Relationship Between Posture During Sleep, Otological Symptoms, Psychological Factors, Bruxism, and Sleep Disturbances in Patients with Temporomandibular Disorder: A Clinical Trial Focused on Self-Care

Abstract

Objective: To evaluate the effects of posture during sleep on otological symptoms (such as tinnitus and ear fullness), psychological factors, bruxism, and sleep disorders in patients with temporomandibular disorders (TMD) undergoing an educational intervention based on self-care.

Methods: Prospective single-arm clinical trial with 36 participants diagnosed with joint TMD and self-reported otological symptoms. Patients were stratified into three groups based on self-reported posture during sleep: “Never Had the Habit” (without mandibular support), “Kept the Habit” (with mandibular support), and “Quit the Habit” (with support, but quit). The intervention consisted of an initial 90-minute session and two 40-minute reinforcement sessions, focusing on sleep hygiene, self-management strategies for bruxism, and management of psychological factors. Data was collected at four time points: baseline (T0), 30 days (T1), 60 days (T2), and 180 days (T3). Statistical analysis used repeated measures ANOVA with Greenhouse-Geisser correction and post-hoc comparisons with Bonferroni. Effect sizes were calculated using partial eta-square (η²p).

Results: There was a significant reduction in tinnitus intensity over time (F (3, 99) =56.2; p<0.001; η²p=0.61). The time × postural group interaction was significant (F (6, 99) =12.3; p<0.001; η²p=0.31). The «Quit the Habit» group showed a 58.1% reduction in tinnitus, whereas the «Kept the Habit» group showed a 40.5% reduction (difference at T3: 1.08 points; p=0.003). Otological symptoms improved in all groups, with large main effects for ear fullness (F=6.3; p=0.015; η²p=0.18). Psychological factors, such as anxiety, and sleep disorders, such as insomnia, decreased, with a positive correlation with postural habit abandonment (p<0.05). Nocturnal bruxism was more prevalent in the group that kept the habit (63.6%).

Conclusion: Posture during sleep significantly influences otological symptoms, psychological factors, bruxism, and sleep disorders in patients with TMD. Discontinuation of ipsilateral mandibular support was associated with greater symptom relief. The educational program based on self-care was associated with significant clinical improvements in overall symptoms and should be integrated into conservative strategies for TMD management. This self-care protocol focused on sleep posture correction, stress management, and sleep hygiene education.