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Summary Review/Temporomandibular Disorders

Insufficient evidence to support or reject effect of conservative TMD therapies on otologic signs and symptoms

Question: In adult patients with TMD and related otologic complaints, what is the effect of conservative therapies on changes in otologic signs and symptoms?


Data sources

The search strategy focused on publications up to May 2015 in five electronic databases: PubMed, LILACS, Scopus, Web of Science and Science Direct. Furthermore, a partial grey literature search through Google Scholar and a hand-search of the references of the included studies were also performed.

Study selection

Those studies including patients with TMD associated with otologic signs and symptoms treated with conservative therapies, such as physiotherapy or cognitive behavioural therapy. These studies needed to describe whether the conservative treatments affected the associated otologic signs and symptoms. No language or time restrictions were applied.

Data extraction and synthesis

The search was completed in two stages. 1st stage: titles and abstracts were screened and included (or excluded) independently by two reviewers. 2nd stage: the same selection criteria were applied to the full text of the previously selected studies by the same reviewers. Disagreements were discussed, and a third author was involved, when required, to make a final decision. Study quality was assessed by the two reviewers using two risk of bias tools: ‘Quality Assessment of a Cohort Study’ and ‘Quality Assessment of a Randomised Clinical Trial’. Because of heterogeneity in the study designs only a narrative summary was presented.


Eight studies were finally included in this review. Three of them were randomised clinical trials and five were cohort studies. All studies had an acceptable risk of bias, except one with high risk of bias. Seven of the eight studies showed total or partial resolution of otologic signs and/or symptoms after TMD therapy.


Insufficient evidence was identified to strongly support positive or negative changes in otologic signs and symptoms after conservative management therapies for TMD. Further studies with a higher level of evidence and more representative samples should be conducted to improve our understanding of the effect of TMD therapy on otologic complains.

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Authors and Affiliations


Additional information

Address for correspondence: André Luís Porporatti, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brizolla 9-75, CEP: 17012-901 Vila Universitária, Bauru, SP, Brazil. E-mail:;

Stechman-Neto J, Porporatti AL, Porto de Toledo I, Costa YM, Conti PC, De Luca. Canto G, Mezzomo LA. Effect of temporomandibular disorder therapy on otologic signs and symptoms: a systematic review. J Oral Rehabil 2016; 43: 468-479. doi: 10.1111/joor.12380. Epub 2016 Jan 8. Review. PubMed PMID: 26749516.

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Morell, G. Insufficient evidence to support or reject effect of conservative TMD therapies on otologic signs and symptoms. Evid Based Dent 19, 26–27 (2018).

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