Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss

BMC Ear, Nose and Throat Disorders

Georgios Paraskevas⁷  Panagiotis Kanavaros⁵  Aristides Zimpis⁴  Vasiliki Galani⁶  Kalliopi Iliou²  Aikaterini Marini¹  Panagiotis Kitsoulis³ 

[1]Intern of Internal Medicine, Assistant in the Laboratory of Anatomy-Histology-Embryology, Medical School, University of Ioannina, Greece

[2]Assistant in the Laboratory of Anatomy-Histology-Embryology, Medical School, University of Ioannina, Greece

[3]Orthopaedic Surgeon, Professor of Anatomy-Histology-Embryology, Medical School, University of Ioannina, Greece

[4]Orthopaedic Surgeon, Lecturer of Anatomy, Medical School, University of Larissa, Thessaly, Greece

[5]Professor and Chairman of Anatomy-Histology-Embryology, Medical School, University of Ioannina, Greece

[6]Associate professor of Anatomy-Histology-Embryology, Medical School, University of Ioannina, Greece

[7]Orthopaedic Surgeon, Assistant Professor of Anatomy, Medical School, Aristotle University, Thessaloniki, Greece

关键词: audiometry;    hearing loss;    aural symptoms;    mouth opening;    temporomandibular disorders;   

Others  :  862858
DOI  :  10.1186/1472-6815-11-5

 received in 2010-09-07, accepted in 2011-05-25,  发布年份 2011

【 摘 要 】

Background

The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss.

Methods

The study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests.

Results

The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects.

Conclusions

TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

【 授权许可】

   
2011 Kitsoulis et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Buescher JJ: Temporomandibular joint disorders. Am Fam Physician 2007, 76:1477-82.
• [2]Oral K, Bal B, Ebeoglu B, Dincer S: Etiology of temporomandibular disorder pain. Agri 2009, 21(3):89-94.
• [3]Walker N, Bohannon RW, Cameron D: Discriminant validity of temporomandibular joint range of motion measurements obtained with a ruler. J Orthop Sports Phys Ther 2000, 30(8):484-92.
• [4]Scott B, Butterworth C, Lowe D, Rogers SN: Factors associated with restricted mouth opening and its relationship to health-related quality of life in patients attending a Maxillofacial Oncology clinic. Oral Oncol 2008, 44:430-438.
• [5]Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6(4):301-55.
• [6]Wright EF: Otologic symptom improvement through TMD therapy. Quintessence Int 2007, 38(9):e564-71.
• [7]Ramirez LM, Ballesteros LE, Sandoval GP: Tensor tympani muscle: strange chewing muscle. Med Oral Patol Oral Cir Bucal 2007, 12:E96-100.
• [8]Salvetti G, Manfredini D, Barsotti S, Bosco M: Otologic symptoms in temporomandibular disorders patients: is there evidence of an association-relationship? Minerva Stomatol 2006, 55:627-37.
• [9]Myrhaug H: The incidence of the ear symptoms in cases of malocclusion and temporomandibular joint disturbances. Br J Oral Maxillofac Surg 1964, 2:28-32.
• [10]Naeije M: Local kinematic and anthropometric factors related to the maximum mouth opening in healthy individuals. J Oral Rehab 2002, 29:534-539.
• [11]Dijkstra PU, Bont LGM, Stegenga B, Boering G: Angle of mouth opening measurement: reliability of a technique for temporomandibular joint mobility assessment. J Oral Rehab 1995, 22:263-268.
• [12]Fonseca DM: Disfuncao craniomandibular (DCM) - diagnostico pela anamnese. FOB - Faculdade de Odontologia de Bauru 1992, 1-116.
• [13]Gallo LM, Airoldi R, Ernst B, Palla S: Power spectral analysis of temporomandibular joint sounds in asymptomatic subjects. J Dent Res 1993, 72(5):871-5.
• [14]Skevas A: Otorhinolaryngology. Third edition. Ioannina; 2002:102-106.
• [15]Boenninghaus HG, Röser D: On the practical use of hearing loss tables and the establishment of decrease of earning capacity. Arch Ohren NasenKehlkopfheilkd 1959, 175:396-401.
• [16]Feteih RM: Signs and symptoms of temporomandibular disorders and oral parafunctions in urban Saudi Arabian adolescents: a research report. Head Face Med 2006, 2:25. BioMed Central Full Text
• [17]de Oliveira AS, Dias EM, Contato RG, Berzin F: Prevalence study of signs and symptoms of temporomandibular disorder in Brazilian college students. Braz Oral Res 2006, 20(1):3-7.
• [18]Mezitis M, Rallis G, Zachariades N: The normal range of mouth opening. J Oral Maxillofac Surg 1989, 47:1028-9.
• [19]Yao KT, Lin CC, Hung CH: Maximum mouth opening of ethnic Chinese in Taiwan. J Dent Sci 2009, 4(1):40-44.
• [20]Sheppard IM, Sheppard SM: Maximal incisal opening: a diagnostic index? J Dent Med 1965, 20:13-15.
• [21]Cox SC, Walker DM: Establishing a normal range for mouth opening: its use in screening for oral submucous fibrosis. Br J Oral Maxillofac Surg 1997, 35:40-2.
• [22]Placko G, Bellot-Samson V, Brunet S, Guyot L, Richard O, Cheynet F, Chossegros C, Ouaknine M: Normal mouth opening in the adult French polulation. Rev Stomatol Chir Maxillofac 2005, 106:267-71.
• [23]Ageberg G: Maximal mandibular movements in young men and women. Sven Tandlak Tidskr 1974, 67:81-100.
• [24]Gallagher C, Gallagher V, Whelton H, Cronin M: The normal range of mouth opening in an Irish population. J Oral Rehab 2004, 31:110-6.
• [25]Celic R, Jerolimov V, Knezovic D: Relationship of slightly limited mandibular movements to temporomandibular disorders. Braz Dent J 2004, 15(2):151-154.
• [26]Kaneyama K, Segami N, Nishimura M, Suzuki T, Sato J: Importance of proinflammatory cytokines in synovial fluid from 121 joints with temporomandibular disorders. Br J Oral Maxillofac Surg 2002, 40(5):418-23.
• [27]Dworkin SF, Huggins KH, LeResche LR, Von Korff M, Howard J, Truelove E, Sommers E: Epidemiology of signs and symptoms in temporomandibular disorders: I, Clinical signs in cases and controls. J Am Dent Assoc 1990, 120:273-81.
• [28]Cox KW: Temporomandibular disorder and new oral symptoms. Arch Otolaryngol Head Neck Surg 2008, 134(4):389-393.
• [29]Ardizone I, Celemin A, Aneiros F, Rio J, Sanchez T, Moreno I: Electromyographic study of activity of the masseter and anterior temporalis muscles in patients with temporomandibular joint (TMJ) dysfunction: comparison with the clinical dysfunction index. Med Oral Patol Oral Cir Bucal 2010, 15(1):e14-9.
• [30]John MT, Frank H, Lobbezoo F, Drangsholt M, Dette KE: No association between incisal tooth wear and temporomandibular disorders. J Prosthet Dent 2002, 87:197-203.
• [31]Wright EF, Clark EG, Paunovich ED, Hart RG: Headache improvement through TMD stabilization appliance and self-management therapies. Cranio 2006, 24:104-11.
• [32]Tecco S, Tete S, D'Attilio M, Perillo L, Festa F: Surface electromyographic patterns of masticatory, neck, and trunk muscles in temporomandibular joint dysfunction patients undergoing anterior repositioning splint therapy. Europ J Orthod 2008, 30:592-597.
• [33]Rubinstein B, Axelsson A, Carlsson GE: Prevalence of signs and symptoms of craniomandibular disorders in tinnitus patients. J Craniomandib Dis Facial Oral Pain 1990, 4:186-92.
• [34]Pinto OF: A new structure related to the temporomandibular joint and middle ear. J Prosthet Dent 1962, 12:95-103.
• [35]Ren YF, Isberg A: Tinnitus in patients with temporomandibular joint internal derangement. Cranio 1995, 13:75-80.
• [36]Ash MM, Ash CM, Ash JL, Ash GM: Current concepts of the relationship and management of temporomandibular disorders and auditory symproms. J Mich Dent Assoc 1990, 72(11-12):550-555.
• [37]Myers LJ: Possible inflammatory pathways relating temporomandibular joint dysfunction to otic symptoms. J Craniomandib Pract 1988, 6(1):65-70.
• [38]Marasa FK, Ham BD: Case reports involving the treatment of children with chronic otitis media with effusion via craniomandibular methods. J Craniomandib Pract 1988, 6:256-70.
• [39]Klockhoff I, Anderson H: Reflex activity in the tensor tympani muscle recorded in man; preliminary report. Acta Otolaryngol 1960, 51:184-8.
• [40]Gray LP: The relationship between the ''superior constrictor swallow'' clicking of the ears and ear disease. J Laryngol Otol 1983, 97:1121-8.
• [41]Schames J, Schames M, King E, Ulansey S, Boyd J, Schames E: Trigeminal pharyngioplasty: treatment of the forgotten accessory muscles of mastication which are associated with orofacial pain and ear symptomatology. AJPM 2002, 12:102-12.
• [42]Ogutcen-Toller M, Juniper RP: Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg 1993, 21:2-8.
• [43]Shapiro HH, Truex RC: The temporomandibular joint and the auditory function. J Am Dent Assoc 1943, 30:1147-68.
• [44]Malkin DP: The role of TMD dysfunction in the etiology of middle ear diseases. Int J Orthod 1987, 25:20-1.
• [45]Kierner AC, Mayer R, v Kirschhofer K: Do the tensor tympani and tensor veli palatini muscles of man form a functional unit? A histochemical investigation of their putative connections. Hear Res 2002, 165:48-52.
• [46]Kaygusuz I, Karlidag T, Keles E, Yalcin S, Yildiz M, Alpay HC: Ear symptoms accompanying temporomandibular joint diseases. Kulak Burum Bogaz Ihtis Derg 2006, 16(5):205-8.
• [47]Toller MO, Juniper RP: Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg 1993, 21(1):2-8.
• [48]Ciancaglini R, Loreti P, Radaelli G: Ear, nose and throat symptoms in patients with TMD: the association of symptoms according to severity of arthropathy. J Orofac Pain 1994, 8:293-7.
• [49]Axelsson R, Tullberg M, Ernberg M, Hedenberg-Magnusson B: Symptoms and signs of temporomandibular disorders in patients with sudden sensorineural hearing loss. Swed Dent J 2009, 33(3):115-23.
• [50]Kuttila S, Kuttila M, Le Bell Y, Alanen P, Jouko S: Aural symptoms and signs of temporomandibular disorder in association with treatment need and visits to a physician. Laryngoscope 1999, 109:1669-73.