the involvement of more than one process in the seahorse click signal generation mechanism. However, lack of prior knowledge about the individual PDF components of the data leads towards the mismatch between the data of PDFs. The PDF gives no information on the time and frequency content of the processes as provided by the PSD. Under such conditions, curve fitting of the “power law” expressions to the PSD functions estimates “slope” and “intercept” parameters of the seahorse click signal. Striking differences in the feeding click characteristics of various sizes of the H. kuda and between the sexes were discernable based on the clustering pattern among the estimated “slope” and “intercept” parameters. Further studies using the seahorse body sizes and weight (wet) with respect to the peak frequencies estimated from the PSD distribution show results equivalent to those from previous studies.

C-V coarticulation in consonants with multiple lingual constrictions

C-V coarticulation in monosyllabic words containing initial click consonants and /i:/ vowels is investigated in Mangetti Dune !Xung with 114 fps lingual ultrasound and acoustic data collected using the CHAUSA method [Miller and Finch (2011)]. The 114 fps rate yields an image of the tongue every 9 ms (+/−4.5 ms). Vowels following clicks have three lingual gestures involving the tongue tip/blade (TT), tongue body (TB), and tongue root (TR). TT and TB constrictions carried over from the clicks merge into a single vowel constriction at consonant specific rates. The second formant (F2) distinguishes each word type through the vowel midpoint. In regression analyses, TBCL and TRCL best predict F2 for alveolar click initial words, while TTCL best predicts F2 for dental/palatal click initial words. The more open constriction is acoustically inert. In the palatal click initial word, both constrictions are equally close for some speakers, and the gestures undergo blending [Browman and Goldstein (1990)]. I argue that these patterns are prosodically controlled. Dental and palatal clicks have TB and TR gestures associated with the syllable onset. In alveolar clicks, the right edge of TB and TR gestures are aligned to the right edge of the first mora.

Are Occlusal Characteristics, Headache, Parafunctional Habits and Clicking Sounds Associated with the Signs and Symptoms of Temporomandibular Disorder in Adolescents?

[Purpose] To assess the association between the oclusal characteristics, headache, parafunctional habits and clicking sounds and signs/symptoms of TMD in adolescents. [Subjects] Adolescents between 14 and 18 years of age. [Methods] The participants were evaluated using the Helkimo Index and a clinical examination to track clicking sounds, parafunctional habits and other signs/symptoms of temporomandibular disorder (TMD). Subjects were classified according to the presence or absence of headache, type of occlusion, facial pattern and type of bite. In statistical analyse we used the chi-square test and Fisher's exact test, with a level of significance of 5%. [Results] The sample was made up of 81 adolescents with a mean age of 15.64 years; 51.9% were male. The prevalence of signals/symptoms of TMD was 74.1%, predominantly affecting females. Signals/symptoms of TMD were significantly associated with clicking sounds, headache and nail biting. No associations were found between signals/symptoms of TMD and angle classification, type of bite and facial pattern. [Conclusion] Headache is one of the most closely associated symptoms of TMD. Clicking sounds were found in the majority of cases. Therefore, the sum of two or more factors may be necessary for the onset and perpetuation of TMD.