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

耳鸣、耳痛、眩晕等听觉症状常见于颞下颌疾病（TMD）。本研究的目的是阐明TMD的耳科症状特征及其与咬合因素作为病因的关系。本研究纳入25例伴有耳鸣的TMD患者（年龄16-69岁，平均43.4±17.1岁）。牙医检查了TMD的症状和体征。mri检查患者颞下颌关节。通过耳科检查诊断患者的听觉症状。所有患者伴有耳鸣的一侧均与TMD的主要症状侧一致。12例患者被诊断为耳功能障碍；耳鸣侧感觉性听力损失10例，前庭功能障碍2例。15例颞下颌关节椎间盘移位患者的耳鸣评分明显高于10例椎间盘位置正常的患者。15名椎间盘移位患者中有8名患有耳部疾病，10名正常椎间盘患者中有2名患有耳部疾病。两组间耳部病变比例差异有统计学意义。咬合治疗，如调整咬合、夹板治疗，对TMD的听觉症状均有较好的疗效。治疗后的耳科检查显示治疗前诊断的耳部疾病有所改善。提示TMD患者耳鸣等听觉症状与TMD有关。这些可能与颞下颌关节的髁突位置和椎间盘位置有关，这些可能是由后支撑丧失和下颌位置移位等咬合因素引起的。

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.