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

Data sourcesThe 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 selectionThose 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 synthesisThe 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.ResultsEight 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.ConclusionsInsufficient 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.