A STUDY FOR ASSOCIATION BETEWEEN THE EAR SYMPTOMS AND OCCLUSAL DISTURBANCE, PSYCHOLOGIACL FACTORS N TMD PATIENTS.

颞下颌关节紊乱病（TemporomandibularDisorders，TMD）是一种常见的耳道症状，主要表现为耳鸣、耳痛、眩晕等.本研究旨在探讨颞下颌关节紊乱病（TMD）患者的耳症状特点及其与咬合因素的关系。25例伴有耳鸣的TMD患者，年龄16-69岁，平均43.4 ± 17.1岁。由牙医检查TMD的体征和症状。所有患者均行颞下颌关节MRI检查。所有患者均经耳科检查确诊，耳鸣侧与TMD主要症状侧相吻合。12例患者诊断为耳功能障碍，10例患者耳鸣侧感觉性听力损失，2例患者前庭功能障碍。15例颞下颌关节盘移位患者的Tinnesses评分明显高于10例盘位正常者。15例椎间盘移位患者中有8例有耳部疾病，10例正常椎间盘患者中有2例有耳部疾病。耳部疾病的比例在这些组之间有显著差异。对颞下颌关节紊乱病患者进行咬合调整、夹板治疗等咬合治疗，对改善患者的听力症状有明显效果。治疗后的耳科检查表明治疗前诊断的耳部疾病有所改善。结果提示，TMD患者的耳鸣等听觉症状与TMD有关，可能与颞下颌关节的髁状突位置和盘状突位置有关，而后者是由咬合因素如后牙支持丧失和颌位移位引起的。

The aural symptoms such as tinnitus, earache, vertigo, are commonly observed in Temporomandibular Disorders (TMD). The purpose of this study was to clarify the otological characteristics of aural symptoms in TMD and the relationship to the occlusal factors as an etiological factor. Twenty-five TMD patients (age : ranged 16-69, mean 43.4+-17.1y) with tinnitus were involved in this study. Signs and symptoms of TMD were examined by dentists. TMJs of the patients were examined by MR imaging. Aural symptoms in the patients were diagnosed with otologic examinations.Side with tinnitus were coincided with the main symptomatic side of TMD in all patients. Twelve patients were diagnosed with disorders of ear function ; 10 patients had sensory hearing loss at tinnitus side, 2 patients had vestibular dysfunction. Tinnitus score in 15 patients with disc displacement of TMJ were significantly higher than those in 10 patients with normal disc position. Eight out of 15 with disc displacement had ear disorders and 2 out of 10 with normal disc had ear disorders. The ratio of ear disorders was significantly different between these groups. Occlusal treatment, such as occlusal adjustment, splint therapy, for TMD were effective on the aural symptoms. Otologic examination after occlusal treatment indicated improvement of ear disorders diagnosed before treatment. These results indicate that aural symptoms such as tinnitus observed in TMD are related to TMD.Those might be related to condylar position and disc position in TMJ, which are caused by occlusal factors such as loss of posterior support and displacement of jaw position.