Temporomandibular disorders – insufficient evidence for or against impact of conservative therapies on otologic signs and symptoms


Temporomandibular disorders (TMD) are common with an estimated 12-65% of the populations being affected. Common signs and symptoms are related to muscle sensitivity through palpation, restricted mouth opening, asymmetric mandibular movements, joint sounds, pain and otologic signs and symptoms. Initial treatments for TMD usually involve conservation techniques such as counselling, occlusal splints, myofunction therapy, exercises, manual therapies, biofeedback and acupuncture.

The aim of this review was to investigate the effect of conservative therapies for TMD on otologic signs and symptoms


Searches were conducted in the PubMed, LILACS, Scopus, Web of Science and Science Direct databases. Studies in adult (≥ 18 years) TMD patients with otologic signs and symptoms using recognised TMD classification and treated using conservative therapies were considered.

Two reviewers independently selected studies abstracted data and assessed risk of bias for selected studies. A narrative summary of results was presented


  • 8 studies (3 RCTs, 5 Cohorts) were included
  • 5 studies used a Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD) protocol.
  • Average age of the patients was 42 years and 63.2% were female.
  • 7 of the 8 included studies reported resolution or improvement in otologic symptoms with conservative TMD treatment.


The authors concluded:-

Based upon the limitations of the studies included in this systematic review, the present outcomes suggested insufficient evidence in favour or against the conservative therapies for TMD on changes in otologic signs and symptoms. Thus, further studies with a higher level of evidence and more representative samples should be conducted to better understand the effect of TMD therapy on otologic complains.


Otologic symptoms associated with TMD are tinnitus, dizziness, vertigo, earache, hypoacusis sensation, ear fullness, hyperacusis and stuffy sensation. In this review tinnitus was the most commonly issue reported by the patients. While a number of databases were searched only a small number of the studies could be included and only 3 of these were randomised controlled trials. Given that it is estimated that patients with TMD have a greater prevalence of otologic symptoms it possible that there may be under recording of these symptoms or the possibility of publication bias given that 7 of the included studies report a positive outcome. Higher quality studies are clearly needed to understand both the signs and symptoms reported by patients suffering with TMD and the impact of the various treatment modalities. Common methods of recording and reporting outcomes would also help comparisons in the future.


Primary paper

Stechman-Neto J, Porporatti AL, Porto de Toledo I, Costa YM, Conti PC, De Luca Canto G, Mezzomo LA. Effect of temporomandibular disorder therapy on otologic signs and symptoms: a systematic review. J Oral Rehabil. 2016 Jan 8. doi: 10.1111/joor.12380. [Epub ahead of print] Review. PubMed PMID: 26749516

Other references

Original review protocol on PROSPERO database







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