RESUMEN
BACKGROUND: The tensor tympani muscle is the largest muscle within the middle ear. Its voluntary contraction is a very unusual event. Only a few papers have documented its audiometric effects. OBJECTIVE: To report an unusual case of voluntary tensor tympani muscle contraction and describe its audiometric effects. CASE REPORT: A 27-year-old man, who presented complaining of voluntarily evoked bilateral tinnitus, was found to be able to voluntarily contract the tensor tympani muscle in both ears simultaneously. Audiograms were performed under conditions of rest and maximal contraction of the tensor tympani muscle. The most remarkable effects were conductive hearing loss at lower frequencies and an increase in middle-ear impedance. CONCLUSION: The importance of the tensor tympani muscle in middle-ear physiology remains unclear. It has been related to the attenuation of sounds produced during the mastication process. Voluntary control over the tensor tympani muscle is an extremely rare event. However, an understanding of the potential audiometric effects of its contraction could aid the diagnosis of hearing disorders.
Asunto(s)
Pruebas de Impedancia Acústica , Contracción Muscular , Tensor del Tímpano , Acúfeno/etiología , Pruebas de Impedancia Acústica/métodos , Adulto , Oído Medio , Pérdida Auditiva Conductiva/etiología , Humanos , Masculino , Acúfeno/diagnósticoRESUMEN
UNLABELLED: Tonic tensor tympani syndrome (TTTS) is an involuntary, anxiety-based condition where the reflex threshold for tensor tympani muscle activity is reduced, causing a frequent spasm. This can trigger aural symptoms from tympanic membrane tension, middle ear ventilation alterations and trigeminal nerve irritability. TTTS is considered to cause the distinctive symptoms of acoustic shock (AS), which can develop after exposure to an unexpected loud sound perceived as highly threatening. Hyperacusis is a dominant AS symptom. Aural pain/blockage without underlying pathology has been noted in tinnitus and hyperacusis patients, without wide acknowledgment. This multiclinic study investigated the prevalence of TTTS symptoms and AS in tinnitus and hyperacusis patients. This study included consecutive patients with tinnitus and/or hyperacusis seen in multiple clinics. DATA COLLECTED: Symptoms consistent with TTTS (pain/numbness/burning in and around the ear; aural "blockage"; mild vertigo/nausea; "muffled" hearing; tympanic flutter; headache); onset or exacerbation from exposure to loud/intolerable sounds; tinnitus/hyperacusis severity. All patients were medically cleared of underlying pathology, which could cause these symptoms. 60.0% of the total sample (345 patients), 40.6% of tinnitus only patients, 81.1% of hyperacusis patients had ≥ 1 symptoms (P < 0.001). 68% of severe tinnitus patients, 91.3% of severe hyperacusis patients had ≥ 1 symptoms (P < 0.001). 19.7% (68/345) of patients in the total sample had AS. 83.8% of AS patients had hyperacusis, 41.2% of non-AS patients had hyperacusis (P < 0.001). The high prevalence of TTTS symptoms suggests they readily develop in tinnitus patients, more particularly with hyperacusis. Along with AS, they should be routinely investigated in history-taking.
Asunto(s)
Estimulación Acústica/efectos adversos , Hiperacusia/epidemiología , Espasmo/epidemiología , Tensor del Tímpano , Acúfeno/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/psicología , Australia/epidemiología , Brasil/epidemiología , Niño , Estudios de Cohortes , Femenino , Humanos , Hiperacusia/etiología , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Prevalencia , Reflejo de Sobresalto , España/epidemiología , Espasmo/etiología , Síndrome , Acúfeno/etiología , Adulto JovenRESUMEN
INTRODUCTION AND OBJECTIVES: Temporomandibular disorders are associated with symptoms such as tinnitus, vertigo, sensation of hearing loss, ear fullness and otalgia. The connection and dysfunction of the tensor tympani and tensor veli palatini muscles seems to be associated with the aforementioned symptoms. We seek to demonstrate and explain this connection through the morphometry of these structures. METHODS: We studied 22 paired blocks and 1 left side of human temporal bone. Digital measurements were made of the tensor tympani muscles and stapes. RESULTS: The average length of the stapedial muscle was 5.8 mm SD 0.61, and that of the tensor tympani was 19.69 mm SD 1.07. Anatomical connections were found in all the samples between the tensor veli palatini muscles through a common tendon. CONCLUSIONS: There is a need for an interdisciplinary management between physician and specialized dentist in cases of craniofacial pain.
Asunto(s)
Músculo Esquelético/anatomía & histología , Trastornos de la Articulación Temporomandibular/fisiopatología , Tensor del Tímpano/anatomía & histología , Adulto , Fenómenos Biomecánicos , Cefalometría , Osículos del Oído/anatomía & histología , Osículos del Oído/fisiología , Oído Medio/anatomía & histología , Trompa Auditiva/anatomía & histología , Trompa Auditiva/fisiología , Femenino , Humanos , Masculino , Movimiento , Contracción Muscular , Músculo Esquelético/fisiología , Músculo Esquelético/fisiopatología , Paladar Blando/anatomía & histología , Hueso Temporal/anatomía & histología , Hueso Temporal/fisiología , Tendones/anatomía & histología , Tendones/fisiología , Tensor del Tímpano/fisiología , Tensor del Tímpano/fisiopatologíaRESUMEN
This work seeks to alert medical and odontological staff to understanding and using interdisciplinary handling for detecting different pathologies common otic symptoms. It offers better tools for this shared symptomatology during therapy s conservative phase. Tensor tympani muscle physiology and function in the middle ear have been veiled, even when their dysfunction and anatomical relationships may explain a group of confused otic symptoms during conventional clinical evaluation. Middle ear muscles share a common embryological and functional origin with chewing and facial muscles. This article emphasizes that these muscles share a functional neurological and anatomical dimension with the stomatognathic system; these muscles increased tonicity ceases to be a phenomenon having no logical connections. It offers functionality and importance in understanding referred otic symptoms in common with other extra-otical symptom pathologies. Tinnitus, vertigo, otic fullness sensation, hyperacusia, hypoacusia and otalgia are not only primary hearing organ symptoms. They should be redefined and related to the neighboring pathologies which can produce them. There is a need to understand temporomandibular disorders and craniofacial referred symptomatology from neurophysiologic and muscle-skeletal angles contained in the stomatognathic system. Common symptomatology is frequently observed in otic symptoms and temporomandibular disorders during daily practice; this should be understood by each discipline from a broad, anatomical and clinical perspective.
Asunto(s)
Músculos Masticadores/fisiopatología , Trastornos de la Articulación Temporomandibular/fisiopatología , Tensor del Tímpano/fisiopatología , Osículos del Oído/fisiopatología , Oído Medio/fisiopatología , Dolor de Oído/fisiopatología , Femenino , Trastornos de la Audición/fisiopatología , Humanos , Hiperacusia/fisiopatología , Masculino , Contracción Muscular/fisiología , Reflejo/fisiología , Trastornos de la Articulación Temporomandibular/etiología , Acúfeno/fisiopatología , Vértigo/fisiopatologíaRESUMEN
Para investigar sobre la participación del nervio trigémino y del músculo tensor del tímpano en el reflejo acústico humano se planteó un estudio prospectivo en once pacientes portadores de neuralgia del trigémino y programados para microcompresión del Ganglio de Gasser con balón percutáneo. Todos los pacientes presentaron estudios audiológico normales, incluyendo umbrales tonales, BéKésy, logoaudiometría, potenciales evocados y timpanograma, así como integridad del nervio facial detectada por clínica y por electroneuronografía. Los once pacientes presentaban ausencia del reflejo acústico. Seis meses después de la compresión del Ganglio de Gasser, tres pacientes presentaron reflejo acústico normal y en el resto permaneció ausente. Los ocho pacientes que no presentaron reflejo cursaron con paresia de músculos masticadores. Nuestros resultados parecen indicar que para la integridad del reflejo acústico es necesario tanto el sistema facial como el trigeminal. El reflejo acústico puede ser una prueba útil en el estudio de la neuralgia de trigémino
Asunto(s)
Humanos , Masculino , Femenino , Audiología , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Ganglio del Trigémino/fisiopatología , Nervio Trigémino/fisiología , Neuralgia del Trigémino/diagnóstico , Oído Medio/anatomía & histología , Reflejo Acústico/fisiología , Tensor del Tímpano/fisiología , Pruebas de Impedancia AcústicaRESUMEN
Clasicamente se describe el complejo del nervio trigémino conformado por dos componentes. Uno es motor voluntario, encargado de la inervación de los musculos de la masticación y del tensor del timpano. El otro es sensorial, relacionado con aferencias de dolor, temperaturas de la cara y membranas meningeas. El primero tiene origen real a nivel del núcleo motor del V par, localizado a nivel medio de la pretuberancia; mientras que el componente sensorial tiene origen real en el ganglio trigeminal localizado en la fosa media del cráneo. De este se derivan prolongaciones centrales orientadas hacia el núcleo sensitivo del V par, localizado a lo largo del tallo cerebral. Del mismo ganglio se desprenden prolongaciones periféricas, que se integran a las ramas oftálmicas, maxilar y mandibular extendidas hasta los receptores.