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Prognosis of conservative treatment in individuals with temporomandibular disorders and tinnitus: a systematic review

The temporomandibular joint (TMJ) is situated anteriorly to the external acoustic meatus (ear canal) between the head of the mandible and the mandibular fossa (squamous and tympanic parts of the temporal bone). It contains an articular disk covered by a fibrous capsule and interposed anteriorly into the lateral pterygoid muscle and posteriorly into the fat pad. The muscles of mastication are responsible for movement in this joint1,2. The anatomical relationship between the TMJ and the ear begins with embryonic development of the first pharyngeal arch, and the innervation of some structures by the trigeminal nerve can generate pain throu ghout the facial region3. Anatomical dysfunctions of the TMJ are defined as temporomandibular disorders (TMD), which affect the TMJ, masticatory and facial muscles, spreading to the stomatognathic and auditory systems. Its etiology is multidimensional and involves neurobiological, biomechanical, neuromuscular and biopsychosocial factors. An assessment of the anatomical and mechanical characteristics associated with the TMJ can serve as the basis for understanding an individual’s clinical condition3,4. The main incapacitating symptoms are muscle and/or joint pain, restricted or deviated joint movement, joint noises, headaches, neck pain, earache and tinnitus1,5. Tinnitus is the term for hearing sounds in the inner ear that are not from an external source and can be mild, characterized by occasional ringing of varying intensities, or severe, in the form of constant loud noise that is untreatable6. Considered one of the greatest medical mysteries, it is suggested that the somatosensory stimuli that induce tinnitus are closely linked to anomalous crossmodal plasticity of somatosensory-auditory interactions, whereby the somatic modulations of tinnitus are the result of abnormal auditory neural interactions and the distortion of normal synaptic activity in the central nervous system, that is, information on muscle contractions is carried by the somatosensory system and, on reaching the cuneiform nucleus, can influence tinnitus through its projection on the auditory Prognosis of conservative treatment in individuals with temporomandibular disorders and tinnitus: a systematic review Review article