Ann Ital Chir. 2022;93:210-216.
To investigate the changes of audiological tests and the cone beam computed tomography (CBCT) measurements of temporomandibular joint (TMJ) and middle-inner ear structure after occlusal splint therapy in temporomandibular disorders (TMD) patients with otological symptoms, and explore the etiological mechanism between TMD and otological symptoms.
The 25 subjects aged 18 to 40 years who diagnosed with TMD combined the otological symptoms enrolled in the study.They all had received orthodontic treatment in the outpatient clinic of the orthodontic department in Beijing Stomatological Hospital. All the subjects underwent the audiological tests of pure tone audiometry (PTA) and CBCT before and after the occlusal splint therapy.
After the stabilization occlusal splint therapy, subjects with improvement or complete remission in TMD and otological symptoms accounted for 84% and 80% in all subjects respectively. There were statistically differences in the distances between condylar center (CoC) and sella (S) in sagittal and vertical directions before and after treatment, and statistically difference between ATM and S in sagittal direction. The threshold of PTA at 8000Hz were negatively correlated with the sagittal displacement of condyle and positively correlated with the coronal displacement of condyle. The thickness of top 1/3 of anterior wall of tympanum in sagittal were positively correlated with the threshold of PTA at 4000Hz.
The changes in the TMJ position through occlusal splint therapy might cause the changes in structure of middle-inner ear, which might be one of the reasons for the improvement in otological symptoms.
Audiology, CBCT, Otological symptoms, TMD.
本研究旨在探讨颞下颌关节紊乱病(TMD)伴耳部症状患者经咬合板治疗后,听力学检查和颞下颌关节(TMJ)及中耳内耳结构锥形束 CT(CBCT)测量值的变化,并探讨 TMD 与耳部症状之间的病因机制。
本研究纳入了 25 名 18-40 岁诊断为 TMD 伴耳部症状的患者,他们均在首都医科大学附属北京口腔医院正畸科门诊接受过正畸治疗。所有患者在咬合板治疗前后均接受了纯音听阈测试(PTA)和 CBCT 检查。
经稳定型咬合板治疗后,TMD 及耳部症状改善或完全缓解的患者分别占所有患者的 84%和 80%。治疗前后,髁突中心(CoC)与鞍底(S)矢状和垂直方向的距离以及关节窝前间隙(ATM)与 S 的矢状方向均有统计学差异。8000Hz 的 PTA 阈值与髁突的矢状位移呈负相关,与髁突的冠状位移呈正相关。鼓膜前上 1/3 厚度在矢状位上与 4000Hz 的 PTA 阈值呈正相关。
通过咬合板治疗改变 TMJ 位置可能导致中耳内耳结构的变化,这可能是耳部症状改善的原因之一。
听力学;CBCT;耳部症状;TMD。