Subjective Otologic and Vestibular Symptom Changes During 12 Months of Neuromuscular Orthotic Therapy in Patients with Temporomandibular Disorders: An Exploratory Longitudinal Study with Mandibular Kinesiography

Background/Objectives: Otologic and vestibular complaints are frequent in patients with temporomandibular disorders (TMDs), but evidence that TMD-directed treatment improves dizziness or aural fullness remains limited. This exploratory study evaluated 12-month changes in subjective otologic/vestibular symptoms and mandibular kinematics during neuromuscular orthotic therapy. Methods: Thirty-five patients with TMD underwent clinical assessment and K7 three-dimensional mandibular kinesiography at baseline (T0) and 12 months (T1); 20 asymptomatic subjects provided cross-sectional kinematic reference data. Audiologic and bedside otoneurological assessment screened for clinically evident primary auditory and vestibular disorders. Kinesiography was recorded on natural dentition at T0 and with the orthotic in situ at T1. Raw XYZ trajectories were analyzed with a reproducible post hoc signal-processing and segmentation pipeline. Results: Vertigo/dizziness improved or resolved in 10/10 patients (100%), aural fullness in 7/8 (87.5%), and tinnitus in 22/24 (91.7%). Across 35 paired recordings, vertical excursion decreased from 4.20 ± 3.16 to 3.14 ± 2.90 mm (p = 0.084), 3D path length from 16.84 ± 14.60 to 11.94 ± 11.74 mm (p = 0.078), and mean 3D speed from 5.25 ± 2.88 to 4.42 ± 3.42 mm/s (p = 0.065). A post hoc sensitivity analysis of 27 higher-confidence segmentations showed significant reductions in vertical excursion (p = 0.049), path length (p = 0.049), and mean speed (p = 0.030). Conclusions: Orthotic therapy was temporally associated with marked improvement in subjective otologic/vestibular symptoms and directional kinematic changes. The uncontrolled design, categorical symptom outcomes, non-age-matched controls, and different T0/T1 recording conditions preclude causal claims.