以耳痛为主要临床表现的颞下颌关节紊乱病病例分析研究

An Analytical Study of Temporomandibular Joint Disorders with Earache as Main Clinical Manifestation

目的分析耳痛伴颞下颌关节紊乱病病例,探讨两者之间的相关性,并研究临床上难治性耳痛的病因与治疗。方法收集2011年5月至2017年3月间我科门诊病例81例,所有病例的主要症状为耳痛,给予"抗感染"治疗5-15d,耳痛无明显缓解。所有病例均实施纯音测听+鼓室导抗测量检查、颞下颌关节紊乱病及耳鸣相关问诊查体、颞下颌关节X平片及头颅MRI检查,81例病例均诊断为"颞下颌关节紊乱病",并按"颞下颌关节紊乱病"实施治疗6-120d。结果所有病例鼓膜正常,听力正常,鼓室导抗图A型。头颅MRI检查未见异常。经治疗TMD耳痛完全消失46例,耳痛有效减轻26例,总有效率为88.89%。结论颞下颌关节紊乱病与耳痛存在相关性,有可能导致耳痛,临床上对难治性耳痛患者应考虑是否存在颞下颌关节紊乱病。

Objectives To analyze the earache cases accompanied with Temporomandibular Joint Disorders(TMD).The purpose was to discuss the relation between them and to study the causes and treatments in patients with refractory earache.Methods Eighty-one patients,who had earache as the main complaint,presented to the Otolaryngology Head and Neck Department,PLAArmy General Hospital,between May 2011 and March 2017.Patients’medical history indicated that they had been performed the“anti-infection”treatments for 5-15d.There were no positive results for earache.Patients were subjected to pure tone audiometry and acoustic immittance screening using GSI-61 clinical audiometer and GSI TympStar middle ear analyzer respectively.Patients were also examined by questionnaire,X-ray scan of temporomandibular joint,head magnetic resonance imaging examination.Eighty-one patients were diagnosed and treated for TMD.The course of treatment was 6-120d.Results All the patients showed normal eardrum,normal hearing and type A tympanogram.The results of these patientshead magnetic resonance imaging examination were normal.Earache was completely resolved in 46 and improved in 26 patients respectively following treatments aimed at improving TMD,with a combined effectiveness of 88.89%(72/81).Conclusion There is relevance between TMD and earache.TMD may induce earache.The doctors should consider TMD in otolaryngology practice when they treat the patients with unknown cause and refractory earache.