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Otological symptoms and audiometric findings in patients with temporomandibular disorders: Costen's syndrome revisited

Published online by Cambridge University Press:  12 December 2016

K G Effat*
Affiliation:
Department of Otolaryngology, El-Sahel Teaching Hospital, Cairo, Egypt
*
Address for correspondence: Dr K G Effat, 6 Falaky Square, Cairo, Egypt E-mail: kamaleffat@hotmail.com

Abstract

Objective:

Otological symptoms (otalgia, subjective hearing loss, blocked ear sensation, tinnitus and vertigo) associated with temporomandibular disorders are documented features of Costen's syndrome. However, the origin of these symptoms and the causes of hearing loss are unknown. This study aimed to characterise hearing loss in a large number of patients with temporomandibular disorders. The causes of these symptoms were explored in patients with otological symptoms and normal audiometric findings.

Methods:

A prospective case study and literature review were performed. The audiometric features of 104 temporomandibular disorder patients were compared with those of 110 control participants.

Results:

A large proportion of temporomandibular disorder patients had several otological symptoms. Twenty-five per cent of unilateral or bilateral temporomandibular disorder patients had either unilateral (ipsilateral) or bilateral hearing loss; respectively, which was usually mild (p = 0.001). Hearing loss was predominantly sensorineural.

Conclusion:

The main cause of otological symptoms (apart from otalgia) and of audiometric findings in temporomandibular disorder patients is postulated to be an altered middle-ear to inner-ear pressure equilibrium.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2016 

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References

1 Villalón, P, Arzola, JF, Valdivia, J, Fresno, MJ, Santander, H, Gutiérrez, MF et al. The occlusal appliance effect on myofascial pain. J Craniomand Sleep Pract 2013;31:8491 Google ScholarPubMed
2 Ramirez, LM, Ballesteros, LE, Sandoval, GP. Topical review: temporomandibular disorders in an integral otic symptom model. Int J Audiol 2008;47:215–27Google Scholar
3 Costen, JB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhinol Laryngol 1934;43:115 Google Scholar
4 Costen, JB. Neuralgias and ear symptoms associated with disturbed function of the temporomandibular joint. JAMA 1936;107:252–8Google Scholar
5 Costen, JB. Some features of the mandibular articulation as it pertains to medical diagnosis, especially in otolaryngology. J Am Dent Assoc 1937;24:1507–11Google Scholar
6 Costen, JB. Outline of the mandibular joint syndrome. Laryngoscope 1959;69:404–14Google Scholar
7 Penkner, K, Köle, W, Kainz, J, Schied, G, Lorenzoni, M. The function of tensor veli palatini muscles in patients with aural symptoms and temporomandibular disorder. An EMG study. J Oral Rehabilit 2000;27:344–8Google Scholar
8 Lam, DK, Lawrence, HP, Tenenbaum, HC. Aural symptoms in temporomandibular disorder patients attending a craniofacial pain unit. J Orofac Pain 2001;15:146–57Google Scholar
9 Tuz, HH, Onder, EM, Kisnisci, RS. Prevalence of otologic complaints in patients with temporomandibular disorder. Am J Orthod Dentofacial Orthop 2003;123:620–3CrossRefGoogle ScholarPubMed
10 Pihut, M, Majewski, P, Wisniewska, G, Reron, E. Auriculo-vestibular symptoms related to structural and functional disorders of stomatognatic system. J Physiol Pharmacol 2011;62:251–6Google ScholarPubMed
11 Totta, T, Santiago, G, Gonçales, ES, Saes, SO, Berretin-Felix, G. Auditory characteristics of individuals with temporomandibular dysfunctions and dentofacial deformities. Dental Press J Orthod 2013;18:70–7Google Scholar
12 Pekkan, G, Aksoy, S, Hekimoglu, C, Oghan, F. Comparative audiometric evaluation of temporomandibular disorder patients with otological symptoms. J Craniomaxillofac Surg 2010;38:231–4CrossRefGoogle ScholarPubMed
13 Toller, , Juniper, RP. Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg 1993;21:28 Google Scholar
14 McKenna, SJ, Hall, HD. Audiometric assessment of patients with painful TMJ internal derangements: failure of audiometry to change following arthrotomy. J Craniomandib Disord Facial Oral Pain 1990;4:109–12Google ScholarPubMed
15 Baldursson, G, Blackmer, ER. Temporomandibular joint symptoms in patients with midfrequency sensorineural hearing loss. Ear Hear 1987;8:63–7Google Scholar
16 Dolowitz, DA, Ward, JW, Fingerle, CO, Smith, CC. The role of muscular incoordination in the pathogenesis of the temporomandibular joint syndrome. Laryngoscope 1964;74:790801 Google Scholar
17 Kuttila, S, Kuttila, M, Bell, YL, Alanen, P, Jouko, S. Aural symptoms and signs of temporomandibular disorder in association with treatment need and visits to a physician. Laryngoscope 1999;109:1669–73CrossRefGoogle ScholarPubMed
18 Brookes, GB, Maw, AR, Colemnan, MJ. ‘Costen's syndrome’ – correlation or coincidence: a review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms. Clin Otolaryngol 1980;5:23–6Google Scholar
19 Bag, AK, Gaddikeri, S, Singhal, A, Hardin, S, Tran, BD, Medina, JA et al. Imaging of the temporomandibular joint: an update. World J Radiol 2014;6:567–82Google Scholar
20 de Souza, ST, de Mello, VVC, Magalhães, BG, Morais, MPLA, Vasconcelos, MMVB, Junior AFC et al. The role of occlusal factors on the occurrence of temporomandibular disorders. Cranio 2015:33:211–16Google Scholar
21 Shaffer, SM, Brismée, J-M, Sizer, PS, Courtney, CA. Temporomandibular disorders. Part 1: anatomy and examination/diagnosis. J Man Manip Ther 2014;22:212 Google Scholar
22 Peck, CC, Goulet, J-P, Lobbezoo, F, Schiffman, EL, Alster-Gren, P, Anderson, GC et al. Expanding the taxonomy of the diagnostic criteria for temporomandibular disorders. J Oral Rehabilit 2014;41:223 Google Scholar
23 Jun, HJ, Hwang, SY, Lee, SH, Lee, JE, Sang, J-J, Choe, S. The prevalence of hearing loss in South Korea: data from a population-based study. Laryngoscope 2015;125:690–4Google Scholar
24 Schröder, S, Lehmann, M, Sauzet, O, Ebmeyer, J, Sudhoff, H. A novel diagnostic tool for chronic obstructive eustachian tube dysfunction – the eustachian tube score. Laryngoscope 2015;125:703–8Google Scholar
25 Kramer, PR, Bellinger, LL. Modulation of temporomandibular joint nociception and inflammation in male rats after administering a physiological concentration of 17β-estradiol. Eur J Pain 2013;17:174–84Google Scholar
26 Sarlani, E, Greenspan, JD. Why look in the brain for answers to temporomandibular disorder pain? Cells Tissues Organs 2005;180:6975 Google Scholar
27 Sessle, BJ. Peripheral and central mechanisms of orofacial inflammatory pain. Int Rev Neurobiol 2011;97:179206 Google Scholar
28 Jahn, AF: Abnormal patient, normal test: the otologist's dilemma. J Laryngol Otol 2013;127:111–13Google Scholar
29 Ullas, G, McClelland, L, Jones, NS. Medically unexplained symptoms and somatisation in ENT. J Laryngol Otol 2013;127:452–7Google Scholar
30 Moayedi, M, Weissman-Fogel, I, Salomons, TV, Crawley, AP, Goldberg, MB, Freeman, BV et al. White matter brain and trigeminal nerve abnormalities in temporomandibular disorder. Pain 2012;153:1467–77Google Scholar
31 Hind, SE, Haines-Bazrafshan, R, Benton, CL, Brassington, W, Towle, B, Moore, DR. Prevalence of clinical referrals having hearing thresholds within normal limits. Int J Audiol 2011;50:708–16CrossRefGoogle ScholarPubMed
32 Hilgenberg, PB, Saldanha, ADD, Cunha, CO, Rubo, JH, Conti, PCR. Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients. J Oral Rehabilit 2012;39:239–44Google Scholar
33 Riga, M, Xenellis, J, Peraki, E, Ferekidou, E, Korres, S. Aural symptoms in patients with temporomandibular joint disorders: Multiple frequency tympanometry provides objective evidence of changes in middle ear impedence. Otol Neurotol 2010;31:1359–64Google Scholar
34 Rodríguez-Vázquez, JF, Mérida-Velasco, JR, Mérida-Velasco, JA, Jiménez-Collado, J. Anatomical considerations on the discomalleolar ligament. J Anat 1998;192:617–21Google Scholar
35 Loughner, BA, Larkin, LH, Mahan, PE. Discomalleolar and anterior malleolar ligaments: Possible causes of middle ear damage during temporomandibular joint surgery. Oral Surg Oral Med Oral Pathol 1989;68:1422 CrossRefGoogle ScholarPubMed
36 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;165:4852 Google Scholar
37 Noreńa, AJ. Revisiting the cochlear and central mechanisms of tinnitus and therapeutic approaches. Audiol Neurotol 2015;20(suppl 1):53–9CrossRefGoogle ScholarPubMed
38 Kimitsuki, T. The effect of pressure on potassium currents in the inner hair cells isolated from guinea-pig cochlea. Acta Neurobiol Exp 2013;73:521–8Google Scholar
39 Mom, T, Pavier, Y, Giraudet, F, Gilain, L, Avan, P. Measurement of endolymphatic pressure. Eur Ann Otorhinolaryngol 2015:132:81–4Google Scholar
40 Franco-Vidal, V, Bonnard, D, Bellec, O, Thomeer, H, Darrouzet, V. Effects of body tilt on multifrequency admittance tympanometry. Otol Neurotol 2014;36:737–40Google Scholar
41 Franz, B, Anderson, C. The potential role of joint injury and Eustachian tube dysfunction in the genesis of secondary Ménière's disease. Int Tinnitus J 2007;13:132–7Google Scholar
42 Chen, H, Nackley, A, Miller, V, Diatchenko, L, Maixner, W. Multisystem dysregulation in painful temporomandibular disorders. J Pain 2013;14:983–96Google Scholar