Somatic Tinnitus and What I'm Doing to Address It

Life hasn't been the same since I got tinnitus.

I went to sleep a week ago with some mild buzzing in my right ear and didn't think too much of it - we all hear it before we sleep, right? Couldn't have been more wrong, woke up the next day with a 3/10 high pitch sound, it didn't stop and was always in the background. I found that if I didn't focus on it too much, it wouldn't really manifest itself.

However, I noticed the next day that my tinnitus became more pronounced, I tried ignoring it but couldn't. I booked an appointment with an ENT and my fears were confirmed - tinnitus in the right ear (somatic probably). I was given a prescription for proton pump inhibitor drugs and Eperisone (aside from a vitamin B supplements). The ENT and I think it's somatic as the day before, I was playing badminton and experienced the worst neck spasms (both sides) I've ever had. The ENT said my neck and upper back was very tense still.

Right now I'm researching the topic (somatic tinnitus, the neck's connection with it + vagus nerve) and will broach the idea of dry needling/TENS as a way of alleviating the tinnitus during our next session in 6 days. Of course, I've also invested in a better chair for studies as my posture has degenerated to a mild slouch and have started on some light neck exercises + making sure my posture is okay.

To people with similar probable causes as mine - will it get worse? What do I need to do? Should I get an MRI? I'd like to tag @Greg Sacramento as I've read posts of his that make it seem like his condition and mine are similar. Thanks in advance Greg.

Did I mention the fact that I'm only 17? Tinnitus sucks.

 

@andrewsomatict, I would get a physical therapy consultation. At your young age, measurement of leg height would be important with tense muscles of neck and back. If one leg is shorter than the other, injury can happen to shorter leg side, thus somatic tinnitus to the injured side can happen. Look into a wall mirror to see if your shoulders are balanced.

It appears that muscle tension and nerve pressure has happened. Your back spine and C spine are probably receiving muscle pressure. I would get a neck MRI to see all that's going on. X rays of both back and neck may also be needed. Wear metal free ear plugs for the MRI and get exam results.

When it comes time to discontinue your mentioned medications, you will need to taper them by 20-25% a week.

Stay in touch.

 

@Greg Sacramento, thank you so much for the helpful advice.

Some updates:

I'd like to mention the fact that my neck was very stressed 2 weeks prior from the improper exercises I was doing as part of my school's varsity - the coach didn't notice as we're conducting practice online but my cousin who is a physical therapist noticed and alerted me to this 3 days ago. Might this be one of the causes? Aside from the neck spasms and bad posture.

I went to sleep last night and noticed my teeth kept trying to grind each other (aside from my jaw now being uneven), I'm really now worried this might be TMJ - I hate the fact that my tinnitus might've caused it. I've got an appointment with the dentist soon so hopefully, it might be addressed. Aside from my appointments with a physical therapist and the ENT (where I'll ask if dry needling is good to go in my case + ask for an MRI).

Reading the other posts, I realized that I may need earplugs even if my tinnitus isn't noise induced. Would 3M 25 dB CSA Class AL earplugs be enough? Also, what's your opinion on an MRI with contrast dye - I may need the one with contrast as my tinnitus is unilateral in nature (can't rule out an acoustic neuroma sadly, even if its 1/1000).

Do you think physical therapy, better posture, and supplements to address any possible deficiencies will be enough to get rid of tinnitus? I know tinnitus depends a lot on the case by case basis but my anxiety is through the roof - the fact that it may be curable is the only thing keeping me going, I don't know what I'd do if it became worse. Do you have any other suggestions?

Thank you again for taking the time to share your knowledge, I doubt my ENT really truly knows how hard it is to live with tinnitus.

Also, I really do think stress played a major part here - I was running on 6 hours of sleep when my usual was 10. Life goes on I guess.

Here's to hoping things get better,
Andrew

 

I did consider TMJ as cause of tinnitus - more so at your age. Initial cause of jaw problems may be from a neck injury where muscles have pressured your C spine and tilted your C1 - C2. Having bad posture or being born with one leg shorter than the other would increase chance of neck muscles pressuring your C spine, thus causing a jaw problem from inbalance. Once inbalance happens, when sleeping, it can become natural to grind.

It's also possible that oral trauma may be cause of neck muscle spasms. Whiplash, hitting your head or a dental procedure may be cause. Lifting your head off dental headrest with mouth open or having mouth open too wide and too long during a dental procedure.

From article: In addition, besides the medial ptyergoid, the tensor veli palatini is the only muscle of the palate that is innervated by the medial pterygoid nerve, a mandibular branch from the trigeminal nerve. As such, trigeminal over activation may directly impact the auditory system via the tensor veli palatini.

Somatosensory Tinnitus: Neurophysiological Considerations & Treatment Options - Spinal Manipulation Institute

If this, you probably don't have concerning hearing loss.

You may have to see an endodontist or orthodonist to confirm and to have an oral treatment program established. MRI may be needed.

You may need C spine X rays or a CT to confirm postion of neck vertebra.

Have your cousin check your leg height with other posture exam. Your cousin may have already done this.

 

Hi Greg, thanks for the reply. I will be seeing an orthodontist ASAP. My TMJ has worsened to the point where grinding my teeth actually feels good. I've confirmed through the use of some diagnosis videos that the TMJ is on my right side (when I open my jaw, it moves to the right) which the diagnosis video states as evidence its the temporomandibular joint in the right side that's the issue. Now, my research into it's relation with tinnitus leads me to consider the fact that they're both connected, solve the TMJ = solve the tinnitus hopefully?

EDIT: I'll also be getting a CT scan/MRI to see once and for all if my C spine really is being pressure. Also yes, I don't have any hearing loss.

Thanks Greg, my parents are supportive but they don't really truly understand the pain/stress/anxiety I'm in, more so with the TMJ.

 

@Greg Sacramento, I think your mentioning of the tilted C1-C2 which was caused by my bad posture on the desk is the problem. There's a noticeable tilt in my posture - my right is slightly below my left. Do you think it's a coincidence that my TMJ, unilateral somatic tinnitus, and tilt are due to this C spine pressure? Will be having a CT of the neck vertebra to be sure. Right now I've got multiple options/treatment paths to consider and would greatly appreciate your opinion on this.

1. Go to a NUCCA chiropractor to have my C1-C2 gently fixed. No schedule for this yet, it's a 1 hour drive.
2. Go to a physical therapy place that specializes in dry needling/posture correction. Planning on doing this 2 days from now.

I also have to do the following:

1. Go to an orthodontist to get a treatment plan for my TMJ before it gets any worse- no problem opening jaw/clicking or popping sounds at the moment, but want to address it before it gets any worse. Tomorrow.
2. Go to my ENT to give feedback on meds she gave me: proton pump inhibitors for GERD, vitamin B complex, and Eperisone - the meds don't have any good noticeable effects so there's that. 4 days from now.

Now the things worrying me are:

- What if my somatic tinnitus gets worse? Right now it's a 3/10 but when I move my lower jaw forward, my left ear also squeals with a high pitch.
- What if the TMJ specialist just gives me a splint? I've read reports of it getting worse (TMJ) because of the expensive splint- it doesn't help that I think it's not treating the underlying cause of all this, which is my bad posture and tilted C1-C2.
- I only have till the 18th of December before we go on holiday lol.

Do you think I should get a splint still? Will a NUCCA chiropractor really work (is it worth it)? Can dry needling solve the symptoms? What would your recommendation be on how I'll get through this? What treatments/specialists should I prioritize?

My problems/reservations so far:

My problem with dry needling is the fact that while it may give me relief- it's not solving my tiled C1-C2/spine problems. Of course, the physical therapy center also does posture rehabilitation so it might help to go there nevertheless.

I think the TMJ specialist might just scam me into getting a splint or something- isn't my body imbalance + muscle tenseness causing the TMJ?

I think all the information and possible treatments has my brain overloaded. I just want the TMJ and tinnitus to be gone damn it.

Also here's what I'm doing while I'm at home:

- Vitamin B complex + Vitamin D3 800IU supplements twice a day (thinking of adding Magnesium supplements as well)
- Some posture correction exercises I found on YouTube.
- Exercises to rebalance my pelvis (need advice on this if you have any)

Once again, I'd like to thank Greg for his continued response, your hope in my possible getting rid of this is what keeps me going. Cheers!

 

@andrewsomatict, glad that you went and got a lower body exam from waist down for imbalance.

Yes, see an orthodontist. You may need a splint (not rock hard) as grinding may be causing trigeminal over activation to the tensor veli palatini. This is possibly direct cause of tinnitus.

Yes - vitamin D3 800IU once/twice a day.

Magnesium Glycinate 400 - 1/3 pill - 3 times within 24 hours. Take 1/3 - one hour before sleeping. Liquid form is better.

Very light and careful posture correction exercises until CT is taken. Ask your primary physician for CT. Get CT radiological notes. Pictures would be very careful. I wouldn't consider neck therapy - NUCCA, until after CT ordered by your physician. I prefer physical therapy.

Do you get back muscle tension?

As mentioned in the article above, dry needling might help some - over time.

Eperisone may be OK for now, but do taper before you discontinue.

Do you have GERD?

We will need more discussion. You have done homework as well. I'm impressed - 17 years old. Thanks for your kindness.

 

@Greg Sacramento, hey! Thanks for replying.

I've had heartburn now for around 5 years, just drinking iced tea triggers it - the ENT gave me PPIs to eliminate it being the cause.

Today, I came across @oceanofsound26's treatment plan and I do believe our cases are similar. This led me down the rabbit hole of posture, pelvic tests, and the like. I plan on asking my physical therapist tom (haven't met him/her yet but here's to hoping it helps) about my posture, I suspect I have an anterior pelvic tilt due to my constant sitting down - it doesn't help that the old chair I spent 10 hour days on for 2 years since COVID-19 started had bad back support and a hard surface- recipe for disaster.

Regarding the CT scan, I'll be asking one from my ENT during my appointment on Sunday, looking forward to that. I also regret trying to stretch my neck now - my right SCM became untensed while my left has tensed up, here's to hoping it doesn't give me tinnitus on the left as well. The tinnitus hasn't been as detrimental to my mental health as TMD has, so I'm hoping I get my problem diagnosed soon, I personally think it's a combination of poor sitting posture- exacerbated by the fact that my muscles are ever tense, especially my traps and hamstrings.

I think I should mention my spraining of the left ankle btw, might it contribute to the muscle imbalance of my body, leading to TMD/tinnitus? My aunt is a really good radiologist but I'll ask my physical therapist or NUCCA Chiro (if ever I decide to go) as well.

Also I'm worried about my C4 nerve/spine - I read that it controls the breathing aspect. Might it have been affected? I realize that my breathing hasn't been right lately, I'm breathing through my shoulders/neck and not through my diaphragm, not that I don't know how, more like I cant.

I also have this feeling of my throat constricting and jaw in the back. I'm sure my dentist will be shocked by the effect all this has on my teeth, will probably be given a mouthguard as I grind my teeth at night and have the urge to do so during the day - I read a forward head posture may cause the jaw to move to the back, really interesting might I say, what the body does and changes to keep us alive. It's restricted my breathing and I'm terribly worried, what should I do? I don't normally breath through the mouth, never have.

Lastly, my conspiracy theory is tetanus/lockjaw may have something to do with this lol. I got a wound on the 3rd of Nov and was only vaccinated with a Td shot + 250IU tetanus immunoglobin (TIG) on the 12th. Could this have been a trigger? My status of vaccination as a child, the primary course basically, is unknown. Tetanus takes 7-21 days to show symptoms of and the TIG can only help with the nerves that haven't been affected. Sounds crazy I know, maniacal even, but the timing of the tinnitus/TMD plus the wound has me all going "Maybe..?"

So to recap what I'll be doing:
1. Have my posture checked by physical therapist
2. Hopefully address any muscle imbalances through physical therapy
3. Have my CT taken hopefully
4. ENT

Also before I forget: I read from @oceanofsound26 that when you address the muscular/posture problems- you have to do them all at once. Meaning, splint from the dentist, physical therapy, and lifestyle changes. Otherwise, the body won't change the painful cycle it's in. I feel like my constricted breathing + TMD is just the body's way of accomplishing it's prime directive- keeping me alive by making sure I can breathe. So, to recap, how do you think I should go about changing my posture effectively and hopefully thus solving my breathing, TMD, and tinnitus? Goal right now is to get rid of these before they get any worse.


Wishing you well and my thanks for your correspondence/advice,
Andrew

 

@andrewsomatict, Andrew, I'll answer and comment on your latest questions to me here.

You probably gave yourself minor whiplash or over stretch foward head posture when playing badminton. Bad posture previously developed.

This can cause swallowing difficulty, prior breathing difficulty, brain fog, headaches, muscle spasms and jaw tenderness.

Hopefully, your mild tinnitus will disappear within two months. Correct posture will make all the difference. Stay relaxed for benefit of nervous system, posture, and physiology.

See a sports rehab doctor where all issues will be addressed.

 

@andrewsomatict, stuff happens - don't blame yourself.

See a sports doctor. Write down some of what you posted here to bring with you.

I would place a clothwash under cool water - ring it out and then gently hold it around neck. Right after that I would do the same with warm water. Doing this two or three times a day may help.

Neck muscles and breathing:

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

 

Hey @Greg Sacramento! I really do appreciate the tips and great advice. I've taken a break from researching my condition as it might just stress me out more- I think the amount of information I've seen will be enough for the year lol. I found researching about similar happening on other forums like those for TMD can help. I've got an appointment with a NUCCA chiro tom and sports rehab doc sometime this week.

Current theory I'll float with the NUCCA doc tom is

C spine may have been straightened out by the neck spasms. C3/C4 disc consideration due to the right side tinnitus, when usually it's both ears. Right side SCM has limited movement and occipital nerves may be involved- tilted C1/C2 may be a possibility.

Will update this thread on any findings.

Thanks and regards,
Andrew

 

Updating this thread with some relevant articles for those who think their Tinnitus was caused by neck injuries/whiplash/tight SCM/poor posture (particularly forward head and scoliosis).

Pain of Temporomandibular Disorders: from Etiology to Management 2020

Listening to Another Sense: Somatosensory Integration in the Auditory System

The association between tinnitus, the neck and TMJ

 

Yes and lots of nerves are upset due to C spine being straightened - especially occipital nerves. Cause is muscle spasms pressuring C spine. C1 - C2 gets tilted and lower jaw moves inwards. Tinnitus from this is usually occipitial nerve pressure around C1 and can be pressured more by C4. This will then pressure your lower jaw. So it's possible that both occupital nerves and nerves of lower jaw are causing tinnitus. Right SCM has effects, but probably not responsible for tinnitus sounds.

C spine X rays will note problems with C spine, but an MRA or CTA is needed to see what damage - a damaged C spine caused.

I would then see either a sports doctor or an upper cervical doctor, not NUCCA.

 

Hey @Greg Sacramento, thanks again.

Got a neck X-ray and would appreciate you taking a look.



Thanks and wishing you well.

 

Also, the NUCCA chiro I went to had this instrument he used to roll down my neck - a paraspinal infared instrument? It showed an abnormality with my nerves in the C1 left side, which *may* be causing problems with my tinnitus, apparently nerves in the left of the neck "cross over" to the right. Will be pursuing the sports rehab doctor also but they need an MRI/MRA and my parents want me to try the NUCCA dude first, the sports rehab doctor might be useful for more permanent changes though with regards to my poor posture so I'll pursue that avenue soon.

Also seeing the dentist tomorrow. Might see if I can get a 2mm or less repositioning splint for my jaw problems, no clicking but my jaw hurts from grinding at night :>>

Regards,
Andrew

 

@andrewsomatict, also possible very slight C4 (C3-C5) nerve root extension with occipital nerves association - would experience slight breathing difficulties. MRA would be needed to confirm and physical therapy would help.

 

Thanks @Greg Sacramento, I missed that part. It would explain why I've had trouble breathing lately, will bring this up with my doctors and physical therapist soon to hopefully get an MRI/MRA. This weekend probably. My ulnar nerve has been feeling impinged upon also, when I shrug I get a pins and needles sensation, could the upper cervical area play into that?

Could an MRA/MRI also see whats causing the tingling in my fingers? Also, would a TMJ repositioning splint help? What would the prognosis or successful treatment of these conditions result in? Maybe you came across some success stories with these types of things.

Thanks for the continued feedback btw, appreciate it.

 

@andrewsomatict, elbow injury by bending and straightening the elbow joint repeatedly. Upper cervical area wouldn't play into that. Probably will heal, but have physical therapist take a look.

I would get a thin upper splint.

 

@andrewsomatict, it's interesting that you mention neck spasms. I have had tinnitus for 12 years or so, but about a year ago I experienced neck spasms on the right side of my neck. Since then my tinnitus has become more intrusive. I got the MRI of my neck area. It turns out that I have cervical spondylosis. My tinnitus is on my left side.

 

Hi @Peter Q, sorry for the late reply. I recently had an appointment with my NUCCA chiro and he said the nerves actually "cross" to the other side. He found that my nerves in the left were irritated and he said it might've been what was causing my tinnitus on the right, my tinnitus is unilateral and somatic. Definitely something to look into.

 

Hey @Greg Sacramento, hope you're doing well. Wanted to ask your opinion on @donotringatme's post regarding ETD being the cause of somatic tinnitus. What do you think?

If this is the case, I may need to re-evaluate my approach right now to something broader. I'm currently doing NUCCA and have postponed the sports rehab physical therapist as my chiro wants to see what NUCCA itself can do, I agreed but with the info presented in @donotringatme's post, I'm re-evaluating my choice. What if it gets worse? The NUCCA Chiro said any fixes on the neck will translate to better posture ala top to bottom, yet physical therapists believe that it's the opposite, fixing a pelvis issue or flat feet will allow the upper body to relax and "unstrain" itself, thus fixing any neck tension as well. (Also add the fact that I'll have to board a plane in December).

I'm currently on a strict diet and trying to fix my posture by taking breaks from the computer and minimizing forward head posture. But if I'm to really "cure" this ETD and by extension somatic tinnitus, I may have to hasten the pace and start strengthening/fixing my pelvis issues, thus helping fix my neck tension + SCM problems which cause ETD/T.

Apologies if this message is all over the place, running low on sleep.

Cheers and kind regards,
Andrew

 

Some have deep vertically jaws in the molar region caused by adaptation to counter increased sagittal bending stress and balancing-side mandibular during unilateral mastication. This increases bending stress and the balancing side caused by an increase in the amount of balancing-side muscle force. This increased muscle force will also cause an increase in dorso-ventral shear stress along the mandibular symphysis. Since increased symphyseal stress can be countered by symphyseal fusion and as increased bending stress can be countered by a deeper jaw, deep jaws and symphyseal fusion are often part of the same functional pattern. This is often inherited and some from Mediterranean countries have a much higher tendency to develop this.

ETD can cause somatic tinnitus, but often due to fluid travel to ears. You don't appear to have ETD as primary problem.

For you, physical therapy has been my advice.

Again yes. See physical therapists. Your C spine X ray is not really problematic and since you mention silence at times, I would focus on posture and your pelvis and this will balance your SCMs. As I said to you early on, it's probably not going to take much posture treatment for tinnitus to completely resolve. Avoid forward posture/head twisting and more so after getting up in the morning.

 

@Greg Sacramento, thanks Greg, moving forward, I'll definitely stick with what you're suggesting. Will go NUCCA still as they sold me the package (insurance doesn't cover it but hey) but will supplement with a competent sports rehab doctor/physical therapist.

I mentioned the ETD theory as my left ear has fleeting bouts of tinnitus, the only change I recognize which may be causing this is the fact that my incisors have been worn down and when I do grind at night, it's the back molars receiving the stress - might my left TMJ been now tense at times as well?

 

Yep, caused from muscle force. Have a dentist make you a thin splint.

 

Hey @Greg Sacramento, thanks again! So I've got a 3mm overbite - not too bad but my bite and teeth were in perfect alignment/occlusion before this all happened. Also, is this splint your talking about something for reducing tension only and spreading it, or is it a repositioning type? Worried about the repositioning type as I feel my TMJ is being caused by my cervical instability/forward head posture (further exacerbated by bruxism/uneven bite/stress). Wouldn't getting a repositioning splint be "fighting" my CNS? Correct me if I'm wrong. If it's the nigh splint to reduce muscle tension, then I'm all for it.

I hope you won't mind me barraging you and consulting you but I came across this interesting article (I'm sure you've seen it) and the things he talks about are quite interesting.

https://mskneurology.com/true-cause-solution-temporomandibular-dysfunction-tmd

What do you think about the things he states and proposes overall?

Some key points I'd appreciate your opinion on

(I think I should mention I think the dysphagia I've had that lasted for a week was caused by tight hyoid muscles, the suprahyoid muscles are still tight but the swallowing difficulties have been minimized)

He advocates mewing as a way of expanding the maxilla?

And the protocol he advises and mulling about

I'll still be of course trying to fix my posture, take frequent breaks from sitting all day, and the NUCCA treatment (aside from the sports rehab I'll be starting after I go on holiday, in January 2022).

I think combining this therapy (whether the one from the article minus the mewing and/or getting a night splint with the NUCCA/PT/Lifestyle changes will get me the best results at the fastest possible time.

Also, I don't think I've said it enough but thank you so much for the invaluable advice and wisdom you've given (not to mention your precious time).

 

@andrewsomatict, you get it - good post.

For most with somatic issues- bad posture, then injury causing neck/back muscles spasms. Injury often comes from forward head motion force. From mechanics, all sorts of stuff can happen. More so - as time go on. Somatic spikes happen with head posture and jaw posture for some will accompany.

C spine may straighten and sometimes only slight. C1 sometimes get titled causing lower jaw disc movement. Quotes on TMJ/jaw from article are correct. I had posted all of author's somatic articles, but some are long winded.

Use your 3mm overbite.

 

Okay, thanks @Greg Sacramento! I'll be trying to protract my mandible forward without clenching my suprahyoid muscles then.

Just to confirm, this splint you're suggesting isn't a repositioning one yes? just one to lessen the tension?

Thanks and cheers,
Andrew

 

I'm betting that you don't need a repositioning splint. Your 3M splint should stop grinding / tension.

Your C spine X rays looked fine. Warm/cool compress use on neck when needed, a little light muscle therapy and you should be completely tinnitus free. Thought this since we first talked. Work on posture. Take care my friend.