Tinnitus in Temporomandibular Disorders: Axis I and Axis II Findings According to the Diagnostic Criteria for Temporomandibular Disorders

Aims: To examine the associations of self-reported presence of tinnitus with subtypes of temporomandibular disorders (TMD) as assessed by Axis I of the Diagnostic Criteria for TMD (DC/TMD) and with psychologic characteristics as assessed by Axis II. Methods: This retrospective controlled study included 108 consecutive TMD patients referred to the Tel Aviv University Orofacial Pain Clinic. Each patient received full Axis I and Axis II diagnoses according to the DC/TMD. The patients were asked about currently experiencing tinnitus. Pearson chi-square test and Fisher exact test were used to test the associations between categorical variables. Mann-Whitney test was used to assess differences in continuous variables between categories. A P value < .05 was considered statistically significant. Results: Thirty-three (30.6%) TMD patients reported experiencing tinnitus. There was a significantly higher prevalence of myofascial pain with referral (P = .008) and nonspecific physical symptoms (P = .014) among the TMD patients who reported tinnitus. In addition, those patients reported significantly longer pain duration compared to TMD patients without tinnitus (P = .039). Conclusion: This study emphasizes the necessity of assessing both Axes I and II according to the DC/TMD in future studies and supports creating a standardized tinnitus screener tailored to TMD patients for future studies on tinnitus in TMD patients.

diagnostic criteria for TMD; myofascial pain with referral; nonspecific physical symptoms; temporomandibular disorders; tinnitus

1. Haider HF, Hoare DJ, Costa RFP, et al. Pathophysiology, diagnosis and treatment of somatosensory tinnitus: A scoping review. Front Neurosci 2017;11:207.

2. Esmaili AA, Renton J. A review of tinnitus. Aust J Gen Pract 2018;47:205–208.

3. Levine RA. Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis. Am J Otolaryngol 1999;20: 351–362.

4. Sanchez TG, da Silva Lima A, Brandão AL, Lorenzi MC, Bento RF. Somatic modulation of tinnitus: Test reliability and results after repetitive muscle contraction training. Ann Otol Rhinol Laryngol 2007;116:30–35.

5. Sanchez TG, Guerra GC, Lorenzi MC, Brandão AL, Bento RF. The influence of voluntary muscle contractions upon the onsetand modulation of tinnitus. Audiol Neurootol 2002;7:370–375.

6. Coad ML, Lockwood A, Salvi R, Burkard R. Characteristics of patients with gazeevoked tinnitus. Otol Neurotol 2001; 22:650–654.

7. Shore SE, Roberts LE, Langguth B. Maladaptive plasticity in tinnitus—triggers, mechanisms and treatment. Nat Rev Neurol 2016;12:150–160.

8. Shore S, Zhou J, Koehler S. Neural mechanisms underlying somatic tinnitus. Prog Brain Res 2007;166:107–123.

9. Levine RA, Nam EC, Oron Y, Melcher JR. Evidence for a tinnitus subgroup responsive to somatosensory based treatment modalities. Prog Brain Res 2007;166:195–207.

10. Pinchoff RJ, Burkard RF, Salvi RJ, Coad ML, Lockwood AH. Modulation of tinnitus by voluntary jaw movements. Am J Otol 1998;19:785–789.

11. Simmons R, Dambra C, Lobarinas E, Stocking C, Salvi R. Head, neck, and eye movements that modulate tinnitus. Semin Hear 2008;29:361–370.

12. Rocha CB, Sanchez TG. Efficacy of myofascial trigger point deactivation for tinnitus control. Braz J Otorhinolaryngol 2012; 78:21–26.

13. Ralli M, Greco A, Turchetta R, Altissimi G, de Vincentiis M, Cianfrone G. Somatosensory tinnitus: Current evidence and future perspectives. J Int Med Res 2017;45:933–947.

14. Ward J, Vella C, Hoare DJ, Hall DA. Subtyping somatic tinnitus: A cross-sectional UK cohort study of demographic, clinical and audiological characteristics. PLoS One 2015;10:e0126254.

15. Abel MD, Levine RA. Muscle contractions and auditory perception in tinnitus patients and nonclinical subjects. Cranio 2004;22:181–191.

16. Michiels S, De Hertogh W, Truijen S, Van de Heyning. Cervical spine dysfunctions in patients with chronic subjective tinnitus. Otol Neurotol 2015;36:741–745.

17. Michiels S, Sanchez TG, Oron Y, et al. Diagnostic criteria for somatosensory tinnitus: A Delphi process and face-to-face meeting to establish consensus. Trends Hear 2018; 22:2331216518796403.

18. Defining TMDs. In: De Leeuw R, Klasser GD (eds). Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management, ed 5. Chicago: Quintessence, 2013:129–130.

19. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

20. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992; 6:301–355.

21. Kochkin S, Tyler R, Born J. The prevalence of tinnitus in the United States and the self-reported efficacy of various treat-ments. Hearing Review 2011;18:10–26.

22. Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med 2010; 123:711–718.

23. Mottaghi A, Menéndez-Díaz I, Cobo JL, González-Serrano J, Cobo T. Is there a higher prevalence of tinnitus in patients with temporomandibular disorders? A systematic review and meta-analysis. J Oral Rehabil 2019;46:76–86.

24. Skog C, Fjellner J, Ekberg E, Häggman-Henrikson B. Tinnitus as a comorbidity to temporomandibular disorders—A systematic review. J Oral Rehabil 2019;46:87–99.

25. Krog NH, Engdahl B, Tambs K. The association between tinnitus and mental health in a general population sample: Resultsfrom the HUNT Study. J Psychosom Res 2010;69:289–298.

26. Salviati M, Bersani FS, Terlizzi S, et al. Tinnitus: Clinical experience of the psychosomatic connection. Neuropsychiatr Dis Treat 2014;10:267–275.

27. Milerová J, Anders M, Dvorˇák T, Sand PG, Königer S, Langguth B. The influence of psychological factors on tinnitus severity. Gen Hosp Psychiatry 2013;35:412–416.

28. Sahin C, Aras HI˙, Yilmaz MS. Somatoform disorders in patients with chronic subjective tinnitus. Eur Arch Otorhinolaryngol2016;273:3603–3607.

29. Belli S, Belli H, Bahcebasi T, Ozcetin A, Alpay E, Ertem U. Assessment of psychopathological aspects and psychiatric comorbidities in patients affected by tinnitus. Eur Arch Otorhinolaryngol 2008;265:279–285.

30. Manfredini D, Olivo M, Ferronato G, Marchese R, Martini A, Guarda-Nardini L. Prevalence of tinnitus in patients with different temporomandibular disorders symptoms. Int Tinnitus J 2015;19:47–51.

31. Henry JA, Griest S, Austin D, et al. Tinnitus Screener: Results from the first 100 participants in an epidemiology study. Am JAudiol 2016:25:153–160.

32. Ohrbach R (ed). Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments (HEBREW). Version 15 May 2016. Hebrew version by: Reiter S, Winocur E, Akrish S, et al.

33. Omidvar S, Jafari Z. Association between tinnitus and temporomandibular disorders: A systematic review and meta-analysis. Ann Otol Rhinol Laryngol 2019;128:662–675.

34. Manfredini D. Tinnitus in temporomandibular disorders patients: Any clinical implications from research findings?Evid Based Dent 2019;20:30–31.

35. Calderon Pdos S, Hilgenberg PB, Rossetti LM, Laurenti JV, Conti PC. Influence of tinnitus on pain severity and quality of lifein patients with temporomandibular disorders. J Appl Oral Sci 2012;20:170–173.

36. Lam DK, Lawrence HP, Tenenbaum HC. Aural symptoms in temporomandibular disorder patients attending a craniofacial pain unit. J Orofac Pain 2001;15:146–157.

37. Teachey WS, Wijtmans EH, Cardarelli F, Levine RA. Tinnitus of myofascial origin. Int Tinnitus J 2012;17:70–73.

38. Bezerra Rocha CA, Sanchez TG, Tesseroli de Siqueira JT. Myofascial trigger point: A possible way of modulating tinnitus. Audiol Neurootol 2008;13:153–160.

39. Hilgenberg PB, Saldanha AD, Cunha CO, Rubo JH, Conti PC. Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients. J Oral Rehabil 2012; 39:239–244.

40. Pinto PC, Marcelos CM, Mezzasalma MA, Osterne FJ, de Melo Tavares de Lima MA, Nardi AE. Tinnitus and its association with psychiatric disorders: Systematic review. J Laryngol Otol 2014;128:660–664.

41. Camparis CM, Formigoni G, Teixeira MJ, de Siqueira JT. Clinical evaluation of tinnitus in patients with sleep bruxism: Prevalence and characteristics. J Oral Rehabil 2005;32:808–814.

42. Saldanha AD, Hilgenberg PB, Pinto LM, Conti PC. Are temporomandibular disorders and tinnitus associated? Cranio 2012;30:166–171.

43. Fernandes G, Siqueira JT, Godoi Gonçalves DA, Camparis CM. Association between painful temporomandibular disorders, sleep bruxism and tinnitus. Braz Oral Res 2014;28: S1806-83242014000100220.

44. Wright EF, Bifano SL. Tinnitus improvement through TMD therapy. J Am Dent Assoc 1997;128:1424–1432.

45. Wright EF, Syms CA 3rd, Bifano SL. Tinnitus, dizziness, and nonotologic otalgia improvement through temporomandibulardisorder therapy. Mil Med 2000;165:733–736.

46. Wright EF. Otologic symptom improvement through TMD therapy. Quintessence Int 2007;38:e564–e571.

47. Totta T, Santiago G, Gonçales ES, Saes Sde O, Berretin-Felix G. Auditory characteristics of individuals with temporomandibular dysfunctions and dentofacial deformities. Dental Press J Orthod 2013;18:70–77.

48. Buergers R, Kleinjung T, Behr M, Vielsmeier V. Is there a link between tinnitus and temporomandibular disorders?J Prosthet Dent 2014;111:222–227.

49. Tuz HH, Onder EM, Kisnisci RS. Prevalence of otologic complaints in patients with temporomandibular disorder. Am J Orthod Dentofacial Orthop 2003;123:620–623.

50. de Felício CM, Melchior Mde O, Ferreira CL, Da Silva MA. Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy. Cranio 2008;26:118–125.

51. Reiter S, Eli I, Friedman-Rubin P, Emodi-Perlman A, Ziv-Baran T, Winocur E. Comparing Axis II scores according to the RDC/TMD and DC/TMD in Israeli patients. J Oral Facial Pain Headache 2017;31:323–330.

52. Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2010;9:CD005233.

53. Hesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clin Psychol Rev 2011;31:545–553.

54. Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JW, Hoare DJ. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2020;1:CD012614.

55. Palla S. Biopsychosocial pain model crippled? J Orofac Pain 2011;25:289–290.

56. Koca TT, Seyithanoglu M, Sagiroglu S, Berk E, Dagli H. Frequency of audiological complaints in patients with fibromyalgia syndrome and its relationship with oxidative stress. Niger J Clin Pract 2018;21:1271–1277.

57. Iikuni F, Nomura Y, Goto F, Murakami M, Shigihara S, Ikeda M. Why do patients with fibromyalgia complain of ear-related symptoms? Ear-related symptoms and otological findings in patients with fibromyalgia. Clin Rheumatol 2013;32:1437–1441.

58. Ayouni I, Chebbi R, Hela Z, Dhidah M. Comorbidity between fibromyalgia and temporomandibular disorders: A systematicreview. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:33–42.

59. Costa YM, Conti PC, de Faria FA, Bonjardim LR. Temporo-mandibular disorders and painful comorbidities: Clinical association and underlying mechanisms. Oral Surg Oral Med OralPathol Oral Radiol 2017;123:288–297.

60. Michelotti A, Alstergren P, Goulet JP, et al. Next steps in development of the diagnostic criteria for temporomandibular disorders (DC/TMD): Recommendations from the International RDC/TMD Consortium Network workshop. J Oral Rehabil 2016;43:453–467.