Temporomandibular steroids in patients with tinnitus: Only on indication.

Introduction: Patients with tinnitus without an identifiable cause may have temporomandibular joint dysfunction and can be treated by an intra-articular injection of steroids.

Objectives: The aim of this study was to determine the efficacy of temporomandibular steroids for treating patients with tinnitus, and more specifically, to assess the parameters associated with a long-term benefit in order to improve patient selection.

Design: Subjects were 70 consecutive patients who came to our clinic from October 2016 to October 2018 for consultations on their tinnitus that persisted for one month or longer and were treated with an intra-articular injection of the temporomandibular joint with steroids. Patients charts, cervical spine radiographs and audiogram were reviewed retrospectively and data from these patients were recorded. An independent observer conducted a long-term follow-up assessment of the therapy by telephone interview.

Results: Relief of tinnitus at seven-week follow-up was achieved in 20% of the patients treated with temporomandibular steroids. At 18 months, 50% of the patients successfully treated with temporomandibular steroids for tinnitus still experienced a benefit. Adverse events of the temporomandibular steroids reported at 7 weeks of follow-up were an increase of the intensity of their tinnitus in 11% of the patients and in 3% of the patient's side-effects of the steroids. Patients with temporomandibular disorders as cause of their tinnitus were identified by the presence of unilateral tinnitus in combination with cervical pain. In patients with unilateral tinnitus together with cervical pain, 53% of them had a reduction of their tinnitus at 7 weeks following treatment with temporomandibular steroids and for 40% of them the reduction of the tinnitus was 50% or more. An increase in the intensity of their tinnitus as adverse effect occurred in 7% of the patients in this group.

Conclusions: Temporomandibular steroids can be a useful alternative for patients with tinnitus with a long term effect. However, patient selection is of vital importance, since patients with unilateral tinnitus and cervical pain respond the most to this therapy. Moreover, patient without these symptoms risk worsening the tinnitus. A prospective study should further evaluate these findings.