Journal of Oral & Facial Pain and Headache, 02/2001

Aims: To determine (1) the prevalence of aural symptoms in orofacial pain patients and (2) a potential association between temporomandibular disorders (TMD) and aural health, while controlling for covariates known to be associated with TMD or auditory dysfunction. Methods: In a retrospective study, health questionnaires, medical histories, clinical findings, diagnoses, and treatments were systematically retrieved from the charts of 776 patients. The dates of initial assessment ranged from May 1987 to June 1999. Of the included subjects, 39.7% were female; the median age was 39 years; 16.4% displayed only aural symptoms (otalgia, tinnitus, vertigo, or perceived hearing loss); 26.4% had both TMD and aural symptoms; 17.8% had TMD but no aural complaints; and 39.4% had neither TMD nor aural symptoms. Results: Of the 344 subjects who had TMD, 59.9% complained of aural symptoms, versus 29.2% of the 432 patients without TMD. Of the subjects with otalgia, tinnitus, vertigo, or perceived hearing loss, 67%, 64.1%, 65.2%, and 62.2% had TMD, respectively. Subjects with aural symptoms were significantly more likely to be female; to consider themselves in poor health; to smoke; or to have TMD, orofacial pain, headaches (temporal, occipital, or frontal), neck and shoulder pain, altered vision and sensation, sleep disturbances, loss of appetite, memory loss, or low energy. Clinical findings indicated that pathognomonic signs of TMD were associated with an increased risk of aural complaints in this patient population. A significantly greater negative impact on normal life functions was found in subjects exhibiting aural symptoms versus those who only had TMD complaints. Conclusion: These findings indicate that TMD is significantly correlated to aural health, although no cause-and-effect relationship has yet been demonstrated. Aural symptoms were also found to have a measurable impact on the subjects' quality of life. Keywords: temporomandibular disorders, otalgia, tinnitus, vertigo, perceived hearing loss, quality of life

Aims: Little has been reported on the use of health care services and consequent costs among persons with temporomandibular disorders (TMD). This project compared the use and cost of medical and dental care services for TMD patients and matched comparison subjects. Methods: Patients were continuously enrolled members of Kaiser Permanente Northwest Division who had at least 1 TMD Clinic visit or TMD-related procedure between January 1990 and December 1995 (n = 8,801). An equal number of comparison subjects were identified electronically and matched on 14 variables, including age and gender. Utilization and cost estimates were determined and compared for selected medical and dental services. Results: For both groups, the mean age was about 40.5 years, and approximately 80% were female. The TMD subjects used significantly more services than did comparison subjects and had mean costs that were 1.6 times higher for all services. Outpatient visits accounted for about 40% of the difference in mean costs. About 10% of TMD subjects and comparison subjects accounted for about 40% and 47% of the costs in each group, respectively. Female TMD subjects and comparison subjects had higher costs than their male counterparts, and male TMD subjects had higher costs than female comparison subjects. Conclusion: Patients with TMD used more of all types of services and had higher costs. A small proportion of the subjects accounted for a large proportion of the costs. Gender was an important factor in utilization and cost. Utilization and cost differences were consistent over a wide range of service categories and could not be explained by TMD alone. Keywords: temporomandibular disorders, health services, utilization, economics, health care costs