The aim of this study is to investigate the relationship between Temporomandibular Disorders (TMD) and subjective tinnitus at both morphological and functional levels. Current literature suggests that somatosensory inputs from the temporomandibular joint (TMJ) and masticatory muscles can modulate auditory pathways, a phenomenon known as Somatosensory Tinnitus. However, the specific role of TMJ bone morphology and critical neighboring structures, such as the Petrotympanic Fissure (PTF), in this interaction remains unclear.
In this clinical study, patients with tinnitus will undergo a comprehensive evaluation including Cone Beam Computed Tomography (CBCT) to quantitatively analyze condylar morphology and osteoarthritic changes. Additionally, audiological tests will be performed to assess the functional state of the auditory system. This multidisciplinary approach aims to clarify the biological link between TMD and tinnitus, potentially improving diagnostic protocols and highlighting the importance of TMJ stabilization in tinnitus management.
Patients aged 18 years and older.
Patients presenting with otological symptoms such as tinnitus and ear pain.
Patients diagnosed with Temporomandibular Disorders (TMD) based on clinical and radiographic examination.
Patients who have been referred for CBCT imaging as part of their routine diagnostic process for TMD.
Presence of objective tinnitus (e.g., vascular or muscular origin).
History of chronic otitis media or other middle ear pathologies that could cause hearing loss or tinnitus.
Previous history of temporomandibular joint surgery or major maxillofacial trauma.
Presence of systemic metabolic bone diseases or inflammatory rheumatic diseases (e.g., Rheumatoid Arthritis).
Patients who applied to the Otorhinolaryngology clinic with tinnitus complaints and were subsequently diagnosed with TMD in the Dentomaxillofacial Radiology clinic
Cohort
Prospective
Cone Beam Computed Tomography (CBCT)
Diagnostic testHigh-resolution 3D imaging of the temporomandibular joint (TMJ) using the Instrumentarium OP300 Dental unit. The procedure involves evaluating condylar morphology, osteoarthritic changes (flattening, resorption, osteophytes), and the anatomical structure of the Petrotympanic Fissure (PTF) based on the Sato et al. classification.
Audiological Assessment
Diagnostic testA comprehensive evaluation of the auditory system to determine hearing thresholds and the functional status of the ear. This includes pure tone audiometry and specific tests to characterize the frequency and intensity of tinnitus in the patient group.
Clinical TMJ Examination
Other interventionSystematic physical examination of the masticatory muscles and the TMJ. This includes bilateral palpation for pain and tenderness, assessment of mandibular range of motion (maximal mouth opening, lateral and protrusive movements), and recording of joint sounds (clicking or crepitation).
Frequency of Petrotympanic Fissure (PTF) Morphological Types
The morphology of the PTF will be categorized into three types according to the Sato et al. classification: Type 1 (Open), Type 2 (Partially Open), and Type 3 (Closed) using CBCT imaging.
Presence of Osteoarthritic Changes in the Mandibular Condyle
Evaluation of degenerative changes including flattening, resorption, subchondral cysts, generalized sclerosis, and osteophytes on CBCT images. Each change will be recorded as "present" or "absent".
Pure Tone Thresholds
Evaluation of hearing levels across standard frequencies (250 Hz to 8000 Hz) measured in decibels (dB).
Maximum Pain-Free Mouth Opening
Measurement of the distance between the incisal edges of the upper and lower central incisors during maximum mouth opening, recorded in millimeters (mm).
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