Role of Somatic Issues with Tinnitus

[kmohoruk]

Hello Dr.Nagler,

It is great see you a part of Tinnitus Talk again!

I had a question relating to the somatic component of tinnitus. In the past, I have had instances of fleeting tinnitus (i.e. ear pressure, drop in hearing, spike in tinnitus, and reactive tinnitus) that have come and usually diminish within a couple hours to a couple days. When I've spoken with my audiologist (Glynnis Tidball), she has mostly attributed it to the somatic issues interfering with my tinnitus, and has recommended that I keep my shoulders and neck limber.

About 5 days ago, I experienced the fleeting tinnitus symptoms above when I was just sitting at my desk at the office. Most of it subsided (fleeting tinnitus and diminished hearing); however, I now have a higher pitcher and reactive ring (gets louder around other sounds) and was wondering if this sounds like something that could be caused by somatic issues affecting my tinnitus (ie, compressed nerves in the neck or shoulders)?

If it is, how long can symptoms like this last for?

I know with tinnitus you never know what it's going to do; however, a little clarity would help

Thank you!

 

[Dr. Nagler]

Hello @kmohoruk ... and thanks for the welcome back.

I tend to look at somatic tinnitus from a highly pragmatic standpoint. Maybe it's not the best way to consider this particular phenomenon - but it makes sense to me.

There are various maneuvers that most anybody can do to aggravate his or her tinnitus. Some are unique to the individual, while others are fairly universal. For instance, if you clasp your hands tightly behind your head and then pull forward firmly without moving your head, I suspect that your tinnitus will change in pitch or loudness or both. Most everybody's does!

The way I have come to see it, you can drive yourself crazy trying to figure out which particular maneuvers will aggravate your tinnitus and which might lessen its intensity. To what end? It's all temporary. And who wants to be a contortionist?

Now you did ask about how long "symptoms like this" can last for. In terms of your fleeting tinnitus - that's anybody's guess. [See the thread directly below this one for my thoughts on fleeting tinnitus.]

But as far as regular tinnitus goes, if the change in loudness or pitch is long lasting, then I would have a lot of trouble attributing it to some sort of somatic component unless you had other symptoms (like for instance neck pain) related to that component. And if you did have those other symptoms, then I would treat the underlying somatic problem and consider any improvement in your tinnitus to be a bonus rather than the primary reason to undergo this treatment or that.

As an example, some people have tinnitus that their dentist feels might be due to a TMJ disorder. But I personally would be hard-pressed to recommend that they undergo a TMJ procedure unless they had other symptoms (like severe jaw pain) that would compel them to seek correction of their TMJ problem. Then, if their tinnitus happened to improve (usually it does not!), that would be a nice bonus.

In summary, I do not believe I have ever seen tinnitus as an isolated symptom of a musculoskeletal disorder. I guess it's possible - but I suspect that it is extremely rare.

If you tend to experience a lot of tension in your neck and shoulders, then by all means attend to it with relaxation exercises, stretching, heating pad, etc. Whatever your doctor recommends. But leave your tinnitus out of the equation. And if along the way you happen to notice that your tinnitus has lessened in severity, then that's totally wonderful. But don't do it with the expectation that your tinnitus will improve as a result. Why don't you show this post to Glynnis Tidball, and see if she doesn't agree. I'm a huge fan of hers. You chose your audiologist well!

I hope my post has provided some of the clarity you were looking for.

All the best -

Stephen M. Nagler, M.D.