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Tuesday, June 7, 2011

Tinnitus: The TMJ (TMD) and Headache Connection. Can we predict and prevent tinnitus?

A new article "Signs and symptoms of temporomandibular disorders and the incidence of tinnitus." in the April 2011 Journal of Oral Rehabilitation showed that TMD and Headache were the two primary predictors of tinnitus. Tinnitus is a frequent symptom of TMJ disorders and is routinely considered to be related to TMD. There are many causes of tinnitus that are related to dentistry and posture.

The medial pterygoid muscle and the tensor of the ear drum (tensor veli tympani) have a common trigeminal nerve root. They are embryologically the same muscle that splits in two as the embryo develops into a fetus. Tinnitus is frequently triggered by palpating the medial pterygoid muscle which is also implicated in sleep apnea, a common finding in TMJ disorders.

The Sterncleidomastoid muscle can also have trigger points that cause both tinnitus, vertigo and feelings of loss of equilibrium.

The study analysed 3134 subjects Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ),24 or 12.6% over a five year period later developed tinnitus. Only 124 of the entire group developed tinnitus or 5.8% so there was a 7.7% increased risk in the group with palpation pain.

This study certainly shows that not treating TMD problems can lead to future problems. What is remarkable is that they only looked at one possible TMD symptom, if they had expanded this study to other TMD symptoms they probably would have found a much larger increased risk of developing tinnitus.

When a neuromuscular Dental orthotic is used to begin treatment of a TMD problem it is not unusual to see rapid elimination of tinnitus when there are other symptoms of TMD such as headache, sinus pain, muscle soreness or trigger points etc. Patients who present with tinnitus as a single symptom do not always respond as well as patients with multiple symptoms.

I strongly Rx starting treatment for all tinnitus patients with a neuromuscular orthotic after ruling out organic disease.

J Oral Rehabil. 2011 Apr 23. doi: 10.1111/j.1365-2842.2011.02224.x. [Epub ahead of print]
Signs and symptoms of temporomandibular disorders and the incidence of tinnitus.
Bernhardt O, Mundt T, Welk A, Köppl N, Kocher T, Meyer G, Schwahn C.
SourceDepartment of Restorative Dentistry, Periodontology and Endodontology, Center of Oral Health, University of Greifswald Department of Prosthodontics, Gerodontology and Biomaterials, Center of Oral Health, University of Greifswald Unit of Periodontology, Department of Restorative Dentistry, Periodontology and Endodontology, Center of Oral Health, University of Greifswald Statistical Department, Center of Oral Health, University of Greifswald, Greifswald, Germany.

Abstract
Summary  In a cross-sectional analysis of data from the Study of Health in Pomerania (SHIP 0), temporomandibular disorders (TMD) were the strongest predictors for tinnitus beside headache. The aim of this study was to investigate whether signs and symptoms of TMD can be identified as risk factors for developing tinnitus. The SHIP 1 is a population-based 5-year longitudinal study intended to systematically describe the prevalence of and risk factors for diseases common in the population of Pomerania in northern Germany. A total of 3300 subjects (76% response) were reevaluated after 5 years for tinnitus and signs and symptoms of TMD using the same questionnaires and examination tools as baseline. To estimate the relative risk (RR) appropriately, a modified Poisson regression was used. After exclusion of prevalent cases with diagnosed tinnitus, 3134 subjects were analysed. Among the 191 exposed subjects with palpation pain in the temporomandibular joint (TMJ), 24 subjects (12·6%) received diagnosed tinnitus after 5 years, whereas among the 2643 unexposed subjects 142 subjects (5·8%) received tinnitus yielding a risk difference of 7·7% (95% confidence interval [CI]: 3·0%-12·5%) and a risk ratio of 2·60 (95% CI: 1·7-3·9). The risk ratio was 2·4 (95% CI: 1·6-3·7) after adjustment for gender, age, school education and frequent headache. Pain on palpation of the TMJ, however, did not worsen the prognosis for tinnitus in prevalent tinnitus cases (RR = 0·8, P = 0·288). Signs of TMD are a risk factor for the development of tinnitus.

© 2011 Blackwell Publishing Ltd.

PMID: 21517934 [PubMed - as supplied by publisher]

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posted by Dr Shapira at 11:57 AM

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