Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review

Abstract

Movements of the neck and jaw may modulate the loudness and pitch of tinnitus. The aim of the present study was to systematically analyze the strength of associations between subjective tinnitus, cervical spine disorders (CSD), and temporomandibular disorders (TMD). A systematic literature search of the Medline, Embase, and Pedro databases was carried out on articles published up to September 2017. This covered studies in which tinnitus and CSD or TMD were studied as a primary or a secondary outcome and in which outcomes were compared with a control group. Included articles were evaluated on nine methodological quality criteria. Associations between tinnitus and CSD or TMD were expressed as odds ratios. In total, 2,139 articles were identified, of which 24 studies met the inclusion criteria. Twice, two studies were based on the same data set; consequently, 22 studies were included in the meta-analysis. Methodological quality was generally limited by a lack of blinding, comparability of groups, and nonvalidated instruments for assessing CSD. Results indicated that patients with tinnitus more frequently reported CSD than subjects without tinnitus. The odds ratio was 2.6 (95% CI [1.1, 6.4]). For TMD, a bidirectional association with tinnitus was found; odds ratios ranged from 2.3 (95%CI [1.5, 3.6]) for arthrogenous TMD to 6.7 (95%CI [2.4, 18.8]) for unspecified TMD. Funnel plots suggested a publication bias. After adjusting for this, the odds ratios decreased, but associations persisted. There is weak evidence for an association between subjective tinnitus and CSD and a bidirectional association between tinnitus and TMD.

The role of the dentist in the treatment of patients with tinnitus

“…© 2019 Polish Dental Association than two symptoms of TMD (compared to 35% of patients in a tinnitus-free control group) and that among TMD patients from 7% to 60% had tinnitus, according to different studies [24]. Higher prevalence of tinnitus in TMD patients was also observed in other studies, supporting the hypothesis that TMD may play a causal role in the development of tinnitus [2,16]. However, it seems that there are no significant patterns of correlation with specific TMD [13].…”

Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress

“…Interestingly, prevalence of tinnitus in patients with TMJ disorders reaches 60% in comparison to 15–30% in patients with no TMJ disorder (Chole and Parker, 1992; Tuz et al, 2003). 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.…”

“…Quality ranged from low to high indicating some risk of bias in reported findings. Bousema et al (2018) evaluated 22 studies which investigated the presence of cervical spine disorders (CSDs) or TMJ disorders in patients with and without tinnitus, or the presence of tinnitus in patients with and without TMJ disorders. In contrast, Mottaghi et al (2019) evaluated findings from just five studies comparing patients with and without TMJ disorders.…”

Abnormal findings on digital vectoelectronystagmography in patients with temporomandibular disorders

“…Several studies were conducted to understand the relationship between otoneurological symptoms and TMDs, and these studies showed that the head position influences the mandibular resting position, thereby increasing muscle tension 5 . In addition, most patients with tinnitus, headache, and dizziness presented abnormalities during mandibular movement 6,7 , dislocated articular disk 8 , and abscesses or diseases of the dental pulp due to bruxism 9 .…”