Tinnitus in patients with orofacial complaints

Abstract

Background: This study explored subjective tinnitus frequency in patients referred to an interdisciplinary orofacial pain clinic using the "web-based interdisciplinary symptom evaluation" (WISE) tool, which included a wide range of psychometric data. Our goal was to analyze the correlation between orofacial complaints and tinnitus, as well as their association with other psychometric data-an approach that, to our knowledge, has not been undertaken to this extent before.

Methods: From 2017 to 2020, we analyzed 1369 anonymized patient records using completed WISE. This included diverse questionnaires and symptom-related screener questions. Positive screening responses triggered additional assessments, such as short Tinnitus Handicap Inventory (THI-12) and Patient Health Questionnaire 4 (PHQ-4). Ear symptoms, tinnitus severity and tinnitus frequency were evaluated. Furthermore, Spearman correlations were performed with other questionnaires addressing pain, anxiety, depression, health, stress and insomnia.

Results: Among 1369 patients with orofacial complaints, 69% were female. Notably, 19.7% (269) completed THI-12 due to severe ear symptoms; of these, 62.1% were female. Female mean THI-12 score was significantly lower (p = 0.007) with 9.3 (SD = 7.0) compared to males 11.6 (SD = 6.8). Additionally, there was a significantly different gender distribution between all patients with tinnitus and those with severe tinnitus (p = 0.032), with an increased proportion of men in the latter group. THI-12 positively correlated with all WISE questionnaires, strongest with PHQ-4 (p < 0.01).

Conclusions: Our study unveils a common co-occurrence of orofacial and ear complaints, particularly tinnitus. The practical implication of the observed gender differences suggests that in male patients presenting with orofacial pain, tinnitus and its associated distress should be actively addressed to initiate a multidisciplinary treatment approach.

Clinical trial number: Not applicable. Since this study was a retrospective analysis of anonymized data, trial registration was not necessary.

Keywords: Orofacial complaint; Somatosensory tinnitus; TMD; Temporomandibular dysfunction; Tinnitus; WISE; Web-based interdisciplinary symptom evaluation.

Fig. 1

Print screen from a sample WISE-questionnaire

Fig. 2

Subgroups of the patient sample

Fig. 3

Venn diagram of ear symptoms in patients who suffered 'a lot' from it. The intersections show the percentage of how frequently ear symptoms co-occur in patients with orofacial complaints

Fig. 4

Gender distribution between groups

Fig. 5

Comparison of THI-12 Score by Gender

Fig. 6

Correlations matrix plot. GCPS-B = Graded Chronic Pain Status (Body); GCPS-H = Graded Chronic Pain Status (Head); PHQ-stress = Patient Health Questionnaire Stress; PHQ-9 = Patient Health Questionnaire 9; GAD-7 = Generalized Anxiety Disorder 7; PCS = Pain Catastrophizing Scale; PHQ-4 = Patient Health Questionnaire 4; ISI = Insomnia Severity Index; IEQ = Injustice Experience Questionnaire; B-IPQ = Illness Perception Questionnaire; THI-12 = Tinnitus Handicap Inventory 12

Fig. 7

Weighted correlation network graph: The higher the correlation between two questionnaires, the thicker and bluer the line between them. The arrangement of the questionnaires in space is based on these correlations