Somatic Tinnitus and Treatment ⁠— New Evidence

Hi everyone,

I've just stumbled across this thread, but I'm not very well educated on all the different types of tinnitus.

I got tinnitus suddenly over 3 years ago after taking multiple punches by some thugs, one most notably that caught me in the ear/TMJ area that I believe did the damage. I supposedly have no hearing loss and apparent super hearing so my audiologist says, but I've had 24/7 tinnitus ever since.

I have around three different sounds, one sounding like morse code, and I can make my tinnitus louder by neck and especially jaw movements. It also seems to get worse when my jaw or neck is sore and I have a jelly bean sized lump in front of my ear/TMJ area, that feels like a ligament of some sort, which moves when I open and close my mouth.

Is this somatic tinnitus or some other type?

 

Treatment of Somatosensory Tinnitus:
A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program

Abstract
Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity. The purpose of this study was to evaluate the effect of orofacial treatment on tinnitus complaints in patients with TST.

Methods: Adult patients with TST were included, and all patients received information and advice about tinnitus and conservative orofacial treatment consisting of physical therapy, and, in case of grinding, occlusal splints were applied. Included patients were randomly assigned to an early start group and a delayed start group according to our delayed treatment design.

Results: In total, 40 patients were included in each group. The treatment effect on tinnitus severity was investigated using the tinnitus questionnaire (TQ) and Tinnitus Functional Index (TFI). Regarding the TQ score, no clinically relevant reductions were observed, and no significant differences in the decrease were observed between the early start group and delayed start group. Contrarily, a significantly higher percentage of patients showed a decrease in the TQ degree in the early start group compared to the delayed start group (30.0% versus 2.8%, p= 0.006). The TFI score did show a significantly greater and clinically relevant reduction in the early start group compared to the delayed start group (p = 0.042).

Conclusion: A multidisciplinary non-invasive orofacial treatment was able to reduce tinnitus severity in patients with temporomandibular related somatosensory tinnitus, compared to a single session of information and advice.

• moderate to severe chronic subjective tinnitus was defined as a TFI score between 25 - 90 that had been stable for at least three months; 25 seems quite low for moderate
• they don't mention for how long the patients had had tinnitus

 

A new paper from Sarah Michiels (I don't know if it can integrate the pool of articles for the next round vote, it is not a breaktrough new per se but rather a summary of what Sarah Michiels achieved so far).

Diagnosing and managing somatic tinnitus

 

A population-based case–control study of the association between cervical spondylosis and tinnitus

Abstract
Objective
This population-based study aimed to study the association between tinnitus and cervical spondylosis.

Design
A case–control study.

Study sample
We retrieved data from the Taiwan Longitudinal Health Insurance Database. We identified 2465 patients with tinnitus (cases) and 7395 comparison patients by propensity score matching. Multivariable logistic regressions were conducted to estimate the odds (OR) of a diagnosis of cervical spondylosis preceding the tinnitus diagnosis relative to controls.

Results
We found that 1596 (16.19%) of 9860 sample patients had received a diagnosis of cervical spondylosis before the index date, significantly different between the tinnitus group and control group (17.20% vs. 15.85%, p < 0.001). Logistic regression analysis showed an adjusted OR for prior cervical spondylosis of 1.235 for cases vs. controls (95% confidence interval [CI]: 1.088–1.402). Further, the adjusted ORs were 1.246 (95% CI: 1.041–1.491) and 1.356 (95% CI: 1.016–1.811), respectively, among patients aged 45 ∼ 64 and >64 groups. No difference in cervical spondylosis likelihood between cases and controls was found among patients aged 18 ∼ 44 groups.

Conclusions
In conclusion, the study shows a positive association between cervical spondylosis and tinnitus. The findings call for greater awareness among physicians about a possible somatosensory component of cervical spine function which may contribute to tinnitus.

Source: https://www.tandfonline.com/doi/abs/10.1080/14992027.2020.1817996

 

I am little bit surprised this link has not been shared yet since Tinnitus Hub/Tinnitus Talk had heavy involvement in this study.

Somatosensory Tinnitus Diagnosis - Diagnostic Value of Existing Criteria

 

@Frédéric, I agree with the conclusion, but there are some sub factors. I wrote many posts about this and one just recently. Forward head motion and neck muscle spasms.

 

Is forward head posture always curable or have the ability to get way better?

 

Forward head posture can be cured as long as it hasn't progressed to some kind of calcified/permanent kyphosis, but even then it can still be treated to some degree. Exercise, core training and physio/posture training can all help with posture.

 

What's the best exercise or stretch for forward posture? I currently do neck hangs and chin tucks, etc.

 

Back in 2020. you went to a TMJ specialist, and he slightly adjusted your splint to make it less tight by trimming it so the bottom front teeth weren't touching the splint. This lowered your tinnitus. A posture corrector also helped, but just initially.

More recently, you went to a chiropractor who did TMJ work, and you said he messed up your ear and it feels full. From this, you mentioned that your jaw pops a little...

Your audiogram before this showed minor hearing loss - somatosensory tinnitus.

Malocclusion (misalignment of the bite and jaw) may contribute to neck pain and place strain on the temporomandibular joints and muscles that control the jaw.

Did you ever get a neck X-ray that I recommended? I do remember you asking me how to place a curve back into your C spine.

If your neck has straightened, then this may be cause of misalignment of bite. Do you breathe thru mouth? Ready need to know if your neck has straightened. Is it correct to say your tinnitus fluctuates, but isn't somatic as with either or both jaw/neck movement?

For you, not sure if TMJ joints, not jaw muscles directly or neck anatomy (unless neck injury beyond C spine straightening) is tinnitus cause.

It may be that your C spine has straighten a bit from muscle spasms (head lifting posture) causing bite misalignment without other noted neck trauma. If so, then bite misalignment may be cause of tinnitus.

With all this, not sure if neck stretch exercise is in your best interest.

 

@Greg Sacramento, I will be getting a new TMJ splint soon.

Hopefully my neck and jaw moved out of position or back in the right position from doing physical therapy, etc...

I'm getting a new 360 X-ray thing to tell what's wrong and so they can make the splint.

My previous TMJ splint was just an upper teeth hard splint. Would an upper and lower teeth splint help with alignment better?

 

Greg, based on your post earlier about people having tinnitus from noise trauma developing somatosensory tinnitus later, do you think it’s possible for this somatosensory tinnitus to be treated or reduced via TMJ/cervical treatment?

I have to continue to strengthen my neck or it gets really weak and feels worse pain wise, per your last sentence.

 

@OptimusPrimed, your postings show solid knowledge with much to do with tinnitus. I'm aware of your history.

You recently mentioned, "I can stop the hissing by protruding my mandible or flexing my SCM muscles. I can also make my right ear make a "chirp" sound if I flex my right masseter muscle."

I think we would have agreement with tight muscles often being involved with physical aspects of tinnitus - neck, jaw and facial.

You know about the following, but some others may not:

During mastication on one side, the activity of the SCM is synchronous with the masseter muscle, while with bilateral chewing the SCM anticipates the intervention of the masseter, probably to stabilize the neck.

Activity of the SCM during neck and mandibular movements as well as during head tilting are influenced by TMD.

Consider soft foods as an experiment.

Use good posture stuff with titling of head.

One thing that can make the SCM sore as well as masseter and other muscles is twisting jaw/mouth.

Other treatment is relaxing upper neck cranial nerves. First just try a warm moist washcloth.

Warm moist compresses may help with any muscle tightness.

It's not easy to protect against wrong muscle movements of jaw, facial and neck. Magnesium Glycinate may help to relax these muscles. One whole tablet won't ready help. A tablet broken into pieces taken 3-6 times a day or liquid form taken in sips 3-6 times a day with 400 mg total within 24 hours should help.

Other neck and jaw therapies may help certain individuals.

A TMJ splint should be replaced if there's stress wear or particle build-up that can't be removed - gums may recede due to bacteria within splint.

Functional relationships between the masseter and sternocleidomastoid muscle activities during gum chewing

 

With regards to the chirp with masseter flexing... a high pitched "chirp" not far off from the hissing. Interestingly, when wearing my bite plate, my left masseter when flexed will also evoke an extremely similar "chirp". When I remove the bite plate the left masseter will not chirp upon flexion but the right continues to do so. This has me wondering if the jaw problems or bite plate is partially responsible for the chronic nature of the tinnitus.

I have had a bite plate for Bruxism since 2016 but I was not religious in wearing it and to be honest always felt like it kept my mouth open a bit too much. My teeth are worn down heavily on the right side, my right molars are nearly flat with large pits (I am in my mid thirties) and there are some issues with swelling around the right TMD joint. My mandible is "uneven, non-level" while my neck/head is straight now. I am scheduled to see a dentist this week about it. I suspect TMJ. I have also had some transient issues with tight muscles near the base of the occipitus and somewhere between C2-C4. When I twist my head I have crepitus in my neck/base of the skull. I am a physically healthy individual with a good diet and not obese. I have no physical adaptations.

Your post earlier about how If you have hearing loss tinnitus and gain somatic tinnitus, 95% of the time it's the neck and then often the jaw...This is in line with the research that Dr. Shore et al have conducted and I think many of our subjective experiences validate this. It makes me hopeful that relief might be attainable for a number of people the more we learn about the cranial nerves and their role in producing chronic tinnitus.