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Title
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Tinnitus and temporomandibular disorders : a study on the effectiveness of conservative temporomandibular treatment on tinnitus
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Author
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Abstract
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| Tinnitus, also known as “ringing in the ears”, is the conscious perception of a sound in the absence of a corresponding external stimulus. The prevalence of tinnitus in an adult population ranges from 5.1% to 42.7%. Tinnitus can be very bothersome and largely affect a patient's quality of life. Tinnitus can cause participation problems on work and is often accompanied by sleep disturbances. One specific subtype of tinnitus, that is particularly interesting for physical therapists and dentists, is somatic tinnitus (ST). In patients with ST, the intensity and character of the tinnitus can be altered by influences from the neck and jaw area. For example, increased muscle tension of the neck or jaw musculature or forceful muscle contractions (e.g. by clenching or grinding the teeth) can change the loudness or pitch of an existing tinnitus or, in some rare cases, can cause tinnitus. The connection between the somatic system and the auditory system might explain the higher prevalence of tinnitus in patients with pain or dysfunction in the masticatory muscles and temporomandibular joint, in medical terms called temporomandibular disorders (TMD). Currently, the most effective treatment for TMD is a multidisciplinary treatment comprising orofacial physical therapy and occlusal splint application. This thesis focuses on TMD related ST. We assume that normalization of somatosensory input from the jaw area by orofacial therapy, can also reduce tinnitus. Therefore, part 1 of our study investigates the effect of orofacial therapy on tinnitus complaints in patients with TMD related ST. In addition, we want to explore to what extent a decrease in TMD pain contributes to a reduction in tinnitus severity. To measure the effect of orofacial therapy on patients with TMD related ST, a Randomized Controlled Trial (RCT) with delayed treatment design was performed. This means that patients were at random divided in two groups: a group that immediately starts with the therapy (the “direct” group) and a group with a waiting period for 9 weeks before starting with the same therapy (the “delayed” group). All patients received orofacial treatment for 9 weeks. The evolution of the tinnitus was measured at week 9, 18 and 27 with the Tinnitus Functional Index (TFI) which is a questionnaire that evaluates the tinnitus severity. After 9 weeks, the tinnitus severity was significantly decreased in the direct group compared with the delayed group. Specifically, the direct group decreased 13.8 points compared with 5.0 points of the delayed group which did not receive treatment yet. After completion of the treatment in the delayed group there was an equivalent reduction of 12.2 points on TFI score. Finally, a clinically relevant improvement was found in 61% of the patients after orofacial therapy. Afterwards, based on the data from the RCT we analyzed to what extent the reduction in TMD pain can explain the improvement of tinnitus severity as measured by the TFI. Our analyses showed that 35% of the decrease on TFI score can be explained by the reduction in TMD pain. Future studies are needed to explain the remaining 65% . In Part 2 we investigated potential prognostic indicators for a positive treatment outcome in tinnitus severity after orofacial therapy. As potential prognostic indicators we used a series of patient characteristics such as: age, gender, and duration of the tinnitus. Our analyses showed that young female patients and patients with a shorter duration of the tinnitus and lower pain pressure thresholds on the temporomandibular joint and the sternocleidomastoideus had a higher chance to benefit from orofacial therapy. Finally, in part 3 we explored the impact of tinnitus on a patient’s daily functioning, using the International Classification of Functioning, Disability and Health (ICF). The ICF is an international classification system that is developed to indicate the functioning of people and the possible problems they perceive to structure, register and encode. Patient with ST turned out to have specifically problems in the domains ‘mental functions’, ‘sensory functions and pain’ and ‘sleep functions’. Additionally, they perceived restrictions in ‘focusing attention’. In conclusion, in this thesis we found that orofacial therapy can reduce tinnitus severity in patients with TMD related ST. Specifically, young female patients with a shorter duration of their tinnitus have the best prognosis. Patients in our sample perceived several problems in daily living, but particularly in the categories ‘onset of sleep’ and ‘sound detection’. |
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Language
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English
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Publication
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Antwerpen
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Universiteit Antwerpen, Faculteit Geneeskunde en Gezondheidswetenschappen
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2021
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ISBN
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978-94-6421-498-7
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Volume/pages
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181 p.
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Note
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De Hertogh, Willem [Supervisor]
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Michiels, Sarah [Supervisor]
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Van de Heyning, Paul [Supervisor]
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Full text (publisher's version - intranet only)
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