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Temporomandibular disorder poses a diagnostic challenge to otolaryngologists as orofacial pain, headache and otology symptoms are very common in temporomandibular disorder, and mimic a number of otolaryngological conditions. Missed diagnosis of temporomandibular disorder can lead to unnecessary investigation and treatment, resulting in further patient suffering.
To review the current literature and propose management pathways for otolaryngologists to correctly differentiate temporomandibular disorder from other otolaryngological conditions, and to initiate effective treatment for temporomandibular disorder in collaboration with other health professionals.
A systematic review using PubMed and Medline databases was conducted, and data on temporomandibular disorder in conjunction with otolaryngological symptoms were collected for analysis.
Of 4155 potential studies, 33 were retrieved for detailed evaluation and 12 met the study criteria. There are questionnaires, examination techniques and radiological investigations presented in the literature to assist with distinguishing between otolaryngological causes of symptoms and temporomandibular disorder. Simple treatment can be initiated by the otolaryngologist.
Initial temporomandibular disorder treatment steps can be undertaken by the otolaryngologist, with consideration of referral to dentists, oral and maxillofacial surgeons, or physiotherapists if simple pharmacological treatment or temporomandibular disorder exercise fails.
To evaluate the efficacy of low-dose intratympanic dexamethasone therapy in patients with idiopathic sudden sensorineural hearing loss whose hearing in the affected ear had failed to improve following a course of oral steroid therapy.
A prospective pilot study was undertaken of eight patients with idiopathic sudden sensorineural hearing loss whose hearing had failed to improve after a course of prednisolone. These patients subsequently received 8 mg intratympanic dexamethasone therapy, delivered via a ventilation tube on a weekly basis for 1 month. Clinical outcome was assessed weekly with pure tone audiography.
At the end of the 1-month treatment period, no significant hearing improvement was observed on pure tone audiography in any of the patients (i.e. improvements were all less than 10 dB).
The response to 8 mg of intratympanic dexamethasone used as a salvage therapy for idiopathic sudden sensorineural hearing loss was inadequate. A higher dosage of intratympanic dexamethasone might be required to achieve better outcomes.