My Road to Understanding My (Probably) Somatic Tinnitus

Dear Tinnitus Talk members,

I hope you are all doing great.

My name is "Orba", 33 years old.

I've developed tinnitus in 2021, at least that was the moment I really got aware of it.

I've set myself the goal to al least understand my tinnitus no later than 2022. Let's say I am still learning and it isn't easy to figure it out. I came to the point that there are no professionals around who can help or coach me further with this. That's why I would like to research more on the subject with the use of the forum. Below is my story, combined with hopefully some insights that might beneficial to some of you. It is quite a long story (and there is no short TL;DR version). I'm sorry for that, but it also helps me summarize everything and write down the questions that I'm still trying to figure out with the help of the forum.

My introduction might already give away that I am quite a control freak and furthermore that I can get quite obsessed with understanding something like i.e. tinnitus. I am still really thinking about how I should contribute to the forum. My first suggestion would be that one really should avoid getting obsessed with tinnitus. In the end a big part of your solution could be to sometimes let it just rest (at least from time to time) and stop researching the subject and try to just life the good things in life. Of course you would get better, but you have to find a balance in this.

The balance for me is that from time to time I try to work on solving the puzzle and at least understand more about how it all works. But man, there is a lot of information available and the possible causes and solutions are really endless.

Another thing that I've realized is that - at least in the Netherlands - there is not a professional who can really coach you in the journey. Of course there are professionals like ENTs, physicians, chiropractors etc. etc. Most of the time they have not enough knowledge about the subject and they just look at it from one perspective. And there is no incentive for professionals to invest more time in these personal cases to really figure out what is going on.

The people who also coach you and give you inspiration about how to solve the puzzle and what you could MORE think of, are very very hard to find. So you probably should be your own coach, together with the great contributors of this forum.

Anyway: Very slowly I got aware of my tinnitus. These was no specific situation like an accident. I didn't have any stress. People would consider be as a very down-to-earth person who is emotionally very stable.

However I've realized I actually was (really) prone to stress. I've learned there is something like I call "short-term" stress. Deadlines for work, little problems in the household, traffic jam, cold shower, a verbal fight etc. This "short-term" stress really affects (the muscles in) my body. Around the age of 18 I've developed chronic back pain in the mid and high back which, I now know, is fundamentally caused by "stress" in my muscles. It looks like physicians didn't really understand this or there was no time to really diagnose it well. On and off i was also busy trying this puzzle. 2 years of exercises really worked counter productive and made it worse in short term and reduced maybe 10% after 2 years. Last year I've discover "Body Stress Release", a therapy with subtle touching of the muscles. 7 sessions of "Body Stress Release" managed to take away more than 70% of the pain (after 15 years! and in combination with NO exercises, just more relaxing). It was just a matter of muscles who were to stressed, so the body didn't know how to relax the muscles. Wish I was earlier aware of that...

Question to figure out: Could the back pain have something to do with the tinnitus? Some professionals told me it is too "low" in the body for there to be a connection.

So, as said, I've developed tinnitus in 2021.

High pitch sounds, mostly, but on the left ear side. Around 8000 hertz. This left ear oriented sound is predominant. Sometimes this sound is (almost) gone and I hear also a much lower and less loud sound on the right ear side. In the beginning I also had a 3th form of a sound. This sound was only there when I had very bad posture in my chair. When I corrected this (straighten my back) it was GONE. Nowadays this 3th sound is gone completely.

Question to figure out: What was this 3th sound about and is there a connection with the other 2?

Well, I went to an ENT and was told there was little to very little hearing loss in the 4-8 kHz range and this was the cause of my tinnitus. There was nothing to do about it and I should just life with it. He didn't speak a single word about somatic tinnitus - as I know now, because he wasn't familiar with that (he could have given me a great referral there). I've later told him about somatic tinnitus and send him a YouTube video with 10 most common causes of somatic tinnitus.

Question to figure out: Later I've learned tinnitus is quite a lot of time multifactorial. So maybe an onset from (slight) hearing loss in combination with tense neck/jaw muscles. I'm curious what the ratio is in my case. My hearing loss is around 8000 Hz, and my tinnitus in the left ear is high pitched around 8000 Hz. I was told that this makes sense, since the brain compensates for the loss. But does this really make sense in my case and can you state as a rule of thumb that the Hz level of the tinnitus is around the same as the hearing loss?

I also found out I have a very small allergy for dust mites (0.7 KU/l, which is a low number, but considered as allergy). I've taken an anti-histamine for 9 months now and also use a nasal spray. Now my airways are free, and I think my Eustachian tubes are OK now. No changes in tinnitus. So I personally do rule out tinnitus due to Eustachian tube issues.

Question to figure out: Is 9 months OK to draw this conclusion?

I have had 2 two root canal treatments. There was not more than 6 months between the last root canal treatment and the tinnitus. The teeth now both have crowns. The gnatholog told me he saw I had "(too) well developed" jaws and he thinks the tinnitus is causes by an overload of "the system". But since I didn't have pain in the jaws he didn't want to do anything "big" about it (like investigate more for TMJ). I also grinded my teeth and I got 2 and 3 mm splints. I used it for a week (or maybe two) and noticed the grinding stopped. Now I think I don't grind my teeth anymore. However, I didn't notice changes in my tinnitus. Since yesterday I'm considering to use it again, because I've read some threads where @Greg Sacramento recommended the use of (flexible) splints.

Questions to figure out: Is there still any benefit in using the splint and when should I use it (day/night) and for how long? Any more dental issues that might be relevant? Root canal treatments were done ok, around the crown there seems to be persistent gum inflammation, which I'm now trying to get rid of with cleaning etc.

When I open my mouth wide, I hear another sound of tinnitus (4th sound...) which is different and not related to the other (regular) sounds I've described.

Questions to figure out: My ENT told me this is normal and everybody has this. He told me in that way I put stress on my hearing nerves, which causes the sound. However, my girlfriend doesn't report this. Is the 4th sound of any relevance or is the ENT right here?

The gnatholog also referred me to a physiologist who did a promotion traject on somatic tinnitus. I was grateful for this, since she really knows a lot about the subject. The noticed very tense muscles in the jaw, neck and shoulders. I've been there 7 times now and almost all times she focused on the neck. I think in the beginning there was some effect and also in the morning (only then) I see an effect when I massage the high part of my neck, under the skull and close to the ears. However, I notice that it does not seem to be a long term effect and in the end the tinnitus will get back to "baseline".

However, I think what is very interesting is the following. After sleeping, in the morning, the tinnitus is the best. Then there is a little bit of sound and sometimes when i massage my neck muscles the left ear sound completely disappears. The sound in the right ear is still there. There can be some relief in the morning when I massage it myself and I can really reduce it to a 2 or maybe even a 1 (on a 10 point scale). But it will get back very soon to baseline. Later in the day I don't have the power anymore to slow it down with massaging the neck. After I get up, shower, work etc. the tinnitus slightly progresses throughout the day to around 4 or 5/10.

There is also a very clear relationship with "activity". After a walk the tinnitus gets louder, maybe to 5/10. When I run/jog, it goes up to 6/10 and when I ride my mountain bike it can get up as high to 7/10 (I've noticed the head/neck is a very forward-position with mountain biking). These spikes last until the next morning, because in the night it will go down again. So these spikes don't disappear immediately after the exercising.

Sometimes I do breathing exercises which are very heavy and consist of fast-paced and deep inhales (Wim Hof method breathing). The tinnitus really ramps up here right away. A professional told me to stop with Wim Hof method breathing, since also cases of onset of tinnitus were reported. He thought it was a too aggressive form of breathing.

When I use a heat compress, it looks like tinnitus goes down. Also this is not a long lasting effect and hard to obtain after a full day.

This all does lead me to believe there might be a connection with breathing/blood pressure or some nerves getting tense when breathing.

Questions to figure out: Why does the volume go down after a night of sleep (quality doesn't really matter) and what is my tinnitus now exactly all about? What is the real trigger, so I at least can grasp the issue better. Any changes that it will go completely away? What would be me next step? Should I do neck/jaw exercises on daily bases for a longer period (i.e. the exercises of Liebscher-Bracht on YouTube)?

Just some other information which I could think of that might be relevant:

- As a kid I got tubes in my ear

- I have flat feet and as a kid I always had inlays. I stopped using these when I was around 16. I started using inlays again 2 years ago. I do have a leg length difference (which I was always told). However, I don't notice a difference in shoulder height/position when I look in the mirror (just based on looking, no measuring device was used). This, difference in shoulder height/position, is also something that @Greg Sacramento mentions in several posts.

- I have an orthopantomogram, but no X-rays of i.e. neck (and don't know where to get them and what to ask for).

I hope to speak with you all soon. In case you have any suggestions, that would be great.

 

There is a lot there.

On the teeth grinding - a dental technician friend told me one night of grinding can be up to 10 years of wear and tear on the teeth. So think about that.

Maybe your tinnitus is low in the morning because the bed is taking the weight of your body and your neck and back muscles are relaxed. You may have some spinal issues related to your tinnitus. Go to your doctor and ask for an X-ray - it should not be a big deal as it is not an expensive MRI. Say you have bad back and neck pain and just want to be sure your spine etc is a good shape. There are people who claim a misaligned vertebrae can press on a never and cause tinnitus. This is purely anecdotal - not confirmed. This person went to a chiropractor - something I would not do unless really desperate.

 

@Orba, I'll discuss some possible underlying issues that may be causing your somatic tinnitus.

The levator scapulae muscle (side and back of neck) can get strained doing regular daily activities. This muscle connects the cervical spine to the shoulders. The third and fourth cervical nerves control this muscle (C3 and C4). These particular cervical nerves can be pressured against C3 and C4. Try using your thumb and index finger on sides and back of neck to gently bring skin outwards (not much) away from your neck.

C1 vertebra or Atlas. This bone is between the jaw joints and ears - and everything in this location of your body can be affected by a slight misalignment. With this, ear and jaw issues happen together. A misaligned Atlas can impact your ear structures and the Eustachian tubes. Neck X-rays would help to determine this and if there's been some straightening to C-spine. This may not be your problem, but if an atlas misalignment is found, then it could be the major underlying cause of somatic tinnitus.

Massage your mastoid - which connects to many of the muscles surrounding the ear and neck. A gentle Swedish massage on the mastoid process helps relieve neck and ear muscle tension and permits the neck to shift back into its right alignment. The masseter muscle that connects the jaw to the skull and is located at the jawbone nearest to your earlobe. If this muscle is overly tensed, it will lead to misalignment and ringing.

Carefully, try holding the bottom of your earlobe and softly bring it upwards - not by much.

We can talk more.

 

Dear @Stuart-T and @Greg Sacramento.

Thank you for reading my long post.

I have taken the time to do some more research.

I have spoken to my physiologist about an X-ray. She is an expert in tinnitus related to jaw and neck. She told me she would not advise me to do X-rays, since her treatment would not change. She also said that IF something was found, it wouldn't be treated since it would be way too complicated or dangerous (i.e. atlas correction).

I have also spoken to my family doctor. We have decided to do a 24-hour blood pressure test. The results were OK (blood pressure within acceptable boundaries). However, I figured there was at least a correlation with blood pressure and tinnitus. When the blood pressure was high, the tinnitus was louder and it modulated easier with neck movements. As said earlier, the tinnitus is best in the morning and aggravates throughout the day. It is at its worst after sports.

In general I'll try to focus more on to get control on my autonomic nervous systems.

I did some breathing exercises, also some heavy ones. I've noticed the tinnitus got much much louder when I did the breathing through the nose (I think this contracts way more the neck muscles, like the sternocleidomastoid muscle). When I did the (heavy) breathing through the mouth, there was not much, if any, aggravation of the tinnitus. It maybe even got a bit better. This difference is very interesting.

@Greg Sacramento, I've done your exercises, but only 2 times and on an ad-hoc basis. After reading this post, is this still what you would recommend me to do? And how often? Anything I should look further into?

 

@Greg Sacramento, I came across this thread with your post.

Trying to Understand If My Tinnitus Is Caused by Blood Pressure Meds / Dental Issues / Anxiety?

Do you think this might be something that could work for me?

 

You have raised some excellent questions, many of which are sure to be relevant to the majority of readers on this board.

I don't have any answers for you, being fairly new to tinnitus and hyperacusis myself, but I will say that I also have tinnitus that is usually softer in the morning and louder toward the end of the day. And I believe, from spending many hours reading this board that many other people have reported the same phenomenon. Some people theorize that this could be the result of "listening fatigue," i.e., your ears losing some resilience to sound as the day progresses. Then when you get a good night's sleep or just enjoy a few hours of silence to make up for the noise exposure, your ears will regain their resilience and you will be restored to your baseline level of tinnitus.

Have you tried acupuncture or acupressure? I find it to be temporarily helpful for stress and pain, even if it doesn't seem to affect the tinnitus or hyperacusis directly. There are many acupressure / acupuncture points on the earlobe and on the mastoid and various other parts of the head and neck that can relieve pain. There are even points located far from the head and neck that can bring temporary relief.

 

Hello ECP,

Thank you very much for your post. Listening fatigue is a new concept for me. It was a little hard to understand at first but I will do more research on this.

I spoke to a very good ENT with decades of experience with tinnitus, and he told me it was quite odd that the tinnitus was much softer in the morning. Most of the times it, apparently, was the other way around.

I hope you can cope well with your tinnitus. Are there any specific threads that have helped you in particular?

All the best.

 

The concept of listening fatigue is something I learned about here, but if I remember correctly, it was just an anecdotal phenomenon reported by a lot of people on the board. It may not be something you can verify by researching the Internet for scientific studies, but I could be wrong.

The best thing you can do is see if listening fatigue applies to you, and then use your own judgement to determine when to use ear protection and when not to. Because tinnitus and hyperacusis are extraordinarily labile in the first few months, it's hard for people to figure out what constitutes a typical daily baseline level of noise and pain, and whether more (or less) ear protection is needed in order to make it through the day without a worsening of symptoms. It's interesting that you ENT says that most people find it to be worse in the morning. I have no explanation for that.

I've spent hundreds of hours on this board, trying to learn as much as possible from other people's journeys into the healthcare system. No particular thread(s) stand out in my mind as being particularly helpful--it was just the sum total of personal experiences relayed by all the people on the board.

I've always had a lot of neck and shoulder stiffness, as well as some bruxism (teeth grinding), so I do believe there is a correlative relationship to my ear issues. Like you, I can't figure out the exact relationship, but I'm very curious.

The acupunturist I saw yesterday spent a lot of time working on the C1 area, and it really helped. I walked out of there feeling like my skull was weightless, and when I woke up today, the tinnitus was a lot quieter than it was yesterday.

Please keep us posted on your findings. I hope you get some helpful answers and treatments from the doctors who are treating you.

 

@ECP, I've decided to give supplements a try.

I've bought GABA based on the advice as can be found in:

1 NUTRIENT THAT CAN FIX TINNITUS - Dr Alan...

I've bought Magnesium and Hawthorn berry capsules based on @Greg Sacramento's advice in:

Trying to Understand If My Tinnitus Is Caused by Blood Pressure Meds / Dental Issues / Anxiety?

First I will try GABA for 1 month and then I will try Magnesium and Hawthorn berry capsules. I will keep you posted.

 

I started taking Magnesium because of Greg's advice to me. He recommended the Pure Encapsulations brand of Magnesium Glycinate. I like it a lot. It helps with insomnia when taken before bed. I have yet to try Hawthorn or GABA.

I hope you find some relief soon.

 

Thank you.

For you and for all. In this thread a caution is given about taking supplements and the question is posited whether or not you can benefit from it in the long term. A thing to consider when one tried these kinds of supplements.

Tinnitus without Clear Cause — Related to Stress or Depression?

 

I have also wondered how long supplements can be taken before their effects wear off or before they cause unpleasant side effects. However, I am only taking these supplements in the short term, and there are none that I take daily for now, as I don't want to become dependent on them. I actually stopped taking the magnesium a little over a week ago, just to see how I would do. I still sleep well.

 

I'm more than a month in and so far I don't think GABA has had any positive nor negative effect on my tinnitus.

I will take it for some more weeks, but today I also started with Apple Cider Vinegar, based on this thread:

Apple Cider Vinegar Works

Will post updates later.

 

Yesterday I had my last appointment with the physiotherapist who is specialized in somatic tinnitus (jaw/neck). I think the relation is not strong enough. I have some small relief after neck and jaw massages, but it's very temporary and I think it is not the root cause.

Although the path of somatic tinnitus seems to end here, I booked some progression on the path of acceptance. I probably have to accept the root cause is one I can hardly have control over (i.e. hearing loss).

I will post an update after several weeks/maybe months.

 

I am starting to cope better with tinnitus and it bothers me less. Time apparently helped with acceptance.

Biggest insight last half year: STOP FIGHTING. It doesn't mean you can't have hope. I have hope that one day it will disappear. It doesn't mean you can do (some) research every now and then. Don't give up, but stop fighting...