Our aims were to study the prevalence of abnormal radiographic findings in mandibular condyles and the possible association between such findings and clinical signs and symptoms of temporomandibular dysfunction (TMD) and dental state. Two cohorts of 70-year-old people, 384 men and 484 women, living in Göteborg, Sweden, participated in the study. The first cohort was examined in 1972 and the other one in 1992. Besides a functional and clinical examination, a questionnaire on TMD and panoramic radiography were included. A deviation from the normal appearance of one or both condyles was found in 26% of the subjects (17% of the condyles). There was no significant difference in this respect between the two cohorts. There were in general only minor and no statistically significant differences between those with normal and deviating condylar findings with regard to various TMD signs and symptoms. The subjects in Eichner group A (with dental support in all zones) showed a slightly lower frequency of abnormal radiographic condylar findings (22%) than those in groups B (reduced dental support) and C (edentulous in one or both jaws; both B and C, 28%). It is concluded that abnormal radiographic condylar findings in these elderly people were not at all or only weakly correlated with signs and symptoms of TMD and dental status.

Associations between tinnitus and craniomandibular disorders (CMD) were investigated in an epidemiological sample, in tinnitus patients, and in patients attending a 'CMD-clinic'. Natural course of tinnitus was explored in a longitudinal epidemiological study of an elderly population. Several findings indicating a relatively strong relationship between CMD, tinnitus and subjective hearing loss were noted. This relationship seemed to be independent of objectively assessed degree of hearing loss, occupational noise exposure, general morbidity, medication or socioeconomic status. The prevalence of frequent headaches and fatigue or tenderness in jaw muscles was higher in tinnitus patients than would be expected if these conditions were unrelated. About one third of the individuals affected by tinnitus reported influence on tinnitus by jaw movements or pressure on the temporomandibular joint (TMJ). Diurnal bruxism and jaw fatigue appeared to be related to fluctuating tinnitus, vertigo, and hyperacusis. Stomatognathic and biofeedback treatment seemed to be able to reduce or eliminate tinnitus in some patients. Relatively low severity of tinnitus, normal hearing, fluctuating tinnitus, and some signs and symptoms of CMD are believed to constitute predictors of successful treatment outcome. Substantial longitudinal fluctuations with a high occurrence of spontaneous remissions of tinnitus were found in elderly people.

Thirty-two patients with disabling tinnitus received stomatognathic treatment and biofeedback therapy according to a cross-over design. The evaluation of treatment outcomes showed some improvements at the group level: decrease of tinnitus intensity, mood improvement and reduction of clinical signs of dysfunction in the masticatory system. Qualitative observations indicated numerous positive changes in patients' emotional and cognitive orientation vis à vis tinnitus. Some possible predictors of positive treatment outcome were observed: comparatively low severity of tinnitus, normal hearing or compensated hearing loss, occlusal interferences, jaw fatigue, diurnal bruxism and fluctuations in tinnitus intensity. Left-sided tinnitus seemed to be a negative predictor of stomatognathic and biofeedback treatment outcome. Consequently, stomatognathic and biofeedback treatment seem to have some positive effects on subgroups of tinnitus patients.

Forty-two patients with severe tinnitus and craniomandibular disorders (CMD) are presented from an audiological and psychological point of view. During a 2-week period, the patients rated their mood and their tinnitus. Based upon mood ratings, patients were grouped into three clusters (high, medium and low mood). The three groups differed in a number of respects, audiological as well as psychological. Patients in the low mood group experienced significantly more intense and severe tinnitus and more daily stress than patients in the high mood group. Ratings of irritation and concentration difficulties seemed to be mood related, and discriminated between patients in the low mood group and patients in the moderate and the high mood groups. Difference in hearing level between the left and the right ear was more pronounced in patients with low mood. There were, however, no significant differences between the groups in the stomatognathic variables. It is concluded that the above mentioned audiological and psychological observations should be considered as potentially important for satisfactory management of individual tinnitus patients. Further studies of the effects of optimally compensated hearing on depressed mood in patients with noise-induced hearing loss (NIHL) and tinnitus are required.

Forty-two patients with disabling tinnitus and reported symptoms of craniomandibular disorders (CMD) were investigated by means of questionnaire, semistructured interview, stomatognathic examination and 2-week diary with thrice-daily ratings of tinnitus and mood. The findings have been analysed in order to identify symptoms of CMD related to tinnitus, and it was concluded that awareness of diurnal bruxism and feeling of jaw tenderness/fatigue may be related to fluctuating tinnitus, vertigo and hyperacusis.

One hundred two tinnitus patients were examined to determine the prevalence of signs and symptoms of CMD. The examination comprised determination of the anamnestic and clinical dysfunction indices according to Helkimo; assessment of the dentition, occlusal factors, and signs of parafunctions; and accomplishment of a tension test. Patients also answered a questionnaire concerning the presence and frequency of CMD symptoms and headaches, as well as influence on tinnitus by mandibular movements, by pressure applied to the TMJ, or by dental therapy. Frequent headaches and fatigue/tenderness in jaw muscles were more prevalent in tinnitus patients than in epidemiologic samples, as was the prevalence of clinical findings of pain on palpation of masticatory muscles, impaired mandibular mobility, and signs of parafunctions. About one-third of the patients reported influence on tinnitus by mandibular movements and/or pressure applied to the TMJs. A theoretic model of causal connections between tinnitus and signs and symptoms of CMD in some tinnitus patients is suggested.