Influence of Clinical, Physical, Psychological, and Psychophysical Variables on Treatment Outcomes in Somatic Tinnitus Associated With Temporomandibular Pain: Evidence From a Randomized Clinical Trial

Abstract

ObjectiveTo assess the influence of clinical, psychological, and psychophysical variables on treatment outcomes after application of exercise combined with education with/without manual therapy in people with tinnitus associated with temporomandibular disorder (TMD).MethodsA secondary analysis of a clinical trial was performed investigating the effectiveness of including cervico‐mandibular manual therapy into an exercise combined with education program in 61 subjects with TMD‐related tinnitus. Clinical outcomes including tinnitus severity and tinnitus‐related handicap were assessed at 3 and 6 months post‐intervention. Patients were assessed at baseline for clinical (tinnitus severity, tinnitus‐related handicap, quality of life), physical (range of motion), psychological (depression), and psychophysical (pressure pain thresholds [PPTs]) variables that were included as predictors.ResultsThe regression models indicated that higher scores of tinnitus severity at baseline predicted better outcomes 3 and 6 months post‐intervention (explaining 13% to 41% of the variance) in both groups. Higher scores of tinnitus‐related handicap at baseline predicted better outcome of tinnitus‐related handicap (45% variance) in the manual therapy with exercise/education group. Lower PPTs over the temporalis muscle at baseline predicted poorer clinical outcomes (10.5% to 41% of the variance) in both groups. Other predictors were sex and quality of life (6.7% variance) in the manual therapy group and PPTs over the masseter muscle (5.8% variance) in the exercise/education group.ConclusionThis study found that baseline tinnitus severity and localized PPT over the temporalis muscle were predictive of clinical outcomes in individuals with TMD‐related tinnitus following physical therapy. Other predictors (eg, sex, quality of life) were less influential.

Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders Associated with Tinnitus: A Systematic Review

“…The electronic search generated a total of 1565 articles. From those articles, only four were included [ 35 , 36 , 37 , 38 ] for summarizing the evidence ( Figure 1 ). However, two articles are derived from the same study [ 35 , 37 ].…”

“…However, two articles are derived from the same study [35,37]. One of them [35] was a secondary analysis from the clinical trial of the La Serna et al study [37]. The descriptive characteristics of the selected articles are presented in Table 1.…”

“…Both instruments applied are related to the tinnitus symptomatology but according to the authors, these instruments have different constructs and are more sensitive to differentiate tinnitus annoyance and intensity. The impact of tinnitus on daily life was assessed using the Tinnitus Handicap Inventory (THI) in two articles [35,37]. The descriptive characteristics of the selected articles are presented in Table 1.…”

Treatment of Patients with Somatic Tinnitus Attributed to Temporomandibular Disorder: A Case Report

“…The frequent coexistence of tinnitus and temporomandibular disorders (TMD) has already been demonstrated in scientific literature [3]. A recent review reported that the prevalence of tinnitus is higher in patients with TMD (35.8% to 60.7%) when compared to patients without TMD (9.7% to 26.0%) with an odds ratio of 4.45 [1]. The aim of this case study is to analyze the effects of conservative multidisciplinary management of tinnitus in patients with coexisting tinnitus, TMD and bruxism.…”

“…Temporomandibular disorders (TMDs) present a range of signs and symptoms, which include pain in the masticatory muscles and joints and limitations in the range of mandibular movement. However, patients with TMD may also have other associated symptoms, especially otological symptoms such as tinnitus [1]. The definition of tinnitus can be described as the conscious perception of and the reaction to a sound in the absence of a corresponding external acoustic stimulus, commonly described as a "phantom" perception.…”