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Ann Otol Rhinol Laryngol 108:1999

Annals 1999
Ann Otol Rhinol Laryngol 108:1999

REPRINTED FROM ANNALS OF OTOLOGY, RHINOLOGY & LARYNGOLOGY September 1999 Volume 108 Number 9
COPYRIGHT© 1999, ANNALS PUBLISHING COMPANY

OTALGIA AND AVERSIVE SYMPTOMS IN TEMPOROMANDIBULAR DISORDERS
FRANCIS M. BUSH, DMD, PHD STEPHEN W. HARKINS, PHD WALTER G. HARRINGTON, DDS
RICHMOND, VIRGINIA Theterm Costen’s syndrome has been used in the dentomedical literature to describe a constellation of craniofacial symptoms. Since some of the same complaints have been reported in patients with “generalized” psychological distress, symptoms associated with the syndrome may not be useful in differential diagnosis of temporomandibular disorders. The present study investigated whether some somaticcomplaints, particularly tinnitus and dizziness, were pathognomonic in patients with chronic temporomandibular pain. Illness behavior and personality factors were studied for possible interrelationships with these symptoms. Factor analysis revealed that tinnitus and dizziness loaded on separate factors. Tinnitus loaded with nasal stuffiness, tearing, and itching of the eyelids and nose, whiledizziness loaded with complaints of altered taste and smell and blurred vision. Neither was consistently related to measures of pain or to indices of illness behavior or somatic focus. KEY WORDS — Costen’s syndrome, dizziness, Meniere’s disease, psychological disorder, temporomandibular disorder, tinnitus.

INTRODUCTION

Temporomandibular disorders (TMDs) include musculoskeletal complaints thatrepresent a family of clinical conditions.1 The cardinal symptoms and signs are pain in or surrounding the temporomandibular joint (TMJ), limitation on mandibular opening, tenderness on palpation of the masticatory muscles or TMJs, and joint sounds. Because other, nonspecific symptoms may frequently coexist, there is difficulty in deciding if they should be included in the diagnosis. Part of ourunderstanding of TMDs derives from what has been termed in the dentomedical literature as Costen’s syndrome. The original description was of a constellation of symptoms including otalgia, tinnitus, impaired hearing, and aural congestion.2,3 The dysfunction and associated symptoms were attributed to retroposition of the mandibular condyle and mandibular overclosure that compresses the auriculotemporal orchorda tympani nerve. Presumably, the compression irritates the eustachian tube and changes the intratympanic pressure, leading to ear symptoms.4 Another line of thought was that ear symptoms resulted from the condyle’s pressing against the anterior tympanic artery and the chorda tympani at the petrotympanic fissure.5 Anatomic dissection of the temporomandibular region failed to confirm that thecondyle exerted pressure on these tissues.6-8 Certain modern practitioners endorse the basic philosophy

of Costen’s syndrome for patients suffering symptoms.9 The position is that occlusal dysharmonies produce condylar displacement leading to auditory and vestibular symptoms such as tinnitus and dizziness. Similar symptoms have been reported in patients suffering cervicogenic complaints.Several studies relate soreness of the neck to myofascial10-13 or TMJ14 pain and associate tinnitus and dizziness with these problems. Barre-Lieou syndrome, first described in 1926, includes symptoms virtually identical to those of Costen’s. The cause has been attributed to posttraumatic disk prolapse at the cervical 3 and 4 levels.15 Symptoms common to both syndromes have been reported in patientssuffering bony spinal disorders16 and late whiplash syndrome.17 Dysfunction of the atlanto-occipital joint has been implicated in the frequent combination of facial pain, TMJ pain, and headache.18 Such symptoms have been attributed to vascular compression of cervical 2 and 3 nerve roots, producing an inadequate flow of blood in the vertebrobasilar system.19 Another argument is that disk prolapse of...