Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program

Abstract

Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity. The purpose of this study was to evaluate the effect of orofacial treatment on tinnitus complaints in patients with TST. Methods: Adult patients with TST were included, and all patients received information and advice about tinnitus and conservative orofacial treatment consisting of physical therapy, and, in case of grinding, occlusal splints were applied. Included patients were randomly assigned to an early start group and a delayed start group according to our delayed treatment design. Results: In total, 40 patients were included in each group. The treatment effect on tinnitus severity was investigated using the tinnitus questionnaire (TQ) and Tinnitus Functional Index (TFI). Regarding the TQ score, no clinically relevant reductions were observed, and no significant differences in the decrease were observed between the early start group and delayed start group. Contrarily, a significantly higher percentage of patients showed a decrease in the TQ degree in the early start group compared to the delayed start group (30.0% versus 2.8%, p = 0.006). The TFI score did show a significantly greater and clinically relevant reduction in the early start group compared to the delayed start group (p = 0.042). Conclusion: A multidisciplinary non-invasive orofacial treatment was able to reduce tinnitus severity in patients with temporomandibular related somatosensory tinnitus.

Association between Hyperacusis and Tinnitus

“…The determination from the patient of which symptom arose first, and which is their prime complaint could be used in the formulation of a treatment plan. From our data, the benefits of somatosensory [58] or combined auditory-somatosensory [59] treatments would appear to be limited in patients with severe tinnitus and hyperacusis in combination, which further highlights the importance of monitoring the two.…”

Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review

“…Finally, a total of 23 trials were included in the literature data mapping [ 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Figure 1 shows the flow chart of the study selection.…”

Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus

“…For this study, we used data collected for a RCT (80 patients) investigating the effect of multidisciplinary orofacial treatment. These data were complemented with an additional cohort of 21 patients to increase the power of our analysis ( Michiels et al, 2018b ; Van der Wal et al, 2020 ). The patients in the cohort met the same inclusion criteria and received the same treatment as the patients from the RCT.…”

“…All included potential prognostic indicators were selected based on existing knowledge about potential influence on the outcome after treatment. More information can be found in the RCT paper and the study protocol ( Michiels et al, 2018b ; Van der Wal et al, 2020 ).…”

“…As suggested by these pathophysiological models, studies investigating the effect of orofacial treatment show positive results on tinnitus severity, loudness, and annoyance ( Erlandsson et al, 1991 ; Tullberg and Ernberg, 2006 ; Bosel et al, 2008 ; Michiels et al, 2019b ; Van der Wal et al, 2020 ). Our recently published randomized controlled trial (RCT) showed a clinically relevant improvement after multidisciplinary orofacial treatment of tinnitus severity in 61% and of tinnitus annoyance in 46% of temporomandibular-related ST patients ( Van der Wal et al, 2020 ). This is in accordance with previous studies ( Erlandsson et al, 1991 ; Tullberg and Ernberg, 2006 ) but does not provide information on predicting factors for an individual outcome in a clinical environment.…”