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Voice-Related Outcomes Among Patients With Temporomandibular Disorders: A Systematic Review and Narrative Synthesis
Patrick Abou Raji Feghali1, Abdul-Latif Hamdan1
1Department of Otolaryngology - Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Background:
Temporomandibular disorders (TMD) may influence voice through effects on mandibular movement and vocal tract configuration. This review synthesized subjective and objective voice-related outcomes among patients with TMD.
Methods:
A systematic search of MEDLINE via Ovid, PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar was completed, with no date restrictions. Observational studies were eligible if they included patients with TMD and reported at least one voice-related outcome. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Data were synthesized narratively.
Results:
The search identified 440 records; after duplicate removal, screening, and review, 10 studies comprising 3,467 TMD participants were included. Study designs, TMD definitions, comparator groups, and voice outcome measures varied substantially. Voice outcomes included symptom-based reporting of dysphonia or voice disorder, Voice Handicap Index, voice-related quality of life questionnaires, auditory-perceptual assessment, acoustic and cepstral analyses, spectrography, and the Dysphonia Severity Index. Symptom-based studies reported dysphonia or voice disorder in 12.6% of a 1,000-patient TMD cohort and in 73.1% of older adults with TMD compared with 29.7% without TMD in the same sample. Patient-reported outcomes were variable, but several studies showed greater voice handicap or poorer voice-related quality of life with increasing TMD severity. Auditory-perceptual assessment showed reduced loudness among patients with severe TMD. Objective measures showed reduced loudness, increased antiresonance, lower cepstral peak prominence values, and lower Dysphonia Severity Index scores in patients with TMD or greater TMD severity. Overall methodological quality was high in three studies, moderate in six, and low in one.
Conclusion:
Voice symptoms and abnormal voice findings are frequently reported among patients with TMD and may worsen with increasing TMD severity. However, methodological heterogeneity and predominantly cross-sectional designs limit causal inference. Future studies should use standardized TMD definitions, matched controls, and integrated voice assessment methods.
