Objective: To analyze the effectiveness of manual therapy and exercise therapy on otological symptoms in individuals with temporomandibular disorders.
Methods: A systematic review of clinical trials compared exercise and manual therapy with standard care or placebo/control for individuals with temporomandibular disorders. Otological-related symptoms (tinnitus, earache, ear fullness, vertigo, dizziness, and hypo/hyperacusis) were assessed. The Cochrane risk of bias tool was used to assess the risk of bias, and the certainty of evidence was rated using the GRADE approach. Qualitative data synthesis was performed through evidence tables and graphs.
Results: A total of 4,356 articles were screened, and six studies reported in nine manuscripts were included. Manual therapy combined with exercises targeted to the neck and jaw reduced tinnitus severity and tinnitus-related quality of life after treatment, and at three- and six-month follow-up when compared to exercises alone. Earache and ear fullness improved after orofacial myofunctional therapy and oral motor exercises compared to no treatment. The overall certainty of the evidence was rated as very low.
Conclusions: The combination of neck and jaw exercises with manual therapy potentially reduce otological symptoms in individuals with temporomandibular disorders. Studies with higher methodological quality are needed, due to a very low certainty of evidence.Implications for rehabilitationExercises and manual therapy techniques aimed at the jaw and neck potentially improve otological symptoms related to TMD;Clinicians and researchers should design TMD interventions considering otological symptoms as an important complaint while planning the protocols,A standardization of the tools used to assess otological symptoms is needed.
Keywords: Physical therapy; ear diseases; facial pain; rehabilitation research; tinnitus.