Temporomandibular disorders: high prevalence of otologic signs and symptoms


Temporomandibular disorders (TMDs) are a range of conditions affecting the masticatory muscles, the temporomandibular joint (TMJ), and associated structures.  Pain in the joint and muscles are common symptoms but a range of associated otologic problems are also reported (earache [otalgia], tinnitus, vertigo, ear fullness and hearing loss/impairment

The aim of this review was to estimate the prevalence of otologic signs and symptoms in adult patients with temporomandibular disorders (TMDs).


Searches were conducted in the PubMed, LILACS, Scopus, Web of Science, ProQuest, LIVIVO, Google Scholar and OpenGrey databases. Two reviewers independently selected studies, abstracted data and assessed risk of bias using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data .

Observational studies in adults over 18 years old) with TMD diagnosed using the research diagnostic criteria for TMD (RDC/TMD) or DC/ TMD reporting otologic signs and symptoms were considered. No language or date restrictions were applied. Prevalence of otologic signs and symptoms presented in adults with TMD were expressed by mean percentage and 95% confidence intervals (95%CI).


  • 8 studies were included.
  • 1 was considered to be at low risk of bias, 7 at moderate risk.
  • Sample sizes varies from 12 – 776.
  • The studies demonstrated significant heterogeneity and a random effects meta-analysis found the most frequent symptom associated with TMD in adult is ear fullness
Symptom Frequency Standard deviation Sample size
ear fullness 74.8 % 43.02 to 96.25% 50
otalgia 55.1 % 31.78 to 77.30% 386
tinnitus 52.1 % 38.43 to 65.74% 1293
vertigo 40.8 % 11.29 to 74.72% 374
hearing loss 38.9 % 2.83 to 85.46% 744


The prevalence of otologic signs and symptoms in adult patients with TMD is high. The most prevalent otologic symptom in patient adults with TMD is ear fullness.


The review has searched a good range of databases and has included observational study designs which are appropriate for symptom prevalence studies. However, prospective cohort studies would be the most appropriate and all the 8 included studies are cross-sectional convenience samples, with some being restricted to a single sex, as highlighted by the authors.  Consequently, the findings of this review should be interpreted cautiously as an accurate assessment of the prevalence of otologic signs and symptoms in a TMD population requires a well conducted, population-based prospective studies.


Primary paper

Porto De Toledo I, Stefani FM, Porporatti AL, Mezzomo LA, Peres MA, Flores-Mir C, De Luca Canto G. Prevalence of otologic signs and symptoms in adult patients with temporomandibular disorders: a systematic review and meta-analysis. Clin Oral Investig. 2016 Aug 10. [Epub ahead of print] PubMed PMID: 27511214.

Other references

Original review protocol on PROSPERO



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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