The term Costen's syndrome has been used in the dentomedical literature to describe a constellation of craniofacial symptoms. Since some of the same complaints have been reported in patients with “generalized” psychological distress, symptoms associated with the syndrome may not be useful in differential diagnosis of temporomandibular disorders. The present study investigated whether some somatic complaints, particularly tinnitus and dizziness, were pathognomonic in patients with chronic temporomandibular pain. Illness behavior and personality factors were studied for possible interrelationships with these symptoms. Factor analysis revealed that tinnitus and dizziness loaded on separate factors. Tinnitus loaded with nasal stuffiness, tearing, and itching of the eyelids and nose, while dizziness loaded with complaints of altered taste and smell and blurred vision. Neither was consistently related to measures of pain or to indices of illness behavior or somatic focus.
BushFMDolwickMF. The temporomandibular joint and related orofacial disorders. Philadelphia, Pa: JB Lippincott, 1993: 33.
2.
CostenJB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhinol Laryngol1934; 43: 1–15.
3.
CostenJB. Neuralgias and ear symptoms associated with disturbed function of the temporomandibular joint. JAMA1936; 107: 252–5.
BleickerRE. Ear disturbances of temporomandibular origin. J Am Dent Assoc1938; 25: 1390–9.
6.
ShapiroHHTruexRC. The temporomandibular joint and the auditory function. J Am Dent Assoc1943; 30: 1147–68.
7.
SicherH. Temporomandibular articulation in mandibular overclosure. J Am Dent Assoc1948; 36: 131–9.
8.
ZimmermannAA. An evaluation of Costen's syndrome from an anatomic point of view. In: SarnatBG, ed. The temporomandibular joint. Springfield, Ill: CC Thomas, 1951: 82–110.
TravellJ. Referred pain from skeletal muscle. The pectoralis major syndrome of breast pain and soreness and the sternomastoid syndrome of headache and dizziness. N Y State J Med1955; 55: 331–40.
11.
SchwarzL. Disorders of the temporomandibular joint. Philadelphia, Pa: WB Saunders, 1959.
SharavYTzukertARefaeliB. Muscle pain index in relation to pain dysfunction and dizziness associated with myofascial pain-dysfunction syndrome. Oral Surg Oral Med Oral Pathol1978; 46: 742–7.
14.
GelbHTarteJ. A two-year clinical dental evaluation of 200 cases of chronic headache: The craniocervical mandibular syndrome. J Am Dent Assoc1975; 91: 1230–6.
15.
BraafMMRosnerS. Trauma of the cervical spine as a cause of headache. J Trauma1975; 15: 441–6.
16.
TerraheK. Das Zervikokraniale Syndrome in der Praxis des HNO-arztes. Laryngol Rhinol Otol (Stuttg)1985; 64: 292–9.
KoppSPlatoGBumannA. Die Bedeutung der oberen Kopfgelenke bei der Aeiologie von Schmerzen im Kopf-, Hals-, Nakenbereich. Dtsch Zahnarztl Z1989; 44: 966–7.
19.
PaszterE. Decompression of vertebral artery in cases of cervical spondylosis. Surg Neurol1986; 9: 371–7.
20.
YatesDAHSmithMA. Orthopaedic pain after trauma. In: WallPDMelzackR, eds. Textbook of pain. Edinburgh, Scotland: Churchill Livingstone, 1994: 409–21.
21.
BrookesGBMawARColemanMJ. “Costen's syndrome” — Correlation or coincidence: A review of 45 patients with temporomandibular joint dysfunction, otalgia and other aural symptoms. Clin Otolaryngol1980; 5: 23–36.
22.
PfaffenrathVDankekarRPollmanW. Cervicogenic headache: The clinical picture, radiological findings and hypotheses on its pathophysiology. Headache1987; 27: 495–9.
23.
MeniereP. Sur une forme de surdite grave dependant d'une lesion de l'oreille interne. Gaz Med Paris1861; 16: 29.
24.
FeldmanH. Die Geburt einer Krankheit, Dargestellt am Beispiel des morbus Meniere. Laryngorhinootologie1993; 72: 1–8.
25.
TaniokaHTeraharaAFurutaA. MR imaging of the inner ear; findings of Meniere's syndrome. Rinsho Hoshasen1989; 34: 1365–70.
KoenigHGCohenHJBlazerDGKrishnanKRRSibertTE. Profile of depressive symptoms in younger and older medical inpatients with major depression. J Am Geriatr Soc1993; 41: 1169–76.
32.
RasmussenP. Facial pain. IV. A prospective study of 1052 patients with a view of: Precipitating factors, associated symptoms, objective psychiatric and neurological symptoms. Acta Neurochir (Wien)1991; 108: 100–9.
BushFMHarkinsSW. Pain-related limitation in activities of daily living in patients with chronic orofacial pain: Psychometric properties of a disability index. J Orofacial Pain1995; 9: 57–63.
35.
HarkinsSWLaguaBTPriceDDSmallRE. Geriatric pain. In: RoyR, ed. Chronic pain in old age. Toronto, Canada: University of Toronto Press, 1994: 155–9.
36.
MelzackR. The McGill Pain Questionnaire: Major properties and scoring methods. Pain1975; 1: 277–99.
CarsonRC. Interpretative manual to the MMPI. In: ButcherJN, ed. MMPI: Research developments and clinical applications. New York, NY: McGraw-Hill, 1969: 279–96.
39.
CattellRB. Factor analysis: I. An introduction to essentials. II. The role of factor analysis in research. Biometrics1965; 21: 405–35.
HarkinsSWBushFMPriceDDHamerRM. Symptom report in orofacial pain patients: Relation to chronic pain, experimental pain, illness behavior and personality. Clin J Pain1991; 7: 102–13.
42.
GoodfriendDJ. Deafness, tinnitus, vertigo and neuralgia. Arch Otolaryngol1947; 46: 1–35.
43.
HankeyGT. Some observations on Costen's mandibular syndrome: Including a review of 100 out of 500 cases. Proc R Soc Med1957; 51: 225–32.
44.
GelbHArnoldGE. Syndromes of the head and neck of dental origin. I. Pain caused by mandibular dysfunction. Arch Otolaryngol1959; 70: 681–91.
45.
CappsFCW. Temporomandibular joint syndrome of Costen. Proc R Soc Med1962; 55: 792–3.
46.
HankeyGT. Painful disorders of the temporomandibular joint. Proc R Soc Med1962; 55: 781–92.
47.
DolowitzDAWardJWFingerleCOSmithCC. The role of muscular incoordination in the pathogenesis of the temporomandibular joint syndrome. Laryngoscope1964; 74: 790–801.
48.
MyrhaugH. The incidence of ear symptoms in cases of malocclusion and temporomandibular joint disturbances. Br J Oral Surg1964–65; 2: 28–33.
49.
VeroD. Facial pain in association with temporomandibular joint dysfunction. J Laryngol Otol1965; 79: 707–23.
50.
GelbHCalderoneJGrossSKantorM. The role of the dentist and the otolaryngologist in evaluating temporomandibular joint syndrome. J Prosthet Dent1967; 18: 497–503.
51.
BernsteinJMMohlNDSpillerH. Temporomandibular joint dysfunction masquerading as disease of the ear, nose and throat. Trans Am Acad Ophthalmol Otolaryngol1969; 73: 1208–17.
52.
ZarbGAThompsonGW. Assessment of clinical treatment of patients with temporomandibular joint dysfunction. J Prosthet Dent1970; 24: 542–54.
53.
PrincipatoJJBarwellDR. Biofeedback training and relaxation exercises for treatment of temporomandibular joint dysfunction. ORL1978; 86: 766–8.
CarlssonGEKoppSWedelA. Analysis of background variables in 350 patients with TMJ disorders as reported in self-administered questionnaire. Community Dent Oral Epidemiol1982; 10: 47–51.
56.
GelbHBernsteinI. Clinical evaluation of two hundred patients with temporomandibular joint syndrome. J Prosthet Dent1983; 49: 234–43.
57.
ThornburnDNBlakeP. Mandibular dysfunction in children with otalgia. N Z Dent J1985; 81: 89–93.
58.
WedelACarlssonGE. Factors influencing the outcome of treatment in patients referred to a temporomandibular clinic. J Prosthet Dent1985; 54: 420–6.
WedelACarlssonGE. A four year follow-up by means of a questionnaire of patients with functional disturbances of the masticatory system. J Oral Rehabil1986; 13: 105–13.
61.
BushFM. Tinnitus and otalgia in temporomandibular disorders. J Prosthet Dent1987; 58: 495–8.
62.
RubinsteinBCarlssonGE. Effects of stomatognathic treatment on tinnitus: A retrospective study. J Craniomandib Pract1987; 5: 254–9.
63.
WilliamsonEH. The interrelationship of internal derangements of the temporomandibular joint. Headache, vertigo, and tinnitus: A survey of 25 patients. J Craniomandib Pract1990; 8: 301–6.
64.
RubinsteinBAxelssonACarlssonGE. Prevalence of signs and symptoms of craniomandibular disorders in tinnitus patients. J Craniomandib Disord Facial Oral Pain1990; 4: 186–93.
65.
VernonJGriestSPressL. Attributes of tinnitus that may predict temporomandibular joint dysfunction. Cranio1992; 10: 282–8.
66.
MorganDH. Tinnitus of TMJ origin: A preliminary report. J Craniomandib Pract1992; 10: 124–9.
67.
CholeRAParkerWS. Tinnitus and vertigo in patients with temporomandibular disorder. Arch Otolaryngol Head Neck Surg1992; 118: 817–21.
68.
CooperBCCooperDL. Recognizing otolaryngologic symptoms in patients with temporomandibular disorders. J Craniomandib Pract1993; 11: 260–7.
69.
EnglundGSDahlqvistRLindelofB. DMSA administration to patients with alleged mercury poisoning from dental amalgams: A placebo-controlled study. J Dent Res1993; 73: 620–8.
70.
ParkerWSCholeRA. Tinnitus, vertigo and temporomandibular disorders. Am J Orthod Dentofacial Orthop1995; 107: 153–8.
71.
RenY-FIsbergA. Tinnitus in patients with temporomandibular joint internal derangement. Cranio1995; 13: 75–80.
72.
GelbHGelbMLWagnerML. The relationship of tinnitus to craniocervical mandibular disorders. Cranio1997; 15: 136–43.
73.
WrightEFBifanoSL. Tinnitus improvement through TMD therapy. J Am Dent Assoc1997; 128: 1424–32.
74.
CiancagliniRLoretiPRadaelliG. Ear, nose and throat symptoms in patients with TMD: The association of symptoms according to severity of arthropathy. J Orofacial Pain1994; 8: 293–7.
MaloneyGMatignonEMehtaNForgioneA. SCL-90 scores and symptoms of tinnitus-TMD, TMD patients and controls [Abstract]. J Dent Res1995; 74: 222.
85.
RubinsteinB. Tinnitus and craniomandibular disorders — Is there a link?. Swed Dent JSuppl1993; 95: 1–46.
86.
Harrop-GriffithsJKatonWDobieRSakaiCRussoJ. Chronic tinnitus: Association with psychiatric diagnoses. J Psychosom Res1987; 31: 613–21.
87.
HalfordJBAndersonSD. Anxiety and depression in tinnitus sufferers. J Psychosom Res1991; 35: 383–90.
88.
KirschCABlanchardEBParnesSM. Psychological characteristics of individuals high and low in their ability to cope with tinnitus. Psychosom Med1989; 51: 209–17.
89.
Ogutcen-TollerMJuniperRP. Audiological evaluation of the aural symptoms in temporomandibular joint dysfunction. J Craniomaxillofac Surg1993; 21: 2–8.
90.
LockwoodAHSalviRJCoadBAWowsleyMAWackDSMurphyBW. The functional neuroanatomy of tinnitus. Neurology1998; 50: 114–20.
91.
GranickMSMartuzaRLParkerSWOjemannRGMontgomeryWW. Cerebellopontine angle meningiomas: Clinical manifestations and diagnosis. Ann Otol Rhinol Laryngol1985; 94: 34–8.
