Edvall Niklas K, Gunan Edis, Genitsaridi Eleni, Lazar Andra, Mehraei Golbarg, Billing Mattias, Tullberg Marie, Bulla Jan, Whitton Jonathon, Canlon Barbara, Hall Deborah A, Cederroth Christopher R
Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
National Institute of Health Research, Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.
Front Neurosci. 2019 Aug 22;13:879. doi: 10.3389/fnins.2019.00879. eCollection 2019.
There is increasing evidence of associations between the presence of temporomandibular joint (TMJ) disorders and tinnitus. It has been recently proposed that tinnitus patients with TMJ complaints could constitute a subtype, meaning a subgroup of tinnitus patients responsive to specific treatments. Tinnitus patients with TMJ complaints are often young women with somatosensory features of their tinnitus. Here, we investigate the socio-economic factors, phenotypic characteristics and psychological variables of tinnitus subjects from the Swedish Tinnitus Outreach Project, with ( = 486) or without ( = 1,996) TMJ complaints. The prevalence of TMJ complaints was greater in tinnitus subjects with severe tinnitus (36%) when compared to those with any tinnitus (19%), strongly indicating the contribution of TMJ problems to the severity of tinnitus. Comparing subgroups with or without TMJ complaints in the whole sample, differences were found regarding a large number of socioeconomic, phenotypic, and psychological characteristics. Subjects with TMJ complaints were more often women, more often reported stress as the cause of tinnitus, were more severely affected by tinnitus, scored worse in measures of psychological well-being and life quality, and were more often affected by problems tolerating sounds, headache, vertigo/dizziness, and neck pain. In addition, they more often reported pulsating and tonal tinnitus, somatic modulation of tinnitus, and aggravation of tinnitus by loud sounds and stress. When focusing the analysis in subjects with tinnitus as a big problem using the Tinnitus Functional Index cut-off ≥ 48, or with severe tinnitus according to the Tinnitus Handicap Inventory cut-off ≥ 58, the impact of somatosensory modulations and stress on tinnitus were greater in subjects with TMJ complaints in comparison to those without. In light of these results, we hypothesize that stress could contribute to the co-occurrence of TMJ problems and tinnitus and also to the development of severe tinnitus. Our study supports the need of involving dental care and stress management in the holistic treatment of patients with severe tinnitus.
越来越多的证据表明颞下颌关节（TMJ）紊乱与耳鸣之间存在关联。最近有人提出，有颞下颌关节问题主诉的耳鸣患者可能构成一个亚型，即对特定治疗有反应的耳鸣患者亚组。有颞下颌关节问题主诉的耳鸣患者通常是年轻女性，其耳鸣具有躯体感觉特征。在此，我们调查了瑞典耳鸣外展项目中伴有（n = 486）或不伴有（n = 1996）颞下颌关节问题主诉的耳鸣受试者的社会经济因素、表型特征和心理变量。与任何程度耳鸣的受试者（19%）相比，重度耳鸣的耳鸣受试者中颞下颌关节问题主诉的患病率更高（36%），这有力地表明颞下颌关节问题对耳鸣严重程度有影响。在整个样本中比较有或没有颞下颌关节问题主诉的亚组，发现大量社会经济、表型和心理特征存在差异。有颞下颌关节问题主诉的受试者女性更多，更多地报告压力是耳鸣的原因，受耳鸣影响更严重，在心理健康和生活质量测量中得分更差，更常受到声音耐受问题、头痛、眩晕/头晕和颈部疼痛的影响。此外，他们更常报告搏动性和音调性耳鸣、耳鸣的躯体调节以及大声和压力导致耳鸣加重。当使用耳鸣功能指数临界值≥48将分析重点放在将耳鸣视为重大问题的受试者中，或根据耳鸣障碍量表临界值≥58将重点放在重度耳鸣受试者中时，与没有颞下颌关节问题主诉的受试者相比，有颞下颌关节问题主诉的受试者中躯体感觉调节和压力对耳鸣的影响更大。鉴于这些结果，我们假设压力可能导致颞下颌关节问题和耳鸣同时出现，也可能导致重度耳鸣的发展。我们的研究支持在重度耳鸣患者的整体治疗中纳入牙科护理和压力管理的必要性。
