Case Report: The Relationship Between Orthodontic Care and Tinnitus

Abstract

An important connection between orthodontic therapy and tinnitus has recently been identified.

This report will describe the pleasantly unexpected life-altering experience for this middle-aged woman. For more than 46 years, starting as a child, she suffered with tinnitus for prolonged periods every day. Sometime during the second year of her tinnitus-focused sequential aligner tooth movement therapy, she obtained significant relief that has continued for almost a decade.

Tinnitus is not classified as a disease and it lacks a long-term remedy. Hopefully, both statements will soon need to be updated. A novel twist on a popular dental procedure can help reduce the number who acquire tinnitus and might lead to dentistry being declared the victor in the race to develop its first cure.

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Tinnitus

Tinnitus is a private auditory noise that can manifest as buzzing, hissing or other sound in one or both ears that only that person will hear.1Hackenberg, B.; O’Brien, K.; Döge, J.; Lackner, K.J.; Beutel, M.E.; Münzel, T.; Pfeiffer, N.; Schulz, A.; Schmidtmann, I.; Wild, P.S.; et al. Tinnitus Prevalence in the Adult Population—Results from the Gutenberg Health Study. Medicina 2023, 59, 620. It ranges from being a mere irritation to a debilitating condition that causes severe annoyance, distraction and frustration.2Cleveland Clinic Health Diseases,3https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/With millions suffering and their numbers increasing every day, the rise in tinnitus is showing no signs of slowing down.

How big of a problem is tinnitus? It’s financial drain on the US healthcare and workforce systems is approaching $1 billion per year.4Stockdale, D., McFerran, D., Brazier, P. et al. An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res 17, 577 (2017).,5Daoud, E., Caimino, C., Akeroyd, M.A. et al. The Utility of Economic Measures to Quantify the Burden of Tinnitus in Affected Individuals: A Scoping Review. PharmacoEconomics Open 6, 21–32 (2022).

A somber fact. The official cause of death for many suicides is often attributed to depression,  sleep deprivation or a biopsychosocial disorder.6Seo JH, Kang JM, Hwang SH, Han KD, Joo YH. Relationship between tinnitus and suicidal behaviour in Korean men and women: a cross-sectional study. Clin Otolaryngol. 2016;41(3):222-227.,7Lewis JE, Stephens SD, McKenna L. Tinnitus and suicide. Clin Otolaryngol Allied Sci. 1994 Feb;19(1):50-4. doi: 10.1111/j.1365-2273.1994.tb01147.x.However, it would have been beneficial for data collection, researchers and our healthcare ecosystem if they were recorded as being due to a contributing or the primary cause, tinnitus.8Szibor A, Mäkitie A, Aarnisalo AA. Tinnitus and suicide: An unresolved relation. Audiol Res. 2019 Jun 7;9(1):222. doi: 10.4081/audiores.2019.222.,9Lugo A, Trpchevska N, Liu X, et al. Sex-Specific Association of Tinnitus With Suicide Attempts. JAMA Otolaryngol Head Neck Surg. 2019;145(7):685–687. doi:10.1001/jamaoto.2019.0566,10https://www.npr.org/sections/coronavirus-live-updates/2021/03/22/979929592/texas-roadhouse-founder-kent-taylor-dies-after-struggle-with-post-covid-19-sympt,11 https://fortune.com/2021/03/22/texas-roadhouse-ceo-kent-taylor-suicide-tinnitus-covid/
It is rare for a medical examiner or coroner to reference tinnitus when reporting a death by suicide. 12Matthew F. Garnett, M.P.H., Merianne Rose Spencer, M.P.H., and Julie D. Weeks, Ph.D. Suicide Among Adults Age 55 and Older, 2021. NCHS Data Brief No. 483, November 2023.

Background

In 2022, a 36 year-old male patient who was one year into his advanced sequential aligner therapy shared that his tinnitus and temporomandibular joint dysfunction (TMD) were no longer bothering him as they had for many years. While I had been aware of his TMD, I was unaware he had tinnitus.

At his next visit, he completed two Tinnitus Functional Index (TFI) surveys to measure how it was impacting his life.13https://www.ncrar.research.va.gov/Documents/TFI.pdfOne documented how he was feeling now, the other how he felt a year earlier. The comparisons were remarkable. His quality of sleep improved because tinnitus was no longer impeding his ability to fall asleep or remain asleep. Tinnitus was no longer dulling his ability to remain alert during meetings or straining his ability to concentrate throughout long conversations.14https://www.ncrar.research.va.gov/Documents/TFI.pdf

Description of Events

When the excitement of his progress was casually shared with another patient, a 57 year-old woman realized for the first time that years earlier, her tinnitus just about fully resolved at some point between the first and second years of her advanced aligner therapy. I had not been cognizant of her tinnitus while she was undergoing care.

For decades starting as a child, she suffered with tinnitus for prolonged periods every day. Now, her recovery is believed to be the longest of any patient who has received tinnitus-focused aligner care, having celebrated nine years of near-complete freedom from those aggravating noises.

Prior to Start

figure 1a
anterior view
figure 1a
anterior view
figure 1b
anterior open view
figure 1b
anterior open view
figure 1c
modest smile
figure 1c
modest smile
figure 1e
occlusal view of her mandibular arch
figure 1e
occlusal view of her mandibular arch

figure 1d

right buccal anterior view

figure 1d

right buccal anterior view

Prior to Start

figure 1a
anterior view
figure 1a
anterior view
figure 1b
anterior open view
figure 1b
anterior open view
figure 1c
modest smile
figure 1c
modest smile

figure 1d

right buccal anterior view

figure 1d

right buccal anterior view
figure 1e
occlusal view of her mandibular arch
figure 1e
occlusal view of her mandibular arch

Troubles from her roller-coaster bite diminished as her teeth were moved to healthier positions. Residual sensations from unbalanced and excessive occlusal forces were likely responsible for reverberations in the bone that negatively impacted her tinnitus (figures 1a, 1b). As those forces became gentler and more evenly distributed, they reduced the number and magnitude of occlusion-triggered tinnitus episodes (figures 2a, 2b).

Four Years Into Therapy

figure 2a
anterior view
figure 2a
anterior view
figure 2b
anterior open view
figure 2b
anterior open view
figure 2c
modest smile
figure 2c
modest smile
figure 2e
occlusal view of her mandibular arch
figure 2e
occlusal view of her mandibular arch
figure 2d
right buccal anterior view
figure 2d
right buccal anterior view

Four Years Into Therapy

figure 2a
anterior view
figure 2a
anterior view
figure 2b
anterior open view
figure 2b
anterior open view
figure 2c
modest smile
figure 2c
modest smile
figure 2d
right buccal anterior view
figure 2d
right buccal anterior view
figure 2e
occlusal view of her mandibular arch
figure 2e
occlusal view of her mandibular arch

As her tinnitus went from rampant (figure 1c) to tamed (figure 2c), the corners of her lips stopped pointing downwards and achieved harmonious, visually pleasing positions. The Cupid’s Bow in the middle of the top lip and philtrum between the nose and lip attained their expected definition for the first time in her life. The reshaped and firmer gingiva (gums) confirmed that the intelligent tooth movements and reformulation of the supportive bone was successful.

Those dramatic tooth position changes [buccal and distal translation, intrusion and extrusion (figures 1d, 1e)] reduced tinnitus-inducing stimuli to barely perceptible levels (figures 2d, 2e). To summarize, everything within the mouth and surrounding anatomy became healthier, more esthetic, stronger and more stable.

Her X-rays, Prior to Start

figure 4a
full mouth series of x-rays
figure 4a
full mouth series of x-rays
figure 4b
panoramic x-ray
figure 4b
panoramic x-ray

The majority of orthodontic treatments include the irreversible removal of healthy (no dental caries present) tooth enamel and/or the extraction of one or more healthy (no caries, no infection) teeth.15A Happy Accident ,16Dahhas FY, Almutairi NS, Almutairi RS, Alshamrani HA, Alshyai HS, Almazyad RK, Alsanouni MS, Gadi SA. The Role of Interproximal Reduction (IPR) in Clear Aligner Therapy: A Critical Analysis of Indications, Techniques, and Outcomes. Cureus. 2024 Mar 21;16(3):e56644. doi: 10.7759/cureus.56644. PMID: 38646346; PMCID: PMC11032144. In her case, as is standard with tinnitus-focused aligner therapy, there was no orthognathic surgery, no healthy teeth extracted and no healthy enamel irreversibly removed.

Pre-existing dental conditions (highlights)

Missing teeth: #7, #10, #17, #32
Primary teeth present: #d (resorbed root), #g
Teeth positions transposed: #6 / #d
Overjet: 16mm (start) / 5mm (after)
Overbite: 5mm (start) / 2mm (after)
Full mouth set of x-rays: figure 4a
Panoramic x-ray: figure 4b

Pre-existing medical condition (highlight)

Tinnitus was neither disclosed nor discussed before care started. Prior to 2022, tinnitus was not listed as a checkable selection on the Patient Medical History Questionnaire. Should a patient had wanted to point out that they had tinnitus, they would have needed to select “list any other disease, syndrome or condition not listed” and then write in “tinnitus.” It was during the post-active, passive retainer phase when I became aware that she had been suffering with severe chronic tinnitus for many decades.

Treatment overview

I was the first clinician to assuage her concerns that excellent results could be attained without orthognathic or healthy tooth removal surgeries. Teeth ‘condemned for extraction’ during prior consultations would not only not need to be removed, they would become valuable assets as her occlusion improved.

Some prudent tooth movements reduced the size of her maxilla while others increased the size of her mandible. The jaw size discrepancy was corrected and has remained solidly within the clinically acceptable range for more than a decade. It would not have been possible to achieve her extraordinary results had even one of those surgeries been rendered.

To reduce asymmetry and enhance functionality, a version of enamel replacement, a direct composite restoration (acid etch, bonding agent, composite resin) was placed on her retained deciduous (baby) tooth whose root had fully resorbed decades earlier.17Gonzalo Artuza-Rosado, Liliana Argueta-Figueroa, Mario A. Bautista-Hernández, Rafael Torres-Rosas, Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática., Investigación Clínica, 10.54817/IC.v64n1a07, 64, 1, (81-107), (2023).

 

TFI and THS surveys (2015, 2024)

3a
3a

3b

3b

3c

3c

3d

3d

3e

3e

3f

3f

The TFI and Tinnitus and Hearing Survey (THS), figures 3a-3c (2015) and figures 3d-3f (2024), documented the deleterious influence tinnitus had on her life for almost five decades as well as the dramatic improvements experienced during the past nine years.18Henry JA, Griest S, Zaugg TL, Thielman E, Kaelin C, Galvez G, Carlson KF. Tinnitus and hearing survey: a screening tool to differentiate bothersome tinnitus from hearing difficulties. Am J Audiol. 2015 Mar;24(1):66-77. doi: 10.1044/2014_AJA-14-0042. PMID: 25551458; PMCID: PMC4689225. The amount of time when she was aware of tinnitus, how often it was annoying, the ability to cope with it; her ability to concentrate, think and focus clearly, relax, rest peacefully, etc., all showed life-enhancing improvement.

Duration of Therapy

Active Therapy: 5 years
Passive Therapy: 5+ years, ongoing

Methods

Here is a comparison of the indications and methods for orthodontic aligner care and tinnitus-focused aligner care:

Topic Orthodontic Aligner Care Tinnitus-Focused
Aligner Care
Reasons for Therapy
Malocclusion ([bad bite] based on classification, asymptomatic, symptomatic), smile dissatisfaction, facial asymmetry.
Periodontal disease,19See 20 below TMD, tinnitus*, sleep apnea, malocclusion (symptomatic), facial asymmetry.
Aligner Design
Shapes, materials, and transient additions added to teeth have been used for decades.
Materials have been used for decades. Shape and design are unique and have a patent pending.
Goals by the End of Therapy
Smile improvement, bite health, TMD health, asymmetry reduction.
Gum health, sleep health, tinnitus health, TMD health, bite health, asymmetry reduction, smile improvement.
Enamel Replacement
Has never been a part of treatment. Excessively worn and chipped enamel, exposed dentin, and fillings are infrequently repaired during treatment. Those repairs are made after treatment is deemed to be concluded.
Missing dentin and excessively worn and chipped enamel and fillings are reinforced at opportune times during treatment. Thermal and occlusal force sensitivities are often diminished.
Extractions of Healthy Teeth
Not uncommon. Entire healthy teeth (no infection, no decay) are routinely extracted by an oral surgeon or general dentist at the request of the orthodontist.
Healthy teeth are never extracted. The supporting bone is modified to make room for each part of every tooth.
Irreversible Removal of Portions of Teeth
Interproximal Reduction (IPR), the irreversible removal/shaving down of healthy tooth structure, is performed about half of the time.
IPR is not a part of this therapy because it impedes maximum bone reformulation. Optimal benefits for tinnitus relief would not be able to be achieved with IPR.
Retention Goal
To keep teeth in their current locations after the active phase of care has been completed and final settling of the dentition has occurred.
Subtle, but valuable tooth movements during the post-active, passive movement/retention phase help to ensure that a stable result is achieved.
Retention Methodology
Options include permanent fixed lingual splints, removable retainers or both.
Removable retainers subtly guide teeth to help ensure long-term stability. Fixed splints are not used because they would preclude the top result from being achieved.

Figure 5

*Tinnitus:

  1. Efficacy with tinnitus-focused aligner care has been shown in the treatment of:
    1. bothersome tinnitus
    2. persistent tinnitus
    3. primary tinnitus
  2. Tinnitus-focused aligner therapy was not knowingly been used to treat and may not be as effective when the likely cause of tinnitus is:
    1. COVID-19
    2. Hearing loss
    3. Long COVID
    4. Non-dental traumatic injury

Discussion

Since there has yet to be a half dozen patients confirmed to have experienced dramatic relief from tinnitus, it is fair to ask, “why is there such optimism with, and such confidence in this solution?”

If it had not been brought to my attention by patients, I never on my own would have come up with the concept that removable progressive aligners had the ability to both relieve and exacerbate tinnitus. The notion of a tinnitus-orthodontics connection was never broached in dental school, post-graduate courses (seminars, workshops, lectures) or journal articles (dental, medical, peer-reviewed, open source).

Tinnitus exclusive (American Tinnitus Association [ATA]) and non-tinnitus exclusive (Facebook, Reddit) websites have public and private support groups. Some maintain a section where tinnitus-orthodontics is the subtopic.20https://www.ata.org/your-support-network/find-a-support-group/,21https://www.tapatalk.com/groups/tinnitussupport92262/braces-moving-jaw-caused-tinnitus-and-tmj-disorder-t15600.html,22https://www.facebook.com/groups/402607649885326/,23https://www.reddit.com/r/tinnitus/comments/qicyfj/tinitus_and_orthodontics/ Across all groups (as of June 2024), not one tinnitus sufferer shared experiencing relief while wearing orthodontic aligners. Every post described how they either acquired tinnitus or had their existing tinnitus worsen while being treated with traditional or aligner orthodontics. As with many areas for online expression, that is not a surprise. User gripes and harsh tales tend to far outnumber unincentivized compliments, warm stories and good news.24Naylor, Gillian S. “Complaining, complimenting and word-of-mouth in the digital age: Typology and terms.” Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior 29 (2016): 131-142.

That is why the designing, programming and monitoring of tooth movements, and the qualitative / quantitative monitoring of tinnitus, have become indispensable components of the process currently referred to as Tinnitus-Focused Sequential Dental Aligner Tooth Movement Therapy (figure 5).25Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012 Mar-Apr;33(2):153-76. doi: 10.1097/AUD.0b013e31822f67c0. Erratum in: Ear Hear. 2012 May;33(3):443. PMID: 22156949.

As the aligners ability to impact tinnitus was being validated, the wear, care, and usage protocols were all making significant progress. The unwavering goal was and is to ensure that the maximum potential relief is obtained.

Why did it take so long to identify the tinnitus-orthodontics connection?

In dentistry as well as medicine, it is not unusual for it to take longer and be more costly than expected to determine what causes a disease, condition or ailment; or what makes it get worse.

Tinnitus is a symptom of a variety of underlying diseases, not representative of a distinct disease.26Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5(1):11-19. doi:10.3988/jcn.2009.5.1.11 Since it is not within the scope of practice for dentists, no tinnitus-orthodontics research has ever received funding or been conducted. No tinnitus-orthodontics research has ever been carried out by otolaryngologists (ENT), sleep physicians, psychiatrists, audiologists, etc., as tinnitus-focused aligner therapy is outside their scopes of practice, too.

Searches in 2023 using the American Dental Association’s Discovery electronic collections system and Google Scholar for “tinnitus-dentistry-orthodontics” yielded dozens of scientific articles. All, with one lone exception for orthodontics, centered around TMD.27Kulshrestha R. Tinnitus and Its Role in Orthodontics. Arch Dent. 2019; 1(1):13.

Viewing healthcare visits for tinnitus and orthodontics side-by-side added to my already piqued interest. Over 35+ year periods, those who received care from board certified and board eligible orthodontists (American Association of Orthodontists [AAO]) or sought treatment for tinnitus with primary care physicians [PCP], ENT, psychiatrists and sleep physicians (National Institutes of Health [NIH]) grew at rates that exceeded the rate at which the US population increased by more than six times.28AAO (American Association of Orthodontists) – Figures from Patient Census Surveys. Patient in Treatment by AAO Members in the U.S. and Canada 1982-2018.,29https:www.gao.gov/assets/hrd-88-50fs.pdf,30Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):959-965. doi: 10.1001/jamaoto.2016.1700. PMID: 27441392; PMCID: PMC5812683.

Treatment Provided by
Healthcare Clinicians		 Time Frames Studied
(AAO, NIH)		 Population (US)
Actual Increase		 Population (US)
% Increase		 Patient Visits:
Actual Increase		 Patient Visits
% Increase		 Patients % Increase vs.
% Population Increase

Orthodontics
1982-2016
35 years
232   =>   323 million
39%
2.3   =>   5.6 million
244%*
626%**

Tinnitus Evaluation
and Care
1983-2021
39 years
234   =>   332 million
41%
5.4   =>   16 million
296%
722%
Treatment Provided by Healthcare Clinicians Orthodontics Tinnitus Evaluation and Care

Time Frames Studied (AAO, NIH)

1982-2016
35 years

1983-2021
39 years

Population (US) Actual Increase

232 -> 323 million

234 -> 332 million
Population (US) % Increase

39%

41%
Patient Visits Actual Increase

2.3 -> 5.6
million

5.4 -> 16 million
Patient Visits % Increase

244%*

296%
% Patient Increase / % Population Increase

626%**

722%

Figure 6: There is no universally accepted explanation for the very large increases in patients seeking care for tinnitus (1983-2021).

  • Figures from biannual, triennial, and quadrennial surveys of U.S. board-eligible and board-certified members of the American Association of Orthodontists (AAO).
  • Traditional and aligner orthodontic therapy is also rendered by non-orthodontists: general practitioner dentists, pediatric dentists, periodontists and prosthodontists. When estimates of aligner treatments by non-orthodontists are included, the percentage increase vs. the population percentage increase over the same period (1982-2016) jumps from 626% to 833%.

Statistical perspective

The p value analysis of the data confirmed that the increase in the number of patients who sought medical attention for tinnitus was statistically significant (more than 99.9% certainty) when compared to the US population increase over that 39-year period (figure 6).31https://www.statsdirect.com/help/basics/p_values.htm The increase in the number of patients treated by orthodontists over a similar 35-year period was also statistically significant (more than 99.9% certainty) when compared to the US population increase.

data chart showing orthodontic treatment with aligners for Tinnitus
Figure 7: US population, orthodontist visits, medical visits for tinnitus (1982-2021).

It is not uncommon for disparate entities to have comparable significant growth patterns. That is why statistical similarities alone are insufficient and should not be used to claim interdependent or cause and effect relationships (figure 7).

Because orthodontics involves changes to teeth, muscles, joints, soft tissues, sinuses, bones and ‘things happen’ when portions of human anatomy are repositioned, the speculation that it could affect tinnitus is certainly plausible.

Taken together, the following facts support the premise that a dental treatment (orthodontics) can have a significant influence on a medical symptom (tinnitus):

  1. The ears and oral cavity are in close proximity.
  2. Moving teeth leads to changes in the muscles, gums, joints, sinuses and bones.
  3. Orthodontic movements will have a neutral and/or positive and/or negative impact upon tinnitus.
  4. Non-orthodontic dental treatment (crowns, fillings) and chronic and/or acute malocclusion can impact tinnitus. 32Wójcicki M, Szkutnik J, Różyło-Kalinowska I. The role of the dentist in the treatment of patients with tinnitus. Journal of Stomatology. 2019;72(2):90-93. doi:10.5114/jos.2019.86989.
  5. Researchers have chronicled that orthodontic retainers infrequently leave one with a stable dentition.33Padmos JAD, Fudalej PS, Renkema AM. Epidemiologic study of orthodontic retention procedures. Am J Orthod Dentofacial Orthop. 2018 Apr;153(4):496-504. doi: 10.1016/j.ajodo.2017.08.013. PMID: 29602341.
  6. Relapse and occlusion issues after orthodontic care are not uncommon.34Kaan M, Madléna M. Retention and relapse. Review of the literature. Fogorvosi Szemle. 2011 Dec;104(4):139-146. PMID: 22308954.
  7. US healthcare visits for tinnitus and with orthodontists had large increases over 35+ year time periods (each > 600% when compared to US population growth).

Future research may find the orthodontic-tinnitus association is merely a coincidence, undoubtedly significant or somewhere in between. Until it is determined that orthodontic treatments are independent of and have no connection with undesirable tinnitus consequences, there would seem to be little downside to following cautious, simple and cost-effective steps to reduce negative impacts from repositioning teeth.

Practical Implications

While the discoveries of the connection between orthodontic therapy and tinnitus and the aligner-focused remedy are exciting, they were unplanned.

Hospitals, ENT, PCP, dentists, orthodontists, sleep physicians, psychiatrists and audiologists should incorporate thorough reviews of tinnitus, malocclusion and orthodontics into patient evaluation and treatment processes. Patient tinnitus status should be monitored and updated when a change in symptomology is reported, they receive non-prophylaxis dental care, or an orthodontic treatment is initiated or concluded.

Protections to ensure the efficacy of this advanced tooth movement procedure and longevity of the results have been enshrined within the tinnitus-focused aligner wear, care and precision change protocols.

As tinnitus-focused aligner therapy grows in acceptance, it is hoped that the tide will turn and its geometric rise will be reversed. For those already suffering, it is hoped they experience relief from their chronically disturbing and debilitating noises.

Epilogue: major test of efficacy

In the spring of 2024, this novel tinnitus-focused sequential aligner therapy embarked on its greatest challenge. A 55 year-old male attended a concert 34 years ago where the music was extraordinarily loud. The tinnitus which started that night as faint has over the decades increased logarithmically to frequent and severe. In attempts to get help, he has volunteered as a subject in more than one tinnitus treatment clinical trial. Unfortunately, none have provided him with any meaningful relief. In May 2024, his score was 89 on the TFI scale (0-100):
  1. > 50 = “tinnitus severe enough to qualify for more aggressive intervention”35Henry JA, Griest S, Thielman E, McMillan G, Kaelin C, Carlson KF. Tinnitus Functional Index: Development, validation, outcomes research, and clinical application. Hear Res. 2016;334:58-64. doi:10.1016/j.heares.2015.06.004
  2. > 73 = “very big problem.”36Kalsotra G, Sharma R, Saraf A, Manhas M, Manhas A, Raj D. A Study to Grade the Severity of Tinnitus and its Psychological Impact Using Tinnitus Functional Index (tfi). Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):4218-4225. doi:10.1007/s12070-021-02922-0

This is by far the highest TFI score for any patient who has undergone tinnitus-focused aligner therapy. We look forward to learning whether someone with his severe condition will be able to be helped.
Download Case Report

References

  1. Hackenberg, B.; O’Brien, K.; Döge, J.; Lackner, K.J.; Beutel, M.E.; Münzel, T.; Pfeiffer, N.; Schulz, A.; Schmidtmann, I.; Wild, P.S.; et al. Tinnitus Prevalence in the Adult Population—Results from the Gutenberg Health Study. Medicina 2023, 59, 620.
  2. Cleveland Clinic Health Diseases
  3. https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/
  4. Stockdale, D., McFerran, D., Brazier, P. et al. An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res 17, 577 (2017).
  5. Daoud, E., Caimino, C., Akeroyd, M.A. et al. The Utility of Economic Measures to Quantify the Burden of Tinnitus in Affected Individuals: A Scoping Review. PharmacoEconomics Open 6, 21–32 (2022).
  6. Seo JH, Kang JM, Hwang SH, Han KD, Joo YH. Relationship between tinnitus and suicidal behaviour in Korean men and women: a cross-sectional study. Clin Otolaryngol. 2016;41(3):222-227.
  7. Lewis JE, Stephens SD, McKenna L. Tinnitus and suicide. Clin Otolaryngol Allied Sci. 1994 Feb;19(1):50-4. doi: 10.1111/j.1365-2273.1994.tb01147.x.
  8. Szibor A, Mäkitie A, Aarnisalo AA. Tinnitus and suicide: An unresolved relation. Audiol Res. 2019 Jun 7;9(1):222. doi: 10.4081/audiores.2019.222.
  9. Lugo A, Trpchevska N, Liu X, et al. Sex-Specific Association of Tinnitus With Suicide Attempts. JAMA Otolaryngol Head Neck Surg. 2019;145(7):685–687. doi:10.1001/jamaoto.2019.0566
  10. https://www.npr.org/sections/coronavirus-live-updates/2021/03/22/979929592/texas-roadhouse-founder-kent-taylor-dies-after-struggle-with-post-covid-19-sympt
  11. https://fortune.com/2021/03/22/texas-roadhouse-ceo-kent-taylor-suicide-tinnitus-covid/
  12. Matthew F. Garnett, M.P.H., Merianne Rose Spencer, M.P.H., and Julie D. Weeks, Ph.D. Suicide Among Adults Age 55 and Older, 2021. NCHS Data Brief No. 483, November 2023.
  13. https://www.cdc.gov/nchs/products/databriefs/db483.htm
  14. https://www.ncrar.research.va.gov/Documents/TFI.pdf
  15. https://themanhattandentist.com/a-happy-accident-discovering-the-connection-between-tinnitus-and-aligner-care/
  16. Dahhas FY, Almutairi NS, Almutairi RS, Alshamrani HA, Alshyai HS, Almazyad RK, Alsanouni MS, Gadi SA. The Role of Interproximal Reduction (IPR) in Clear Aligner Therapy: A Critical Analysis of Indications, Techniques, and Outcomes. Cureus. 2024 Mar 21;16(3):e56644. doi: 10.7759/cureus.56644. PMID: 38646346; PMCID: PMC11032144.
  17. Gonzalo Artuza-Rosado, Liliana Argueta-Figueroa, Mario A. Bautista-Hernández, Rafael Torres-Rosas, Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática., Investigación Clínica, 10.54817/IC.v64n1a07, 64, 1, (81-107), (2023).
  18. USPTO: US#11,684,454 B2. Tooth Enamel Replacement. 2023, Jun 27.
    Henry JA, Griest S, Zaugg TL, Thielman E, Kaelin C, Galvez G, Carlson KF. Tinnitus and hearing survey: a screening tool to differentiate bothersome tinnitus from hearing difficulties. Am J Audiol. 2015 Mar;24(1):66-77. doi: 10.1044/2014_AJA-14-0042. PMID: 25551458; PMCID: PMC4689225.
  19. United States Patent and Trademark Office: US#9,861,451 B1. Combination Orthodontic and Periodontal; Orthodontic and Implant; and Orthodontic and Temperomandibular Joint Dysfunction and Orthodontic Orthognathic Treatment, 2018, Jan 9.
  20. https://www.ata.org/your-support-network/find-a-support-group/
  21. https://www.tapatalk.com/groups/tinnitussupport92262/braces-moving-jaw-caused-tinnitus-and-tmj-disorder-t15600.html
  22. https://www.facebook.com/groups/402607649885326/
  23. https://www.reddit.com/r/tinnitus/comments/qicyfj/tinitus_and_orthodontics/
  24. Naylor, Gillian S. “Complaining, complimenting and word-of-mouth in the digital age: Typology and terms.” Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior 29 (2016): 131-142.
  25. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012 Mar-Apr;33(2):153-76. doi: 10.1097/AUD.0b013e31822f67c0. Erratum in: Ear Hear. 2012 May;33(3):443. PMID: 22156949.
  26. Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5(1):11-19. doi:10.3988/jcn.2009.5.1.11
  27. Kulshrestha R. Tinnitus and Its Role in Orthodontics. Arch Dent. 2019; 1(1):13.
  28. AAO (American Association of Orthodontists) – Figures from Patient Census Surveys. Patient in Treatment by AAO Members in the U.S. and Canada 1982-2018.
  29. https:www.gao.gov/assets/hrd-88-50fs.pdf
  30. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):959-965. doi: 10.1001/jamaoto.2016.1700. PMID: 27441392; PMCID: PMC5812683.
  31. https://www.statsdirect.com/help/basics/p_values.htm
  32. Wójcicki M, Szkutnik J, Różyło-Kalinowska I. The role of the dentist in the treatment of patients with tinnitus. Journal of Stomatology. 2019;72(2):90-93. doi:10.5114/jos.2019.86989.
  33. Padmos JAD, Fudalej PS, Renkema AM. Epidemiologic study of orthodontic retention procedures. Am J Orthod Dentofacial Orthop. 2018 Apr;153(4):496-504. doi: 10.1016/j.ajodo.2017.08.013. PMID: 29602341.
  34. Kaan M, Madléna M. Retention and relapse. Review of the literature. Fogorvosi Szemle. 2011 Dec;104(4):139-146. PMID: 22308954.
  35. Henry JA, Griest S, Thielman E, McMillan G, Kaelin C, Carlson KF. Tinnitus Functional Index: Development, validation, outcomes research, and clinical application. Hear Res. 2016;334:58-64. doi:10.1016/j.heares.2015.06.004
  36. Kalsotra G, Sharma R, Saraf A, Manhas M, Manhas A, Raj D. A Study to Grade the Severity of Tinnitus and its Psychological Impact Using Tinnitus Functional Index (tfi). Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):4218-4225. doi:10.1007/s12070-021-02922-0
  1. Hackenberg, B.; O’Brien, K.; Döge, J.; Lackner, K.J.; Beutel, M.E.; Münzel, T.; Pfeiffer, N.; Schulz, A.; Schmidtmann, I.; Wild, P.S.; et al. Tinnitus Prevalence in the Adult Population—Results from the Gutenberg Health Study. Medicina 2023, 59, 620.
  2. Cleveland Clinic Health Diseases
  3. https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/
  4. Stockdale, D., McFerran, D., Brazier, P. et al. An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res 17, 577 (2017).
  5. Daoud, E., Caimino, C., Akeroyd, M.A. et al. The Utility of Economic Measures to Quantify the Burden of Tinnitus in Affected Individuals: A Scoping Review. PharmacoEconomics Open 6, 21–32 (2022).
  6. Seo JH, Kang JM, Hwang SH, Han KD, Joo YH. Relationship between tinnitus and suicidal behaviour in Korean men and women: a cross-sectional study. Clin Otolaryngol. 2016;41(3):222-227.
  7. Lewis JE, Stephens SD, McKenna L. Tinnitus and suicide. Clin Otolaryngol Allied Sci. 1994 Feb;19(1):50-4. doi: 10.1111/j.1365-2273.1994.tb01147.x.
  8. Szibor A, Mäkitie A, Aarnisalo AA. Tinnitus and suicide: An unresolved relation. Audiol Res. 2019 Jun 7;9(1):222. doi: 10.4081/audiores.2019.222.
  9. Lugo A, Trpchevska N, Liu X, et al. Sex-Specific Association of Tinnitus With Suicide Attempts. JAMA Otolaryngol Head Neck Surg. 2019;145(7):685–687. doi:10.1001/jamaoto.2019.0566
  10. https://www.npr.org/sections/coronavirus-live-updates/2021/03/22/979929592/texas-roadhouse-founder-kent-taylor-dies-after-struggle-with-post-covid-19-sympt
  11. https://fortune.com/2021/03/22/texas-roadhouse-ceo-kent-taylor-suicide-tinnitus-covid/
  12. Matthew F. Garnett, M.P.H., Merianne Rose Spencer, M.P.H., and Julie D. Weeks, Ph.D. Suicide Among Adults Age 55 and Older, 2021. NCHS Data Brief No. 483, November 2023.
  13. https://www.cdc.gov/nchs/products/ databriefs/db483.htm
  14. https://www.ncrar.research.va.gov/ Documents/TFI.pdf
  15. A Happy Accident
  16. Dahhas FY, Almutairi NS, Almutairi RS, Alshamrani HA, Alshyai HS, Almazyad RK, Alsanouni MS, Gadi SA. The Role of Interproximal Reduction (IPR) in Clear Aligner Therapy: A Critical Analysis of Indications, Techniques, and Outcomes. Cureus. 2024 Mar 21;16(3):e56644. doi: 10.7759/cureus.56644. PMID: 38646346; PMCID: PMC11032144.
  17. Gonzalo Artuza-Rosado, Liliana Argueta-Figueroa, Mario A. Bautista-Hernández, Rafael Torres-Rosas, Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática., Investigación Clínica, 10.54817/IC.v64n1a07, 64, 1, (81-107), (2023).
  18. USPTO: US#11,684,454 B2. Tooth Enamel Replacement. 2023, Jun 27.
    Henry JA, Griest S, Zaugg TL, Thielman E, Kaelin C, Galvez G, Carlson KF. Tinnitus and hearing survey: a screening tool to differentiate bothersome tinnitus from hearing difficulties. Am J Audiol. 2015 Mar;24(1):66-77. doi: 10.1044/2014_AJA-14-0042. PMID: 25551458; PMCID: PMC4689225.
  19. United States Patent and Trademark Office: US#9,861,451 B1. Combination Orthodontic and Periodontal; Orthodontic and Implant; and Orthodontic and Temperomandibular Joint Dysfunction and Orthodontic Orthognathic Treatment, 2018, Jan 9.
  20. https://www.ata.org/your-support-network/find-a-support-group/
  21. https://www.tapatalk.com/groups/ tinnitussupport92262/braces-moving-jaw-caused-tinnitus-and-tmj-disorder-t15600.html
  22. https://www.facebook.com/groups/ 402607649885326/
  23. https://www.reddit.com/r/tinnitus/comments/ qicyfj/tinitus_and_orthodontics/
  24. Naylor, Gillian S. “Complaining, complimenting and word-of-mouth in the digital age: Typology and terms.” Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior 29 (2016): 131-142.
  25. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012 Mar-Apr;33(2):153-76. doi: 10.1097/AUD.0b013e31822f67c0. Erratum in: Ear Hear. 2012 May;33(3):443. PMID: 22156949.
  26. Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5(1):11-19. doi:10.3988/jcn.2009.5.1.11
  27. Kulshrestha R. Tinnitus and Its Role in Orthodontics. Arch Dent. 2019; 1(1):13.
  28. AAO (American Association of Orthodontists) – Figures from Patient Census Surveys. Patient in Treatment by AAO Members in the U.S. and Canada 1982-2018.
  29. https:www.gao.gov/assets/hrd-88-50fs.pdf
  30. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):959-965. doi: 10.1001/jamaoto.2016.1700. PMID: 27441392; PMCID: PMC5812683.
  31. https://www.statsdirect.com/help/basics/ p_values.htm
  32. Wójcicki M, Szkutnik J, Różyło-Kalinowska I. The role of the dentist in the treatment of patients with tinnitus. Journal of Stomatology. 2019;72(2):90-93. doi:10.5114/jos.2019.86989.
  33. Padmos JAD, Fudalej PS, Renkema AM. Epidemiologic study of orthodontic retention procedures. Am J Orthod Dentofacial Orthop. 2018 Apr;153(4):496-504. doi: 10.1016/j.ajodo.2017.08.013. PMID: 29602341.
  34. Kaan M, Madléna M. Retention and relapse. Review of the literature. Fogorvosi Szemle. 2011 Dec;104(4):139-146. PMID: 22308954.
  35. Henry JA, Griest S, Thielman E, McMillan G, Kaelin C, Carlson KF. Tinnitus Functional Index: Development, validation, outcomes research, and clinical application. Hear Res. 2016;334:58-64. doi:10.1016/j.heares.2015.06.004
  36. Kalsotra G, Sharma R, Saraf A, Manhas M, Manhas A, Raj D. A Study to Grade the Severity of Tinnitus and its Psychological Impact Using Tinnitus Functional Index (tfi). Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 3):4218-4225. doi:10.1007/s12070-021-02922-0