Physiotherapy and Tinnitus

I saw this interesting article lately on tinnitus and the neck muscles and someone kindly translated it for me

https://www.stern.de/gesundheit/tin...eine-frage-der-nackenmuskulatur--7620856.html


It is entitled- "Tinnitus - all a question of the neck muscles?". Basically the article says that in some people tinnitus is related to two small muscles hidden deep in the neck, the splenius capitis muscle and the semispinalis muscle capitis. It says that manual therapy targeting these muscles can help reduce tinnitus in many. I don't know how true this is. But as I do know a very good physiotherapist whose neck exercises hugely helped a permanent headache I had, I decided to go and talk to him about this article and potential physiotherapy that might help tinnitus. He said you can’t access those small muscles in the neck as they are too deep. But you can target the ones around them which will help to relax them.

The exercises he gave me to target these was as follows. I figured it was worth posting here: Sit on a chair against a wall with your head on the wall. Simply slide your head up the wall, creating a double chin. Don’t hold this for the 1st two weeks – the brain will learn the muscle engagement. After 2 weeks start to hold it for 2 seconds. Do 3 sets of 20 a day. I think this was to engage the deep neck flexor muscles.

The physio I saw also commented on an excerpt from my clinic letter from an eminent tinnitus expert in London who had referred to tight paraspinal muscles in neck in the context of tinnitus. The physio said these were the same muscles the German article talks about. This may help corroborate the claims of the article somewhat.

Simple, but possibly worth a shot for many of us, just in case.

 

@Agrajag364 I think for many of us it's subluxation of lumbar vertebrae and this will show discomfort in the lower neck - the trapezius area.

If later the shoulders that extend over the arms start to hurt then this is confirmation. It may be that osteoarthritis is not often the cause, but spinal cord compression is. Often an accident, or anything causing back and neck strain and muscle tenderness such as forward neck bending will cause the DCN or hearing nerves to react. Stress may also be an added factor.

Testing should take place quickly, but muscle relaxing to the trapezius should start as soon as possible. By drinking fluids, toxic muscle storage may disappear.

https://www.merckmanuals.com/profes...nd-back-pain/evaluation-of-neck-and-back-pain

 

What kind of testing Greg?

 

https://www.physio-pedia.com/Cervical_Examination

 

Physio does help for some forms of somatic tinnitus. I had a head trauma 5 months ago that caused thight jaw and neck muscles and thus tinnitus. I'm on the 4th week of physiotherapy (mainly triggerpoint massage for neck and jaw) and since this week the tinnitus drasticly lowered in volume. From not being able to hear ambient sounds to being able to hear it again.

It does take a lot of work and detication though. It only went significantly better after 6 sessions. And many neck stretches and learning how to have a good posture in between.

Maybe you can go to a physio who does dry needling to adress some deeper muscles. They did dry meedling on my shoulder and it helps even better than trigger point massages. Unfortunatly my physio isn't skilled in jaw and neck dry needling. So only massages for me.

Good luck!

 

A good physio can feel if something is of with the spine. They have some methodes to check that. In my case a intern had to check it out so the physio gave instructions on how to feel it. They run their finger up the neck and feel which side their finger meet the jaw first to see if there is any deviation in the spine.
They also pulled my jaw and head to feel if there is more resistance on one side.

Some spinal deviations can fix themself when the muscles around it start functioning normal. This happened to me this week. My spine suddenly popped itself into place (it scared the sh** out of me ) and the physio confirmed it felt normal again.

 

Thanks folks. If anyone wants the article translation message me

 

Is it possible to share it here? I'm very interessted. I can understand some basic german but not enough to read the full article.

Ps: i saw on your profile your cause is still unknown. Any ideas yet? Are the stretches you got helping?

 

I would. And yes, if you could post it here that would be really handy for anyone else looking at this particular avenue for treatment. Thanks!

 

Brilliant if it works for you.

 

What kind of tinnitus would this potentially work for? Pulsatile? High pitched?

 

Idk about pulsatile. According to my doctor it most likely works on people who can alter sounds with movement, but even then there is no gaurantuee.

 

Hi All,

Has anyone tried physiotherapy for tinnitus I am thinking of trying it?

Regards.



Jack.

 

If your tinnitus has a change from body movement or position then it may be muscle stress within the upper trapezius muscle. The highest level of neck disability is from tenderness in the upper part of the trapezius. What may cause this is loss of normal lordosis - kyphosis. This causes tension in the spinal cord - c spine and carotid blood vessels which supply blood to the brain. Improper blood flow can cause pulsatile tinnitus and is also part of the physical/somatic tinnitus connection. With this the straighten spine needs to regain a curve. Using a folded towel exercise behind neck is working for me. There are videos for doing this.

 

@Voice of jack - I'm starting my 3rd PT session tomorrow for suspected TMJ and/or neck issues causing my tinnitus. I will say that PT causes a decent spike during the session that tends to last the entire day and evening. Waking up the next morning is quite amazing though. Either I hear slight crickets or nothing at all. This changes throughout the day but the afternoon spikes are much less.

 

Thank you for the reply, I may try as anything is worth looking at to try to rid myself of T.

Regards.

Jack

 

I agree. I've tried a chiropractor and also acupuncture to see if that would help my condition. I thought my 3 chiro visits helped as well, as there was immediate relief with the adjustments, but I felt he was limited in what he knew about upper cervical care after the 3 visits. I'm planning to find a specialized upper cervical chiropractor in 2 weeks. Acupuncture was a waste of money for me the 3 times I went, but I'm looking at electroacupuncture for the future as an option.

 

As I have said in previous post I have had 3 acupunture treatments so far no relief, I have more booked this week but I don't hold much hope. You have given me an idea, I know a very experienced chiropractor and I will definitely
try him. He treated me a few years ago for back issues but it must be worth a try. I also have an appointment with a ENT consultant on the 20th of March to get results of MRI and CT scans but I suspect that they will not show anything. But he may direct tme o some form of management.

Kind regards.


Jack.

 

80%??? What do you think?

 

Today the orthopaedist and trauma surgeon Christian Sturm is on German television and reports on the connection between tinnitus and cervical spine. There will be a chat, too.
https://www.ndr.de/fernsehen/sendun...l-und-Tinnitus-durch-HWS-Syndrom,chat161.html

 

Here is the stream: https://www.ndr.de/ratgeber/gesundh...d-Tinnitus-ausloesen,halswirbelsaeule100.html
In English: https://www.archynewsy.com/when-the-tension-triggers-dizziness-and-tinnitus-ndr-de-guide/

As far as I know, Dr. Sturm has not yet published in a scientific journal.

 

@Tinniger

From your article: The muscles splenius capitis and semispinalis capitis can stabilize the muscles of the shoulder and neck. If the tension is reduced, vertigo and ear noise disappear in many cases.
There is clear evidence that muscle tension and joint disorders in the cervical spine affect the function of the cranial nerves and therefore trigger or exacerbate neuronal discomfort.
Ear noises can occur when the muscles of the cervical spine, the splenic muscle and the hemispherical muscle contract to press on the nerves that exit the spine.
-------------------

Those are ways among others to wipe physical cervical tinnitus off the map. I think the above is 3rd on the success treatment list of 60 well known cranial problems.

Nerve repair near the cranial discs with C1-C3, between C5 and C6 and C7.
Balance to the sternocleidomastoids and trapezius.
Occipital nerve pathway treatment.

Many times the neck jaw cradle needs therapy as with the oral mouth, thorax and facial which totals 300 major possibilities.
For the jaw alone besides other oral problems the best therapy with focus is to keep the front teeth inline.

Much of this won't hold if correct posture isn't maintained.

A complete physical cause and treatment article can't be written under 20,000 pages.

Radiological testing is needed and a newer method - stand up MRIs is one gold standard.

 

Long-Term Effects of a Multimodal Physiotherapy Program on the Severity of Somatosensory Tinnitus and Identification of Clinical Indicators Predicting Favorable Outcomes of the Program

Background:

Tinnitus, the perception of sound in the absence of external auditory stimuli, is commonly associated with problems of the auditory system. Head and neck disorders can also be involved in tinnitus emergence. In such cases, the term somatosensory tinnitus is used. Physiotherapy treatments have been identified as a promising avenue in the treatment of somatosensory tinnitus.

Purpose:

The aim of the study was to explore the effect of a physiotherapy program on the intensity and severity of somatosensory tinnitus and to identify the clinical characteristics of the patients who respond well to this treatment.

Research Design:

Quasi-experimental pre‐post single-group design.

Study Sample:

Thirty-one adults with presumed somatosensory tinnitus.

Intervention:

All participants received on average ten physiotherapy treatments over six weeks. Treatments included cervical and thoracic mobilizations, as well as muscular strengthening, stretching, postural instruction, and cervical stabilization.

Data Collection and Analysis:

Outcomes were measured at baseline, at the end of the physiotherapy program, and three months later. The primary outcomes were the Tinnitus Handicap Inventory and visual analog scales for loudness and annoyance caused by tinnitus.

After the last evaluation, participants were divided into two groups: improved and unimproved participants. Participants were considered improved if they (1) showed significant improvement in at least two of the three primary outcome measures and (2) indicated subjective improvement. Thereafter, the baseline characteristics that correctly identify participants susceptible to improve significantly following treatment were determined (Cohen’s effect size d > 0.8).

Results:

A significant improvement in tinnitus intensity was observed at the end of the program. Of the 31 participants, 14 experienced persistent improvement in the intensity of their tinnitus and were classified as improved. Baseline characteristics strongly associated with tinnitus improvement were no increase in tinnitus when exposed to noise (d = −1.57), no family history of tinnitus (d = −1.16), somatosensory modulation in response to the contraction used to resist pressure applied to the forehead (d = 1.20), and recent onset of tinnitus (d = 1.03).

Conclusions:

This exploratory study showed that a multimodal physiotherapy program is effective in decreasing the severity of tinnitus, principally in individuals presenting with somatosensory tinnitus in combination with specific clinical characteristics.

Source: https://www.ingentaconnect.com/contentone/aaa/jaaa/2019/00000030/00000008/art00008

 

A review of somatosensory tinnitus:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408030/pdf/fnins-11-00207.pdf

 

I have had a constant tinnitus in my right ear and on/off tinnitus in my left for around 3 months now.

(I also had a tinnitus in my left ear back in Dec. - where I went to an ENT and he said my ears were fine - and that tinnitus went away.)

I noticed the tinnitus in my right ear after a day of traveling (2 short flights). I was also extremely stressed at the time, and had very tense shoulder and neck muscles.

(Also went to a neurologist to get an MRI - everything fine here as well).

I started physiotherapy for my tense muscles around 2 weeks ago and have had 3 sessions as of yet. My physiotherapist works on relaxing the muscles by applying pressure to certain points on shoulder/neck/head.
She also mentioned that I may feel unwell after a session or hear my tinnitus louder.
After the first session I felt fine, and did not notice a change in my tinnitus, only that it did not get worse (which it sometimes did). After the first session my physiotherapist decided to apply more pressure, in the second session, to really get the treatment started.

One day after the second session I experienced a headache, lack of energy and felt unwell/slightly nauseous. My physiotherapist expected this, as it means the body is responding to the therapy but still went easier on me during the third session and applied pressure lightly.

After this third session I noticed the tinnitus in my left ear become louder while my right remains the same. I'm told that this is a good sign as the body is responding to the treatment, but I can't help feel worried...

Has anyone else experienced this? Or had success with physiotherapy?