Subtypes of temporomandibular disorders in patients diagnosed with otalgia: observational study / Subtipos de desordem temporomandibular em pacientes diagnosticados com otalgia: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Temporomandibular disorder (TMD) has complex symptoms that involve the orofacial region, such as otalgia. Considering the difficult differential diagnoses for associating otological symptoms with TMD. The aim of this study was to verify the diagnosis of TMD in patients with otalgia. METHODS: This is a cross-sectional and descriptive study, where 75 patients diagnosed with otalgia were evaluated. The European Academy of Craniomandibular Disorders's (EACD) screening questionnaire was initially applied, and those who answered affirmatively to at least one question were evaluated by the Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), with a final sample of 50 patients. Data were tabulated and ANOVA verified whether there was a statistical difference between TMD subtypes classified by DC/TMD, considering confidence intervals with 95% significance. RESULTS: The mean age of the participants was 39.9±14.1 years, with a predominance of females (76%) (p<0.0001). Among those diagnosed with TMD, females also predominated, with a higher percentage in all evaluated subtypes, with emphasis on arthralgia (82%) and myofascial pain with limited opening (81.8%), followed by myofascial pain (74%) and disc displacement with reduction (72.7%). When observing the distribution of TMD subtypes between genders, there was a predominance of myofascial pain in males (75%) and females (68%), but no statistical significance was observed in this variable and in the others studied. CONCLUSION: Patients with otalgia had one or more TMD subtypes, and the myofascial subtype TMD was the most prevalent among study participants.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) possui sintomas complexos que envolvem a região orofacial, como a otalgia. Considerando os difíceis diagnósticos diferenciais para associar sintomas otológicos com DTM. O objetivo deste estudo foi verificar o diagnóstico de DTM em pacientes com otalgia. MÉTODOS: Este é um estudo transversal e descritivo, com uma avaliação de 75 pacientes diagnosticados com otalgia. O questionário de triagem da Academia Europeia de Disfunções Craniomandibulares (EACD) foi aplicado inicialmente, e aqueles que responderam afirmativamente a pelo menos uma questão foram avaliados pelo Critério Diagnóstico de Pesquisa para Disfunções Temporomandibulares (DC/TMD), com amostra final de 50 pacientes. Os dados foram tabulados e por meio da ANOVA foi verificado se havia diferença estatística entre os subtipos de DTM classificados pelo DC/TMD, considerando intervalos de confiança com 95% de significância. RESULTADOS: A idade média dos participantes foi de 39,9±14,1 anos. Além disso, predominou-se o sexo feminino (76%) (p<0,0001), com maior percentual em todos os subtipos avaliados, destacando-se a artralgia (82%) e a dor miofascial com limitação de abertura (81,8%), seguida da dor miofascial (74%) e deslocamento de disco com redução (72,7%). Quando observada a distribuição dos subtipos de DTM entre os sexos, notou-se predominância de dor miofascial no sexo masculino (75%) e feminino (68%), mas não foi observada significância estatística nessa variável e nas demais estudadas. CONCLUSÃO: Os pacientes com otalgia manifestaram mais de um dos subtipos de DTM, sendo o subtipo de dor miofascial o mais prevalente entre os participantes do estudo.

Otalgia secundaria o referida, lo que el clínico debe saber

Resumen La otalgia es un motivo de consulta frecuente en otorrinolaringología que se puede clasificar en dos tipos: primaria y secundaria. La otalgia primaria es una consecuencia de una enfermedad otológica mientras que la secundaria o referida, surge de procesos patológicos que se originan en estructuras distintas del oído, pero que comparten vías neuronales comunes. Estas vías la componen los nervios craneales V, VII, IX y X y los nervios cervicales C2 y C3. Las causas más comunes de otalgia secundaria son la patología musculoesquelética como la disfunción de la articulación temporomandibular y el síndrome miofascial, la patología dental y las infecciones orofaríngeas. Para encontrar la etiología de la otalgia secundaria, en la mayoría de los casos, una historia clínica y examen físico acucioso resultarán suficientes, sin embargo, existe un grupo de pacientes con factores de riesgo que pudiesen requerir estudios adicionales. El objetivo de esta revisión es otorgar herramientas al lector para comprender los distintos procesos involucrados en la otalgia secundaria, conocer las patologías más relevantes relacionadas y de esta forma entregar al clínico una pauta para enfrentar este motivo de consulta.

Abstract Otalgia is a common reason for consultation in otolaryngology and can be classified into two types: primary or secondary otalgia. Primary otalgia is a consequence of an otological disease while secondary otalgia arises from pathological processes that originate in other structures different than the ears, but share common neuronal pathways. These pathways involve cranial nerves V, VII, IX and X and cervical nerves C2 and C3. The most common causes of secondary otalgia are musculoskeletal pathology such as temporomandibular joint dysfunction and myofascial syndrome, dental pathology and oropharyngeal infections. To find the etiology of secondary otalgia, in most cases a medical history and physical examination will be sufficient, however there is a group of patients with risk factors that may require additional studies. The objective of this review is to give the reader tools to understand the different processes involved in secondary otalgia, know the most relevant related pathologies and thus give the clinician a guide to deal with this problem.

Left Side Otalgia Caused by Acute Myocardial Infarction / 대한이비인후과학회지

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

A Case of Bruxism-Induced Otalgia

Here, the author presents a case of bruxism-induced otalgia in a 29-year-old female patient. The pain was sharp and penetrating in character. It was usually worse in the morning and frequently radiated to the right temporal area. She had received unsuccessful medical treatments for migraine headache. The otoendoscopic examination revealed a normal tympanic membrane. A thorough inspection of her teeth revealed excessive wear on the incisal edges, and the cause of her otalgia was identified as bruxism-related temporomandibular joint disorder. After the use of an occlusal splint and repeated botulinum toxin injections in the masseter and anterior temporalis muscles, along with good sleep hygiene, she experienced significant relief of pain and symptoms. The author suggests that multidisciplinary cooperation between ENT clinicians and dentists is necessary for the quick and accurate diagnosis and treatment of bruxism and the consequential referred otalgia.

Manual acupuncture associated with amitriptyline for treatment of tactile allodynia at concha of the ear: case report and 12-month follow up / Acupuntura manual associada à amitriptilina para o tratamento da alodínia tátil em região de concha do pavilhão auricular. Relato de caso e acompanhamento de 12 meses

BACKGROUND AND OBJECTIVES: Allodynia is a pain induced by stimuli which normally do not induce pain; it is caused by changes in sensory specificity. Acupuncture may be used for neuropathic pains such as allodynia or hyperalgesia. However, most studies in this area are in animal models. This study aimed at reporting the first case of efficacy of the association of acupuncture and amitriptyline in human being with tactile ear allodynia. CASE REPORT: Female patient, 46 years old, complaining of paroxysmal pain, in shock, triggered by touch on the right concha of the ear, irradiating to ipsilateral fundus, as a consequence of epidermoid carcinoma excision in cranial posterior fossa six years ago. Other sequelae of such surgery were right central facial paralysis and left hemiparesis; however they were not her current complaint. Previously, paroxysmal pain had been only partially controlled with amitriptyline, being patient then referred for tentative treatment with acupuncture. Two acupuncture points were selected by the manual technique, together with the maintenance of previous amitriptyline. There has been pain decrease, being that at fifth consultation patient has withdrawn the use of amitriptyline on her own. Pain had totally regressed after the seventh consultation. CONCLUSION: Acupuncture was effective to treat allodynia, with no symptoms recurrence even after six months without intervention or drug use. For being the first report of this association in human beings, specifically for allodynia, further studies are needed...

JUSTIFICATIVA E OBJETIVOS: Alodínia é uma dor provocada por estímulos que normalmente não gerariam dor; causada por alterações da especificidade sensorial. A acupuntura pode ser usada para dores neuropáticas como a alodínia ou hiperalgesia. Entretanto, a maioria dos estudos na área são em modelos animais. O objetivo deste estudo foi relatar o primeiro caso de eficácia da associação entre acupuntura e amitriptilina em um ser humano com alodínia tátil auricular. RELATO DO CASO: Paciente do gênero feminino, 46 anos, queixando de dor paroxística, em choque, desencadeada por toque na região de concha do pavilhão auricular direito, irradiando-se para fundo de olho ipsilateral, decorrente da excisão de carcinoma epidermoide em fossa posterior do crânio havia seis anos. Outras sequelas daquela cirurgia foram a paralisia facial direita de origem central e hemiparesia esquerda; entretanto, não constituíam a queixa atual. Previamente, a dor paroxística havia sido controlada apenas parcialmente com amitriptilina, sendo a paciente então encaminhada para tentativa de tratamento com acupuntura. Foram selecionados dois pontos de acupuntura pela técnica manual concomitantemente à manutenção da amitriptilina prévia. Verificou-se diminuição da sintomatologia álgica, sendo que na quinta consulta a paciente suspendeu o uso da amitriptilina por conta própria. Após a sétima consulta foi observada a completa regressão da dor. CONCLUSÃO: A acupuntura mostrou-se eficaz no tratamento da alodínia, não havendo retorno da sintomatologia mesmo após seis meses sem intervenção ou uso do fármaco. Por ser o primeiro relato dessa associação em ser humano, especificamente para a alodínia, mas mais estudos são necessários...

The Effect of Intramuscular Stimulation on Otalgia due to Myofascial Pain Syndrome by Contraction of Trapezius Muscle

There are several causes of otalgia, specifically primary otalgia, which originates inside the ear, and referred otalgia, which originates outside the ear. In a rare case, otalgia may result from myofascial pain syndrome (MPS) due to a contraction of cervical muscles. The author of this study reports a case in which otalgia caused by MPS due to contraction of the trapezius muscle was treated with intramuscular stimulation (IMS). A 48-year-old female patient with otalgia for two weeks was otolaryngologically tested and no anomaly was found. A pain clinic consultation was requested and severe contraction of the trapezius muscle was observed by history taking, visual inspections and palpation. She was successfully returned to the normal state with two sessions of IMS.

Association between Ear Fullness, Earache, and Temporomandibular Joint Disorders in the Elderly

Introduction An earache (otalgia or ear pain) is pain in one or both ears that may last a short or long time. Earache is prevalent in the population with temporomandibular joint disorders (TMJDs), but there is a dearth of epidemiologic studies regarding the association between TMJD and ear pain and ear fullness in older people. Objective To assess the presence of earache and ear fullness in elderly patients with TMJD. Methods A cross-sectional study was conducted in independently living, elderly individuals. TMJD was assessed by dental evaluation and earache was verified by medical history. Statistical analysis was performed using the chi-square test and relative risk. Results Of the 197 subjects evaluated in this part of the study, 22 had earache, and 35 was verified by ear fullness. Of the 22 subjects with earache, none had conductive or mixed hearing loss in the ears tested. There was a significant association (p = 0.036) between the TMJD and earache (odds ratio = 2.3), but there was no significant association between the TMJD and ear fullness. Conclusion These results highlight the importance of identifying risk factors for earache that can be modified through specific interventions, which is essential in the prevention of future episodes, as well as managing the process of treatment of elderly patients in general...

Wegener's Granulomatosis Presenting as Bilateral Otalgia with Facial Palsy: A Case Report

Wegener's granulomatosis (WG) is defined as a granulomatous inflammation of the upper and lower respiratory tract due to a systemic vasculitis. Facial nerve palsy may occur during the course of any granulomatous or vasculitis disease. But very few cases have been reported in which facial nerve palsy is the presenting feature of WG. We recently experienced an interesting case of WG presenting as acute middle ear infection and subsequent bilateral facial palsy.

Persistent Earache Due to Tonsillolith.

Tonsilloliths are rare dystrophic calcification formed as a result of chronic inflammation of the tonsils. Tonsilloliths tend to occur more commonly with increasing age and are relatively rare in children. We report a case of unilateral tonsilloliths in an eight-year-old boy, who presented with earaches and history of regurgitating tiny yellowish-white foul smelling pellets. The tonsilloliths were successfully removed under local anaesthesia following which the symptoms subsided.

Comparative study on prevention of earache occurred in hyperbaric oxygen therapy / 中国实用护理杂志

Objective This paper aims to find a best position of ephedrine hydrochloride nasal drops by comparing earache occurred in hyperbaric oxygen(HBO )therapy while using ephedrine hydrochloride nasal drops in two positions: laying in lateral position of 45°with head leaning back; laying down flat, so as to supply reference for prevention of earache. Methods We selected 300 cases of HBO patients who were firstly treated by HBO and randomly divided into the observation group and the control group with 150 cases in each group. All these patients were treated by large medical hyperbaric oxygen tank. On the first to third day, ephedrine hydrochloride nasal drops were put into the patients before they were sent into the oxygen tank. Patients in the observation group lay in lateral position of 45°with their head leaning back, and those in the control group were in horizontal position. We put three drops of 1% of ephedrine hydrochloride nasal drops respectively into their nasal cavity. When they came out of the oxygen tank, we asked them if they felt earache and checked their tympanic membrane so as to make a comparison. Results It was found that earache, rate of tympanic membrane injury and the extent of such injury in the observation group was obviously less than that in the control group, there was difference in statistics between these two groups. Conclusions Before HBO treatment, ephedrine hydrochloride nasal drops that put in lateral position of 45°with patients head leaning back can reduce the possibilities of earache occurred in HBO. It was also observed that such position was an ideal one which had anatomical characteristics of Eustachian tube and was safer than laying down flat, so such position is more practical.

Associação entre otalgia, zumbido, vertigem e hipoacusia com desordens temporomandibulares / Association between otalgia, tinnitus, vertigo and hypoacusia, with temporomandibular disorders

Devido à coexistência de sinais e sintomas não específicos com outros bem estabelecidos no contexto das desordens temporomandibulares,torna-se difícil para o clínico decidir o que realmente deve ser incluído no diagnóstico e plano de tratamento. Este trabalho teve por objetivo avaliar, por meio de uma revisão da literatura, a importância da ocorrência dos sintomas aurais de otalgia, zumbido, vertigem e hipoacusia em pacientes com desordem temporomandibular. Ainda que muitas teorias tenham sido relatadas para explicar a relação entre os sintomas aurais e as desordens temporomandibulares, a ampla variação entre os resultados dos estudos revisados dificulta o estabelecimento da prevalência desses sintomas concomitantemente às desordens temporomandibulares. Além disso, essa ocorrência não necessariamente implica em uma relação de causa-efeito. Devido às dificuldades de diagnóstico da relação entre os achados, diferentes tipos de tratamentos devem ser considerados para que os sintomas não específicos das desordens temporomandibulares também sejam efetivamente controlados. É imprescindível que o cirurgião-dentista conheça as possíveis etiologias dos sintomas aurais para saber se há uma provável associação com as desordens temporomandibulares e, assim, incluí-los no plano de tratamento.

Because nonespecific symptoms and signs are associated with others well-established in the temporomandibular disorders, it is difficult for the clinician to decide what symptoms and signs should be considered during the diagnosis and the treatment plan. Therefore, the aim of this literature review was to evaluate the prevalence of aural symptoms (otalgias, tinnitus, dizziness and deafness) in patients with orofacial pain. Although several hypotheses have been proposed to explain the association between aural symptoms and temporomandibular disorders, the results of the previous studies differed in magnitude. For this reason, it is difficult to establish the prevalence of these aural symptoms concomitantly with temporomandibular disorders. Moreover, such relationship does not necessarily imply a cause-effect relationship. Because of the diagnosis complexity, different treatments must be considered, so the nonespecific symptoms of temporomandibular disorders can be effectively controlled as well. It is crucial for the the clinician to be aware of the possible etiology of aural symptoms, so he should determine if such symptoms may be associated with temporomandibular disorders and thus include them in the treatment.