Acupuncture to manage orofacial pain and tinnitus: Case report

CASE REPORT Rev Dor. São Paulo, 2013 jul-set;14(3):226-30 Acupuncture to manage orofacial pain and tinnitus. Case report* Acupuntura no manuseio da dor orofacial e do tinido. Relato de caso Rosario Martha De La Torre Vera1, Cássia Maria Grillo1, Maria Lucia B.Fortinguerra1, María da Luz R. Sousa1, Fausto Berzin1 *Received from the School of Dentistry. Piracicaba, SP. ABSTRACT RESUMO BACKGROUND AND OBJECTIVES: Orofacial pain is associated to soft and mineralized oral cavity and facial tissues. In dentistry, it may have or not odontogenic origin. Temporomandibular disorder (TMD) is the most common musculoskeletal orofacial pain and presents characteristic symptoms such as masticatory muscles pain, jaw movement limitation, joint noises, earache and tinnitus. Tinnitus is a term describing the perception of sound by human ears in the absence of external sounds and causes discomfort impairing quality of life. It may be a symptom indicating TMD especially when other symptoms are present, such as facial muscles pain. Due to etiologic variability, there are several therapeutic modalities, including acupuncture. This study aimed at reporting a case of a patient with orofacial pain and tinnitus treated with acupuncture and the results after treatment. CASE REPORT: Female patient, 32 years old, came to the Acupuncture Clinic of the School of Dentistry of Piracicaba (FOP/ UNICAMP) complaining of facial muscle pain and pricking at the same side, acute right ear tinnitus, already with diagnosis of left ear hearing loss and with sleep disorders and stress. Patient was treated according to her energetic unbalance with 6 sessions of traditional acupuncture, for one week, lasting 20 minutes. To evaluate orofacial pain and tinnitus intensity, the visual analog scale (VAS) was used and was called initial VAS (pre-treatment) and final VAS (post-treatment). After the second session there has been improvement in orofacial pain and tinnitus symptoms. After the sixth session tinnitus had resolved. CONCLUSION: Acupuncture has induced muscle relaxation with benefits for masticatory and middle ear (tensor tympani) muscles, as well as levator palate muscle decreasing orofacial pain and tinnitus intensity. Keywords: Acupuncture therapy, Meridians, Orofacial pain, Tinnitus. JUSTIFICATIVA E OBJETIVOS: Dor orofacial é toda dor associada a tecidos moles e mineralizados da cavidade oral e da face. Na odontologia, podem ser de origem odontogênica e não odontogênica. A disfunção temporomandibular (DTM) é a dor orofacial musculoesquelética mais comum, apresenta sintomas característicos como dor nos músculos mastigatórios, limitação dos movimentos mandibulares, ruídos articulares, otalgia, tinido. Tinido (zumbido) é um termo que descreve a percepção de som no ouvido humano na ausência de som externo, causa de incômodo com prejuízo na qualidade de vida. Pode ser um sintoma indicativo de uma DTM principalmente quando estão presentes outros sintomas característicos da disfunção como dor nos músculos da face. Devido à variabilidade etiológica, encontram-se várias modalidades terapêuticas, incluindo a acupuntura. O objetivo deste estudo foi relatar o caso de uma paciente com dor orofacial e tinido tratada com acupuntura e seus resultados após o tratamento. RELATO DO CASO: Paciente do sexo feminino, 32 anos, compareceu a Clínica de Acupuntura da Faculdade de Odontologia de Piracicaba (FOP/UNICAMP), com queixa de dor muscular na face e formigamento do mesmo lado, tinido agudo no ouvido direito, já com diagnóstico de surdez do ouvido esquerdo e apresentando distúrbios do sono e estresse. Foi tratada de acordo com seu desequilíbrio energético, em seis sessões de acupuntura tradicional, uma por semana, com duração de 20 minutos. Para avaliar a intensidade da dor orofacial e do tinido, utilizou-se a escala analógica visual (EAV), denominada EAV inicial (pré-tratamento) e EAV final (póstratamento). Após a segunda sessão, observou-se melhora nos sintomas da dor orofacial e do tinido, que deixou de se manifestar após a sexta sessão. CONCLUSÃO: Acupuntura propiciou o relaxamento da musculatura com benefícios para os músculos da mastigação e da musculatura da orelha média (tensor do tímpano), bem como do músculo elevador do palato, reduzindo a intensidade da dor orofacial e do tinido. Descritores: Dor orofacial, Meridianos, Terapia por acupuntura, Zumbido. 1. State University of Campinas, School of Dentistry. Piracicaba, SP, Brazil. Submitted in January 02, 2013. Accepted for publication in June 06, 2013. Conflict of interests: None. Correspondence to: Rosario Martha De La Torre Vera Av. Limeira, 901 – Bairro Areão 13414-903, Piracicaba, SP. E-mail: © Sociedade Brasileira para o Estudo da Dor INTRODUCTION Orofacial pain is any pain associated to soft tissues (muscles, nerves, skin, glands, blood vessels) and mineralized tissues Acupuncture to manage orofacial pain and tinnitus. Case report (bones and teeth) of oral cavity and face. It may be referred to head and/or neck or it may be associated to other pathologies (cervical pain, primary headaches and rheumatic diseases)1. In dentistry, most frequent causes of orofacial pain are odontogenic, related to dental tissues and their supporting structures (more severe), and non odontogenic, associated to muscles, joints and nerves (neuropathic pains)2. Musculoskeletal orofacial pain has become known in Brazil among laypeople, patients and health professionals as Temporomandibular Joint Disorder (TMD)3. TMD is a term defining different clinical problems involving muscles of the head, face, mouth, neck and other related structures4. Common TMD signs and symptoms are: masticatory muscles pain, temporomandibular joint pain, headache, joint movements limitation, sensation of hear loss, ear pain and tinnitus5. Tinnitus (or buzz) is a term to describe sound perception by human ear in the absence of external sound6, and may be associated to depressive psychological emotional problems6,7. Tinnitus may also be caused by anatomic abnormalities, but sometimes no etiological structural defect can be found8. The prevalence of tinnitus in people with normal hearing is 26.6%, which increases to 35.1% in people with hearing impairment6. Its incidence is not related to age or gender9. Tinnitus may be classified in: para-auditory (perceptible) with vascular or muscular origin, and subjective tinnitus of neurosensory origin10. Tinnitus may be an ENT symptom indicating TMD, especially when there are also other signs and symptoms characterizing the disorder, such as masticatory muscles pain11. From people with tinnitus, approximately 20% have significant discomfort that impairs their quality of life12. Its treatment is a major challenge and there are several therapeutic modalities to eliminate or, in most cases, attenuate tinnitus, such as Tinnitus Retraining Therapy, auditory prostheses, electrical stimulation with cochlear implants, biofeedback and psychotherapy13. Due to symptoms subje (...truncated)