New Theory: TMD the Cause of Tinnitus

Discussion in 'Support' started by donotringatme, Oct 17, 2020.

    1. donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      Since the neck has been thoroughly examined and treated, to no avail, there is no implication. Plus, one eventually discovers that the jaw not only is responsible for neck discomfort but also is responsible for pretty much everything else. Here are some random text from articles to begin with, before sharing my story:

      Condyle presses against nerve endings and strains aligaments by the ear, and this causes the tinnitus.

      MR-Neurography imaging noted that there was facial nerve irritation as it exits the stylomastoid formen and passes inferior to the external auditory canal which would be consistent with a focal entrapment or irritative syndrome.

      Treatment commonly employs painless procedures which help stimulate muscles and joints to function normally, decrease spasm, remove toxic waste products, and increase blood flow and nutrition to the affected areas.

      Therapies such as low current electrical stimulation to reduce muscle spasm and stimulate healing, ultrasound for deep tissue heating, hydrocollator for moist heat, and cryotherapy (cold therapy) are used with a variety of removable orthopedic appliances aimed to correct the position of the condyle, or “ball”, of the lower jaw within its socket. In addition, joint mobilization procedures, physical manipulation, and other procedures might be employed.

      The TMJ and muscles are innervated by the same nerves that innervate the ear.

      The closeness of the ear to the temporomandibular joint makes the overlap of symptoms natural. In fact, the temporal bone, part of the joint, actually houses the delicate structures of the inner ear. When the joint experiences pressure, that pressure could manifest in ear symptoms. Jaw clenching and ear fullness seem a natural combination. The clenched jaw puts pressure on the ear, creating a sensation of fullness. And the jaw and ear are connected by tiny ligaments. Plus, nerves running from the ear have to go past the joint and interweave with jaw muscles. This means that any type of jaw disorder or displacement could pressure those nerves, leading to long-term or transient symptoms.
       
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    2. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      So the story goes, I was a mouth breather. That can be detrimental to one’s face. I already had nail biting and clenching to my arsenal of bad deeds but frankly I was cleared by all doctors and was told my bite and teeth are fine. It’s true they are, but I wanted to somehow improve my facial structure. Low and behold, came across mewing. And something tells me... a lot more people in this board did.

      Mewing is resting your tongue up to the roof of the mouth all the way to the soft palate which of course is impossible at first, especially for a mouth breather. Since you can’t do it, you have to push to make room for the tongue, as instructed by the author. And here I think lies the problem.

      Long story short, mewing provides you with bone remodeling in favorable manner, as my deep cheek lines were gone, my cheekbone became prominent, my lower jaw also did, becoming more square too, in other words it did come out of my turkey neck. So far so good.

      The problem started when I noticed my temporalis and masseter muscles were sort of way too strong. Then, my temporalis started bulging, this happened months ago. Now I learn this is because of a bad bite.

      There are two big masticatory muscles that are attached to the mandible: the temporalii and the masseters. The first one brings the jaw up and back, the second one up and forward:

      2489-temporalmasseterpattern.png

      When you are using the temporalis too much, you may end up dragging the teeth and the palate towards your temples, which would make the bite feel tense. Then, as the mandibular joint pushes against the ears, this could very well cause tinnitus.

      Apparently TMD does not just cause tinnitus. It causes a variety of tinnitus, pain, ear ache, ear fullness, ETD and it is a bit more complicated than a splint it seems. Any bite irregularities or anatomical ones lead to tinnitus, a tinnitus that may become worse or kickstart hyperacusis and of course completely mess up the neck.

      Anyone with “somatic” tinnitus should definitely have a CBCT and MRI on their jaw. I just tried one-two things on my jaw and got a lovely new tone for ten seconds after discomfort and fullness right at the joint area. This area is affected when doing strenuous activity, lying down, eating, chewing, yawning and of course... talking.

      I always had a feeling the back of my head was being sort of dragged down to my neck. I suppose tongue posture led to the maxilla going up by millimeters, the upper palate expanding by millimeters and the lower jaw not actually following as it should have, or following and dragging the back of my skull twisting it by a few degrees (?) leading to neck stiffness. I don’t believe I can actually “push” the entire joint to the ear canal, that’s just not possible. I do believe it’s a muscle issue. I think one can understand if it’s getting better or worse by ear itchiness to be honest as mine completely went away as soon as I stopped doing it. Tinnitus remains but has a 25% actual reduction since day 1 (no habituation BS) and ETD is also slightly better. The aural fullness never felt normal anyway, it’s as if something is pressing on the bone that hosts the middle ear. Back when I was doing the tongue thing, I could tell I started bulging a bit under my zygomatic arch, there was tension. That’s where the joint was.

      I have no idea how a splint can correct this other than basically relaxing the muscles but I don’t know how you can reprogram a “correct” bite when this whole thing is out of place.

      @Greg Sacramento @oceanofsound26 @just1morething

      Boys, we’re going in.
       
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    3. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      Alright, here are images of 2017 and 2020 x-rays. 2017 is long before I started mewing or clenching hard, 2020 one I took after tinnitus onset so it’s fresh. Also took a cephalometric one that same day. Both X-rays same facility, machine, posture and bite to the machine to take the X-ray.

      45935F60-4461-432E-B127-EB3856770419.jpeg
      09D5E377-AF8A-48C3-B602-60B4CD817356.jpeg
      8C228CF5-C000-4E91-B775-28B15D5CD3CD.jpeg

      2017 one, condyles look good and in position. 2020 one, condyles look changed. Right one out of place, left one also off compared to 2017. Also, in my cephalometric, am I blind or do I see an elongated styloid process? I remember @Greg Sacramento mentioning this and a relevant thread here somewhere. I googled Eagles syndrome to view such images and some of them have the same styloid process length as mine. Is this maybe why 2 days prior to tinnitus I had this weird deep sensation in my SCM, feeling was deeper than muscle.

      I think this is it really. Either it’s just TMD creating aural fullness and tinnitus. Or both. I don’t think an elongated styloid process causes aural fullness, does it? Is this why I lie down in the pillow I have tinnitus change? And lying on the side gives me temporarily a pulsatile feeling in the ear but it goes away tbh.

      How do I fix this mess lol.
       
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    4. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      Okay. It comes down to one thing. TMD.

      X-rays don’t lie. Tongue posture probably worked as an appliance and messed my upper palate up, creating an improper bite, forces created cranial misalignments, accompanied by muscle tension, tension to the ligaments too and tinnitus eventually snapped. I assume many more suffer from this without doing the stupid tongue posture or applying forces. I caused this. Others had no choice to it. But the treatment choice is pretty much laid out. Guard, splint, muscle manual therapy, X-rays and CBCT falling under the category of diagnosis and monitoring, cranial manipulation and of course patience.

      Reversing mewing is the only option to silence. I keep my tongue rested down as it always was before. Muscle tension, bulging temples and forehead, everything seems to be slowly coming down. The joint area is still under pressure. The ears are still under pressure. The mild static tinnitus is always present. The high pitch mild tinnitus appears itself during sleep sometimes or under strenuous activity during which tension is created to the sternocleidomastoid, masseters, temporalis and occipital from habit, therefore leading to more pressure which results to more tinnitus.

      I sincerely wish everyone a speedy recovery or habituation regardless of the cause. This forum helped me identify the problem and rule out other problems. I learned a lot. My most dearest thanks to @Greg Sacramento who has been a catalyst.

      I found many links about TMD affecting the tympani too, causing hyperacusis and a variety of tunes, I mention it for user @weab00 who I think also caused his tinnitus from mewing and not trauma.

      I hope one day I will come back to post in success stories. Take care.
       
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    5. kamil1364

      kamil1364 Member

      Tinnitus Since:
      08/2020
      Cause of Tinnitus:
      Possibly noise-induced
      I suffer from mild static tinnitus and dysacusis/reactive tinnitus.

      I am worried it was brought by too loud headphone use and lawnmowing without proper ear protection.
      But I always had problems with bite - it's bilateral. Always heard and felt that popping noise when chewing, lately it got so much worse.

      I already visited TMJD specialist, and so far he has made molding of my teeth, I'll keep you up to date guys.

      My hearing turned out to be normal in standard audiogram, on the upper frequencies I have slightly better hearing than most of my friends who played in bands with me, so I hope it might all get resolved with proper dental treatment, although I am going to stay away from headphones/loud noise for a while for sure.
       
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    6. Aaron91
      Nerdy

      Aaron91 Member

      Tinnitus Since:
      2007
      Cause of Tinnitus:
      Loud music/headphones/concerts
      I've been doing a lot of reading the last few days about the neck and TMJ disorder. It's interesting to me that although I got my H during lockdown following a loud motorbike passing by me on the road, it was also during lockdown that I started to notice noticeable pain and discomfort in my neck, jaw and shoulders from looking down at my phone/laptop all day long as I had nothing else better to do. I was also under immense stress from losing my Dad around that time and I know I grind my teeth at night.

      A few weeks after I developed H, I had an X-ray to check for any teeth issues. My doctor didn't make any comment on the state of my jaw, even though I know I've had issues with it for years (clicks, pops, inflammation etc.), but I'd be interested if anyone can make any sense of my scan. My hyperacusis has improved considerably in my left ear but it's still quite bad in my right ear.

      PHOTO-2020-06-05-13-17-43.jpg
       
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    7. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      Your X-ray looks fine to me as far as the TMJ is concerned. Go here and check last posts: https://www.tinnitustalk.com/threads/theory-etd-the-root-cause-of-somatic-tinnitus.42770/

      I believe that masticatory muscles can change the mandible and therefore the bite, which creates anatomical changes that can affect the ear directly, muscle hyperactivity and tension that can affect the CNS. Check last 2 posts there.

      I’m still trying to figure out some things because the guy who treats me now is an annoying poser who doesn’t like explaining much but next week I will force him. He is manipulating my temporal area, c1 and c2 and they can see if something is sort of “out of place” or has become “dysmorphic”. It is stated that hyperactivity in the temporal area, bulging and some other nearby clues that I miss, are the preliminary factors for depression.

      Like I said, dude is not being entirely transparent and he’s pissing me off but next week I’ll update with hopefully something of value.

      Long story short, your X-ray looks fine, always check for infection / dental work, check posts from @Greg Sacramento and @oceanofsound26 and the thread I linked, as it’s like both ETD and TMD related now. The one thing I can say is that the way those X-rays are taken, usually force our head and bite in a weird position which can actually not be very indicative of TMD. A CBCT scan would be better.
       
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    8. linearb
      Psychedelic

      linearb Member Benefactor Hall of Fame

      Location:
      destroy all creatures. they cannot be regenerated.
      Tinnitus Since:
      1999
      Cause of Tinnitus:
      karma
      In my experience it's often a significant contributing factor but rarely a cause -- that is, there seem to be a LOT of people who (like me) feel that treating their TMD symptoms makes their tinnitus less bad, but doesn't make it go away. In 20 years of reading tinnitus anecdotes online I have read maybe 3-4 where people claimed complete resolution from TMJD treatment, compared to hundreds of anecdotes reporting either partial relief or no change.

      If we consider the current theory on the neurogenesis of tinnitus then this makes a great deal of sense: tinnitus arises from a miswiring at the DCN level which causes touch-sensing neuronal data to be heard as "sound".

      So, in this model, it makes a lot of sense that TMJD causing inflammation, irritation and compression of the structures around the TMJ would make tinnitus worse, and if you treat the TMJD you will improve the tinnitus. However, you won't fix the fundamental problem (which is some amount of hearing loss combined with a DCN miswiring) just through TMJD manipulations.
       
      • Agree Agree x 2
    9. Greg Sacramento

      Greg Sacramento Member Benefactor Hall of Fame

      Tinnitus Since:
      April 2011
      Cause of Tinnitus:
      syringing and now somatic T dental work
      Most that have posted panoramic film in the last two months, have either the left or right ramus shorter than the other side. Also the left or right condyle was bent forward (morphologic) bending of the condyle. One cause - forward head strain.

      Even when the condyle has come forward that I have seen here in film, the anterior disc needs to be overcome by correct jaw and neck posture. A splint is also needed.

      Degenerating joints from a source of trauma that include whiplash or forward head posture, clenching or having mouth open open too wide without a rest period during dental can cause periodontitis, cortical thickening of the condyle superior surface, hyperostosis - molar region and narrowing of gonial angles is problematic. This will increase an interior bite and cause tooth contact to occur between molar teeth.

      Teeth then must be brushed softly - soft brush and twisting of jaw must be controlled. Otherwise teeth will move and infection and arthritis can set in later. This will increase an interior bite, cause tooth contact to occur between molar teeth.

      In all film that I have seen, the condyles have normal size and shape, but with some, either the right or left condyle is anterior to the center of the fossa. The right or left has been in all scans nearly centered within the fossa, but the resultant posterior joint space is wide to either the right or left TMJ. This is caused from the hinge of neck being displaced. 18 of the 36 associations that cause somatic neck and jaw tinnitus relates to the hinge (hard bone) of jaw, neck and head. This is what causes ear pain, sometimes mild hyperacusis, cheekbone pain, headaches, and teeth movement - more so with infection - fluid movement. A spilt 2mm is needed for this.

      In all scans, the palatal vault is relatively deep and narrow -(transverse dimension). Hyperostosis is often noted extending from the lingual side of the alveolar ridge in the molar region. The mandibular plane is often steep and the gonial angles are obtuse. This is caused from clenching or jaw pressure.

      THIS IS TMJ - THESE ARE THE PROBLEMS.
       
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    10. FGG
      No Mood

      FGG Member Podcast Patron Benefactor Hall of Fame Advocate

      Tinnitus Since:
      01/2019
      Cause of Tinnitus:
      Multi-factorial
      This doesn't apply to everyone, but I think people will dismiss TMJD as being a contributing factor to the severity of their tinnitus because they know their T started with noise and, therefore, the cause and only significant contributor to tinnitus in their eyes must be the noise.

      TMJ is seen in greater numbers of people with severe tinnitus.

      "The prevalence of TMJ complaints was greater in tinnitus subjects with severe tinnitus (36%) when compared to those with any tinnitus (19%), strongly indicating the contribution of TMJ problems to the severity of tinnitus."

      Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress
       
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    11. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      Mouth + tongue + teeth = masticatory muscle imbalance / hyperactivity => cranial bones shift + mandible shift = ear structures affected (incl. ETD) => tinnitus

      That’s my theory so far. I think to treat it you must go backwards. Assess ears, cranial fascial therapy, mandible returns to normal, muscles follow and revert to normal, tension/spasm/hyper reverts, nerve irritation / CNS irritation reverts, mouth+tongue correct movement / forces return, bite theoretically returns. Practically I think the teeth may not be able to return as they are shifted / damaged which is why 24-hour splints and dental work may be necessary. In theory this should correct ETD too.

      If that doesn’t fix tinnitus... I don’t know.
       
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    12. Greg Sacramento

      Greg Sacramento Member Benefactor Hall of Fame

      Tinnitus Since:
      April 2011
      Cause of Tinnitus:
      syringing and now somatic T dental work
      @donotringatme Above, I wrote about - cause - any you wrote about - effect.

      Like a house with a weak wall structure - problematic - and if a wind storm happens - the house becomes more stressed. The ears is an attached garage to the house. So the question is - before the storm - did the garage also have weak wall structure - or did the house lean on the garage where those walls were weakened.
       
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    13. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
      I agree @Greg Sacramento.

      However if I had to try and rationalize tinnitus, it would have to be this:

      tinnitus <= ear structural changes <= x,y,z modulating factors

      My concern is:

      - Tinnitus = Mild? Intense? Can it worsen?
      - Ear structural changes = Permanent? Temporary / Self-resolve? Reversible?
      - X, Y, Z modulating factors = Which is the silver bullet? Is there even one?

      I think the number one confusion is when you exit the ENT’s office and you are told “your ears are fine”. Obviously they are not fine, since I have tinnitus.

      I can attest to the fact that the nervous system is the biggest modulator of tinnitus because the moment I slept (I have been sleeping fine for the past 5 days), the tinnitus disappeared from my radar even though it is still there the same it was before. I could write a success story right now and it would not be a lie.

      However, I do want to find what’s wrong. Partially because this thing may one day worsen.

      My thought process is that one first must focus on one thing: “have my ears changed?”

      The answer is an obvious “yes”. So then we must ask: “what has caused this change and what has changed?”

      I think by logic, we need to separate the parts that attach to the ear structures as the cause, while categorizing all the other parts and conditions as modulators.

      Cause: ligament that connects the middle ear to the mandible, Eustachian tubes connecting the “face” to the middle ear (sort of).

      Modulators: literally everything around the ears plus the nervous system. Then you discover that we all have imbalances and imperfections everywhere, then we blame cortisol and low testosterone and stress and then we lose the ball. I don’t argue anything Greg said, I just think it all boils down to one or two things. It has to, or we will all go nuts chasing ghosts.

      Therefore, one may have an imperfect TMJ and have no tinnitus but someone else can have it due to the structural change issued by x, y, z to the ligament attached to the ear tools responsible for sound. The same way one may have Eustachian tube dysfunction without fluid or nasal inflammation, but caused by x, y, z thus a structural issue, which coincidentally leads to a direct change to the ear tools responsible for sound (eardrum, ossicles).

      Now, all the rambling may be seen as useless because we don’t discuss a direct, simple “cure”. Well.

      I think one must trial and error and attempt to correct body parts not with the intention of correcting THEM, but with the intention of change radiating to the parts directly responsible for ear changes / tinnitus. What do I mean is, I did extensive neck treatment once tinnitus started. It provided objective improvement on my neck and relief but zero improvement on tinnitus. That doesn’t mean the neck can’t be an x,y,z modulator because... it is. However it also means that treating it did not provide “change” to the parts directly responsible for ear changes. I think it can provide change as in “improvement but no cure” as stated by @linearb.

      The same way, a splint may help someone if it actually positively impacts the ligament attaching from the mandible to the ear’s malleus (?). It may have no impact or even negative impact, which is why many do not see themselves cured.

      The same way, manual therapy to the face may shift bones in ways that prevent or reverse the faulty position that directly affects the ears. It may correct muscle imbalance that affects the condyle and therefore the ligament, or it may relieve malfunction of the Eustachian tubes and restore proper equalization so, bam, tinnitus goes away.

      Maybe it doesn’t go away for all instantly. Maybe the changes to the ear drum and ossicles are such that they can’t change but the nervous system has to “adapt” to it and tinnitus dissipates slowly afterwards. It is I think true though that a condition is present, causing tinnitus. Unless we find it, there are excellent chances of worsening in the future and/or fluctuations even daily.

      It is these fluctuations that make me think that something is directly tampering with the ossicles, since we do not have inner ear damage. What is the one thing that can do it? Whatever attaches the rest of “us” to the ossicles and whatever directly impacts the ear drum (ETD is one). The tensor tympani also connects the ear to the palatine muscles and therefore the rest of the muscles of the face.

      I guess one should pretty much try everything until they see actual improvement, then they know they are at the right place. So far I did TENS, TECAR and manual therapy for my neck, no change. Now I do cranial fascial therapy with a manual therapist who attempts to shift bones and also my bite, it affects me mentally but not with tinnitus directly. I’ll try more, I’ll eventually nail it. Haven’t touched the masticatory muscles yet, haven’t done CBCT or a detailed endoscopy.

      TLDR tinnitus requires us to go x,y,z to fix a,b and c that directly affect ear structures responsible for communicating with the inner ear. Not to try and fix x, y, z. That’s my humble opinion. If I have to completely fix my neck and restore it to perfection in order for my tinnitus to go away, it simply won’t happen. And if it does, it will reoccur because there is not a single person out there with a C curve cervix above the age of 50. Guy messed up his neck, is fine. Lifts 500 pounds, is fine. Veins pop, is fine. Yet a healthy young woman develops Patulous Eustachian tubes and consequently tinnitus.

      Anyway. Que sera sera.
       
    14. AUTHOR
      AUTHOR
      donotringatme

      donotringatme Member Benefactor

      Tinnitus Since:
      09/2020
      Cause of Tinnitus:
      ETD, TMD, CI
    15. just1morething
      Benevolent

      just1morething Member Benefactor

      Location:
      U.S.
      Tinnitus Since:
      It started
      Cause of Tinnitus:
      Bad luck
      Surgical or other procedures

      When other methods don't help, your doctor might suggest procedures such as:

      • Arthrocentesis. Arthrocentesis (ahr-throe-sen-TEE-sis) is a minimally invasive procedure that involves the insertion of small needles into the joint so that fluid can be irrigated through the joint to remove debris and inflammatory byproducts.
      • Injections. In some people, corticosteroid injections into the joint may be helpful. Infrequently, injecting botulinum toxin type A (Botox, others) into the jaw muscles used for chewing may relieve pain associated with TMJ disorders.
      • TMJ arthroscopy. In some cases, arthroscopic surgery can be as effective for treating various types of TMJ disorders as open-joint surgery. A small thin tube (cannula) is placed into the joint space, an arthroscope is then inserted and small surgical instruments are used for surgery. TMJ arthroscopy has fewer risks and complications than open-joint surgery does, but it has some limitations as well.
      • Modified condylotomy. Modified condylotomy (kon-dih-LOT-uh-mee) addresses the TMJ indirectly, with surgery on the mandible, but not in the joint itself. It may be helpful for treatment of pain and if locking is experienced.
      • Open-joint surgery. If your jaw pain does not resolve with more-conservative treatments and it appears to be caused by a structural problem in the joint, your doctor or dentist may suggest open-joint surgery (arthrotomy) to repair or replace the joint. However, open-joint surgery involves more risks than other procedures do and should be considered very carefully, after discussing the pros and cons.

      • https://www.tbjafs.com/procedures/tmj-disorders/
       
    16. Greg Sacramento

      Greg Sacramento Member Benefactor Hall of Fame

      Tinnitus Since:
      April 2011
      Cause of Tinnitus:
      syringing and now somatic T dental work
      Sometimes more complex, but tinnitus, pulsatile tinnitus or physical somatic does not happen without a cause. Cause can be a condition, disease or injury and in some cases, emotional input is an additional factor with a condition or disease.

      TMJ often happens from an injury and this could also have association to a pre existing condition - weakness of jaw or neck. Weakness can cause more weakness. TMJ weakness from injury can be from having mouth open too wide and long during dental, influence from muscle spasms of neck, direct pressure to teeth/jaw - clenching. Inflammation can be present pre TMJ or cause/increase development.

      All of this - causes (non pulsatile tinnitus) places pressure to the ears in one way or another, unless there's cranial nerve or aneurysm involvement, where they use pathways to the brain. Toxicity can involve both ear and brain input.
       
    17. Tinniger

      Tinniger Member Benefactor

      Location:
      Germany
      Tinnitus Since:
      06/2017
      Cause of Tinnitus:
      increasingly uncertain, maybe noise, maybe somatic ?
      Question for those affected by somatic tinnitus:

      Do you also have the symptom that you can significantly increase the hissing sound by moving your chin or applying pressure to certain regions of your head?
       
    18. weab00
      Alone

      weab00 Member Benefactor

      Location:
      depression-ville
      Tinnitus Since:
      04/2019
      Cause of Tinnitus:
      noise, whiplash; 08/20 H
      70% of sufferers have this regardless of origin.
       
    19. Tinniger

      Tinniger Member Benefactor

      Location:
      Germany
      Tinnitus Since:
      06/2017
      Cause of Tinnitus:
      increasingly uncertain, maybe noise, maybe somatic ?
      Where did you get this information from?
       
    20. weab00
      Alone

      weab00 Member Benefactor

      Location:
      depression-ville
      Tinnitus Since:
      04/2019
      Cause of Tinnitus:
      noise, whiplash; 08/20 H
      https://www.tinnitusjournal.com/articles/somatic-tinnitus-8696.html
       
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