Tinnitus, TMJ, Headaches, Neck Pain, Facial Pain, etc. — Possible Treatment

@applewine
@just1morething
@chronicburn
@Sjtof
@Viking

Alright, I have got a diagnosis which is bilaterally elongated styloid process. I have suspected this many times, and my case has been sent around to a lot of doctors which are supposed to be very skilled.

Stylohyoid muscle is pinching my carotid artery and the mandibular branch of the trigeminal nerve and glossopharyngeus is probably affected as well. They also found a discontinuity in my left styloid process, and oddly enough, its the left side that has been bothering me the most.

It all makes sense, and I believe they finally might have found the cause of all this shit.

It would also explain why I have experienced a lot of weird stuff when pinching my stylohyoid muscle.

 

@applewine
@65vwbus (please see my post above)

Trauma or surgery can lead to ossification or elongation of the stylohyoid complex, which can then impinge upon cranial nerves V, VII, IX, X, and XI, all of which pass near the styloid process 7].

V = Trigeminal nerve
VII = Facial nerve
IX = Glossopharyngeal nerve
X = Vagus nerve
XI = Spinal Accessory nerve

Now that is an aweful lot of nerves!

--------------------------------------------------------------------------------
Source: http://www.jmedicalcasereports.com/content/6/1/333

 

Very very interesting. I sincerely thank you for this tip. How did you discover this?

 

It is a very long story.. Ive been taking a ton of MRIs, CTs, X-rays and so on in order to figure out what this shit is, and my symptoms have baffled all the doctors and specialists.

It was by pure luck that a very skilled doctor and professor in neuroradiology got my case and he sent it to all his colleagues for an evaluation just because he found my case so interesting, and he was pretty sure what was causing my symptoms that had previously made me question my mental health.

Even if your styloid process is not elongated, you can still end up with the same symptoms because of a hardened/ossified stylohyoid ligament that adds pressure on the soft tissue and in turn irritate the jugular vein, carotid artery sheath, the trigeminal nerve, facial nerve, glossopharyngeal nerve, vagus nerve and spinal accessory nerve.

I will probably opt for surgery in a while, but I was told that relaxation is a nice thing as well, because it makes the muscles relax and might remove _some_ of the compression.

Strength and courage!

 

Wow, this is very interesting to me, and gives me hope. I am also a "computer guy" - computer programmer by trade. I was in a car accident a couple of months ago, and have all the symptoms of somatic tinnitus -- loud static sound, fluctuation of loudness (spike for days, then settles down on others), change of perception (brain some days, left ear others). I went to an ENT, and checked out okay, so now I'm onto a neurologist. The neurologist referred me to a physical therapist.

My tinnitus started after whiplash. Just after impact, I heard the loud, persistent static at the scene of the accident. I thought it would go away with a few days sleep, but no luck. There were days when it felt like it was getting better, only to spike again the next day. My tinnitus actually picks up speed and pitch when I turn my neck - especially to the right. I wonder if my job desk job as a computer programmer has affected my recovery from the accident.

@just1morething
I see that you have tried injections and physical therapy. Has this cured your tinnitus? Have you tried a TENS unit?

@computerguy0-0
I am interested in any steps that you took to get better.

 

@Mr. Cartman It is interesting that you mention this muscle and the artery there. When I do my stretches for the SCM I feel an ache in that area. If I press with my finger and get the good ache sensation it is right on top of the pulse there, which is the artery.

It is also interesting that this is CN VII. CNVII is often involved in lyme disease and a lot of people with TMJ issues have questioned if they have some unconventional form of that.

I am cautious about your surgery, but this sounds informative.

Any more information on this muscle and what you feel would be interesting. I'm unsure if that muscle is involved with me.

 

@applewine

It could be the stylohyoid muscle/ligament you are stretching as well, and its located pretty much behind your SCM and attaches to the hyoid bone.

I have to post something a member on this forum gave to me, and which I found interesting as well:

Styloid process elongation and calcification in subjects with tmd: clinical and radiographic aspects.

Abstract

Knowledge of the Eagle's syndrome shows that its symptoms can be very easily confused with other types of craniomandibular disorders, especially temporomandibular disorders (TMD). The aim of this study was to find a possible correlation between the presence of TMD and elongation of the styloid process as well relate to presence of calcification of the stilohyoid chain. Fifty patients with TMD, confirmed from the RDC/TMD, were examined clinically and radiographically. Radiographic documentation consisted of digital panoramic radiograph and digital lateral cephalometric radiograph. Radiocef software (Radiomemory) was used for the analysis of radiographs by means of specific cephalometric tracing and linear measurements of the styloid process. Each radiograph was traced and measured three times with intervals of 1 month to spread the error. Statistical analysis was performed by Pearson's test (p=0.001) using Biostat 4.0 statistical software. Result showed an incidence of 76% elongation of the styloid process in the sample. There was a correlation between the bilateral measures taken in panoramic radiographs (?<0.001) and also for measures of styloid process length carried out in different panoramic radiographs and lateral cephalometric radiographs (?<0.001). It was concluded that there is prevalence of elongated styloid process in patients with TMD. However, no relationship was found between measurements on the stylohyoid chain and symptoms of headache, orofacial pain, tinnitus and vertigo.

Source: http://www.ncbi.nlm.nih.gov/pubmed/23207864

 

@MikeS

No, I am not cured, but had a silent day 2 days ago. I have static hissing noise today. The injections did not help except when I was sedated a bit the noise went away. I haven't done enough physical therapy yet to know if that helps. I do take some Gabapentin, Clonazepam, and Flexeril.

I'm waiting for a report from a neurosurgeon on his opinion on my cervical MRI. It should come in a day or two. They won't send me a email because it is not secure enough. When I get his letter I will update.

Physical therapy link:
http://www.ncbi.nlm.nih.gov/pubmed/24047942

TRI newsletter link: Page 35
http://www.tinnitusresearch.org/en/news/pdfs/TRI_Newsletter_2914.pdf

 

Great news that you finally found out what's wrong with you!
I hope the surgery doesn't hurt too much x

 

Well, I'm not sure on that.

I'm not sure about that either...may not do surgery.

BTW, Nice pics & videos! Reminds me of when I didn't have noise in my head!

 

@just1morething

Kind of excited to hear about your report

 

Sometimes my jaw clickd while I eat and it clicks loud. When this happenns the t immidiately spikes and calms down on 10-15 seconds. It is like a volume switch. Do you ever get that? It looks like the sound volume coming from the jaw is so loud that it causes the spike?

 

Yeah, had it many times.. Not sure if its the sound that causes it to spike though.. I thought it was from a ligament or a muscle..

 

Vel det var ikke en veldig spennende rapport. Han bare nevnt fysioterapi første og muligens en fusjon på C5-6 hvis det ikke fungerte. Han nevnte aldri tinnitus i det hele tatt. (Norwegian) https://translate.google.com/

 

@just1morething

You need to work a little more on your norwegian

Hey, I might very well invite you to Norway some day, and Ill show you around

Seems like your cervical spine is pretty much ok then, which is good!

 

@Mr. Cartman You have the water sensations don't you? Maybe not as much as me. If you just have eagle syndrome then are the water sensations not related or how could it be eagle syndrome? I read about eagle syndrome a long time ago, but read some more about it. I think I read that this abnormality is common in the general population without symptoms. It can be the elongated bone or the tendon is calcified. Maybe it just has trigger points in it, who knows.

I get water sensations like right now I'm shifting my neck and I felt water on the tip of my left ear top and also on my left outer thigh.

I'm also noticing if I cross my legs I seem to feel it in my feet. I also feel it in my feet when wearing shoes and socks for some reason and walking, but not barefoot.

 

@applewine

Yeah, I get it now and then.. From my understanding, an elongated styloid process or a calcified tendon is able to compress one or more of the following nerves: trigeminal nerve, facial nerve, glossopharyngeal nerve, vagus nerve, spinal accessory nerve, irritate the carotid artery sheath and the jugular vein sheath. Any irritation of the sheath of this artery and vein can (and probably will) trigger an autonomic nervous system response.

It doesnt mean that this is what happens because of my styloid process though, but it has the capability to do some nasty stuff and it might make one more susceptible to other muscular issues in the throat/jaw area.

It is said that about 4% of the general population has an elongated styloid process, and only a small portion of those again will experience any symptoms.

The stylohyoideus has long been a suspect, and I do believe it could play a role in this. It attaches to the styloid process and connects to the hyoid bone.

But this ligament also has a neighbour, the digastric which is attached to the mastoid process and connects to the hyoid bone as well.

I did try some stretches to my digastric once I found out how to access this muscle, but its so darn painful on my left side that its hard to stretch. And today, after I did some stretching of it yesterday, it seems like the muscle and the tissue around it has swollen and is very painful.

Theres something going on here which is not good, Im pretty confident about that.

Another interesting research report I read (I dont remember exactly the numbers, but I have posted it in this thread earlier) they found the digastric muscle to be very tense in people with somatic tinnitus.

I wonder if there might be a connection between the lateral pterygoideus, stylohyoideus and digastric.

Its interesting that A Bjorne (Vertigo, Tinnitus and Pain Unit, Ystad Hospital, SE-271 82) found that lidocaine injections into the lateral pterygoideus reduced or diminished somatic tinnitus in a lot of his patients.

"Since 1988, I have been interested in tinnitus and vertigo related to muscular tension
in the jaw and neck. I made my first observations on tinnitus; the lateral pterygoid
muscle was more tender on the ipsilateral side where single sited tinnitus was
experienced. I also found that intramuscular injection (Lidocaine) in the lateral
pterygoid muscle on the tinnitus side reduced tinnitus in a consecutively sampled
group of 38 tinnitus patients with 63 % according to VAS. When the anaesthetics
were off, tinnitus returned as before the injection."

Its also interesting that the tinnitus returned once the anaesthetics wore off.

Theres a lot of literature saying that the lateral pterygoideus is responsible for sliding the condyle out of its socket, as theres no other muscle positioned to be able to do this movement.

But could injections to the lateral pterygoideus remove some of the tension to the suprahyoid muscles?
Maybe this is actually what happened when people got their lateral pterygoideus injected?

The digastric also works as a jaw depressor, and when the lateral pterygoideus contracts, it would make sense that the digastric would be affected as well. They all seem to work in a finely tuned manner.

On the other hand, I know that in some people, the auriculo-temporal nerve passes through the lateral pterygoideus, which makes this nerve susceptible to compression from the LP.

I have read that a lot of people have got somatic tinnitus from noise, stress, anxiety and physical trauma, and I do believe that some, if not many of those cases might be related to muscular tension.

It would be interesting to learn more about the sonomotoric reflexes, as it could provide a clue as to what muscles might be involved, and how the acoustic reflex really works. It seems like most of the acoustic-stimulated-muscle reflexes are thought to be a brainstem reflex because of its short latency.

 

@applewine

Also, have you tried to massage your lateral pterygoideus from inside your mouth?
I bought some rubber gloves and started doing that, and pretty much each time I do it, I get the sensation of sudden pressure change in my ears and the LP starts to spasm.

I mean, if the lateral pterygoideus is healthy and is not a part of this problem, I find it very weird that it acts up like that.

I havent injected the muscle yet though, as I got a little skeptical of injections after my little sternocleidomastoid incidence and it left me unable to sleep due to extreme dizziness.

 

@Mr. Cartman I've tried to massage my lateral pterygoids with gloves in my mouth many times. I have never been convinced I'm actually on the muscle or felt anything. If anything I feel like I'm on a tendon, flap of skin or just a part of the muscle that doesn't bother me.

I've had physical therapists and dentists examine it as well. The dentists would try to tell me it hurt because they pressed, but they were always pressing on some flap of skin that was tearing or stretching too much or something. The physical therapist most recently didn't do anything, but on the one he tried really hard it just left a thinned and irritated skin spot. It may have caused some discomfort with the jaw a few days after that too.

I've only had success from the outside fit that is the lateral pterygoid.

Of note I was just raising my shoulders to stretch from back back while sitting up very straight or curved back a little and each time I raised my shoulders I would feel pain in my temples.

I was also massaging my psoas muscle a lot and seem to find a lot of interesting referal to the back pain. Not sure if it was the back pain or not. You might want to just learn about fidning the psoas easily all the way up and down at all points and how to feel for pain.

As I mentioned before there is supposed to be some link between the psoas and the jaw and pain mirroring.

 

@applewine

It could very well be a connection there and it wont hurt to get rid of some tension in the pelvis area anyways, however Im slightly skeptical about the connection though, but I remember I read the webpage you pasted regarding the psosas and the neck and jaw connection. Who knows

Ive started doing some serious exercises of the neck though, and yesterday my neck got so sore that I had a hard time moving it around

 

@applewine

Not sure if this has been posted before, but thought you might find it intersting.

Abstract:

Tinnitus represents one of the most common and distressing otologic problems, and it causes various somatic and psychological disorders that interfere with the quality of life. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. In this case report we present a potential treatment, namely pulsed radiofrequency to the ganglion C2.

Keywords: neurology, otolaryngology, tinnitus

--------------------------------------------------------------------------------

INTRODUCTION
Tinnitus is characterized by the perception of sound in the absence of external stimuli. More than 35 million American adults experience tinnitus1, with 2-3 million severely debilitated by this distressing symptom. Although many adjust successfully, others are severely disabled by the condition2.
Numerous neurological, vascular and other somatic disorders have been linked to the development of the tinnitus3. Therefore no single treatment will be effective for treating all tinnitus patients. Different treatments will be needed for different subgroups. Possible treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression4. In this case report we present a possible treatment for tinnitus, namely pulsed radiofrequency to the ganglion C2.

CASE REPORT
A 56-year-old male with a sixteen-year history of tinnitus was admitted to our pain clinic for treatment. He presented himself with complaints of tinnitus bilaterally and of equal intensity. His hearing was intact and he did not have any cervical complaints or dizziness. Ear nose and throat examination and audiogram did not reveal any specific disorders. The tinnitus was unresponsive to medication, in this case betahistine. Further medication included mirtazipine, an anti-depressant, and diazepam, a benzodiazepine. Both did not influence the intensity of his tinnitus.
Physical examination showed an intact movement of his cervical spine, hypertonic and painful trapezial muscles, and no other specific findings. Treatment via pulsed radiofrequency of the ganglion C2 was proposed. The patient gave informed consent to the treatment.
The procedure was performed by an experienced anesthesiologist on an outpatient basis. The procedure took place without sedation and by utilizing a C-arm fluoroscopic machine with a radiolucent table. The patient was placed in the prone position on the fluoroscopic table. The atlanto-occipital joint to be treated was marked in the anteroposterior view. The skin was prepared and two 22-gauge, 100 mm-long needles with a 5 mm active tip were placed and directed toward the posterolateral aspect of the atlanto-occipital joint, shown in Figure 1 A and B. The C-arm was rotated to the horizontal plane and the needles were then advanced between C1 and C2 until bone contact was made. After confirmation of correct needle placement the C2 ganglion was subjected to pulsed radiofrequency at 42 V, 2 Hz, and 10 ms for 120 seconds.

Figure 1. Anteroposterior and lateral view of the atlantooccipital joint and ganglion C2 with correct needle placement.

Following the procedure, patient stayed in the recovery-room for half an hour. The patient's vital signs were stable and he was discharged home in good health.
Four weeks later the patient presented himself for follow up. The tinnitus had resolved majorly, only minor tinnitus remained during the first hours after waking. After three months the tinnitus had not resurfaced, so no further follow-up or treatment was necessary.

DISCUSSION
Tinnitus represents one of the most common and distressing otologic problems, and it causes various somatic and psychological disorders that interfere with the quality of life5. If tinnitus persists for more than 2 years, it is considered permanent and irreversible.
Tinnitus does not represent a disease itself but is a symptom of a variety of underlying conditions6. There is considerable debate about its cause. Any pathologic lesion in the auditory pathway or any reduction in auditory nerve function has the potential to produce tinnitus6. However, in many cases no underlying physical cause is identifiable.
Several theories have been proposed to explain the mechanisms underlying tinnitus. Recent research has employed state-of-the-art imaging and measurement technology to examine tinnitus-related activity in the ear, auditory nerve, and auditory tracts of the brain. These studies have increasingly focused on exploring changes in putative brain-related mechanisms. The complexity of these changes in the nervous system associated with tinnitus might explain why this condition has proved so resistant to treatment.
Chronic tinnitus can be caused by whiplash injuries or functional disorders of the cervical spine7. Craniocervical tinnitus is argued to be caused by central crosstalk within the brain, because certain head and neck nerves enter the brain near regions known to be involved in hearing. Complex multimodal interactions exist between the auditory pathway and other sensorymotor systems innervating the head, neck and shoulders. The atlanto-axial joint and the ganglion C2 can play a role in maintaining the complaints of tinnitus and symptoms can be alleviated via transcutaneous electrical nerve stimulation8. This can be explained via a neuronal pathway described in 1997 by Jansen and Loewy, located in the spine and of sympathetic origin9. Via pseudorabies virus injections in the stellate ganglion they were able to transneurally label a pathway that connects the cervical spine with the second thoracic vertebra and eventually connects with the superior cervical ganglion. These neuronal pathways enable us to explain sympathetic sensory input to result in innervation of the cochlea in the inner ear, and thus cause tinnitus.
Tinnitus remains difficult to treat, care may be directed towards management rather than cure. However, C2 ganglion treatment may prove promising, as shown in this case-report and earlier studies. Further research seems justified to better demonstrate and understand the positive effect of C2 ganglion blockade in tinnitus. In our opinion, C2 ganglion blockade seems worthwhile in patients with treatmentresistant tinnitus. Especially, as it is a feasible and safe technique when performed by an experienced anesthesiologist10.

REFERENCES
1. Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. 2010 Aug;123(8):711-8.
2. Malouff JM, Schutte NS, Zucker LA. Tinnitus-related distress: A review of recent findings. Curr Psychiatry Rep. 2011 Aug;13(1):31-6.
3. Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. N Engl J Med. 2002 Sep 19;347(12):904-10.
4. Seidman MD, Standring RT, Dornhoffer JL. Tinnitus: current understanding and contemporary management. Curr Opin Otolaryngol Head Neck Surg. 2010 Oct;18(5):363-8.
5. Byung In Han, Ho Won Lee, Tae You Kim, Jun Seong Lim, and Kyoung Sik Shin. Tinnitus: Characteristics, Causes, Mechanisms, and Treatments. J Clin Neurol. 2009 March;5(1):11-19.
6. Shulman A, Goldstein B, Strashun AM. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates. Int Tinnitus J. 2009;15(1):5-50.
7. Folmer RL, Griest SE. Chronic tinnitus resulting from head or neck injuries. Laryngoscope. 2003 May;113(5):821-7.
8. Transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for the treatment of somatic tinnitus. Vanneste S, Plazier M, Van de Heyning P, De Ridder D. Exp Brain Res. Jul 2010;204(2):283-7.
9. Jansen AS, Loewy AD. Neurons lying in the white matter of the upper cervical spinal cord project to the intermediolateral cell column. Neuroscience. 1997 Apr;77(3):889-98.
10. Halim W, Chua NHL, Vissers KC. Long-term pain relief in patients with cervicogenic headaches after pulsed radiofrequency application into the lateral atlantoaxial (C1-2) joint using an anterolateral approach. Pain Pract. 2010;10:267-71.

Source: http://www.tinnitusjournal.com/detalhe_artigo.asp?id=508

 

Has any one tried KKT (Khan Kinetic Treatment) ive heard that it has been very helpful for spine pain, and whiplash which causes tinnitus

 

I mentioned my somewhat unusual experiment hypothesis with manipulating acetylcholine through a certain behavior modification that I mentioned before which may be causing excessive acetylcholine release. This behavior has been explained to release or be related to acetylcholine, though it is certainly not the only neurotransmitter involved.

After two weeks I've noticed I've had fairly frequent nightmares and I normally don't remember dreams at all. I'm waking up multiple times with nightmares. I suspect this is a result of neurology of the brain shifting. After doing some searching I found it was hypothesized that low levels of acetylcholine cause nightmares:

"we hypothesize that the low levels of acetylcholine could lead to sleep disturbance and nightmares"
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505136/

The integrated hypothesis of trigger points also states that trigger points are caused by:

"motor endplates release excessive acetylcholine, which is evidenced histopathologically by the presence of sarcomere shortening [1]. These areas of intense focal sarcomere contraction have been described in animals and humans." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440564/

Thus this is why I wanted to see if I could lower my acetylcholine release and see if that would decrease trigger points, or perhaps make them treatable. The constant nightmares my be an indicator of my acetylcholine lowering.

I plan to see if I can keep my acetylcholine levels low for at least 90 days, or run the experiment for that long.

 

@applewine

Thats one heck of a theory, Ill give you that!

But who knows, maybe it actually might be something to it.. Please keep me posted about your experiment

I guess this is why I love reading your posts as well, as you read up a lot, make up a few theories and try them out!

 

@Mr. Cartman Is is a long-shot alright. But either way I'd like to see what it does.

 

Also if you ever want to get tested for lyme disease I think I found a DNA test for it which may be reputable and more advanced than previous tests: http://www.dnalymetest.com/

The other test is using antigens developed by George Mason University with Cernes Nano.

I think if possible it is best to use antigens and DNA which are direct detection methods rather than antibodies which current tests rely on.

The entire Borrelia genus should also be tested for. A second bacterial genus to test for is Bartonella. These may cause chronic disease or prevent optimal health which makes one more prone to developing syndromes like myofascial pain syndrome as a perpetuating factor. I know literature said chronic infections could perpetuate trigger points.

**Edit: I should warn that even if these tests come up positive you should not jump to treatment as the test may not be fully validated at this time and there may be no effective treatment anyway.

 

Yeah, me too! Im actually quite interested to hear about your results

 

I dont quite suspect Lyme though.. But good to know that there are better tests being developed.

 

I'm not so active here anymore. But treatment is still ongoing every week. And I'm seeing a new physiotherapist for my lower back. She made a scan of my spine with a Spinal mouse.

http://www.flare.ch/aditus/main.html

It's not the way it should be, so I got some homework from her. Excersises and due to report twice a week.

I stopped looking for papers and reading stories here. I had the flu for 1 week and my T was lower I think.

But overall it's 50% less than onset. After each session with the manual therapist I feel a bit sick/nauseous. I feel that there is a lot of work to do left. I feel pain in my face, neck, headaches. But every month it's different, less or sometimes temporarily more, I feel improvement. I discuss every aspect of treatment, improvement, homework and excersizes with them. That's the only thing I can do.

And I have fun with my friends in the weekends on non loud events, like a poker night yesterday. When it suddenly turned dead quiet in the room it pops up. Sometimes it freaks me out, but sometimes it does not.

And if you ask my therapists for any forecasts, they refuse to give any. Unknown. But I'm so glad that there is improvement, although the pain and costs are high. And I rest a lot. 10-11 hours of sleep a day are usual.

 

@Mr. Cartman I've been focusing on my scales or muscles in the neck a lot the last few days. I did a google search and found this:

"Some good examples of these relationships are as follows. The temporalis often compensates for inhibited neck flexors and gluteals. The masseters often inhibit those same muscles and the hip flexors. The pterygoids often inhibit the scalenes, the latissimus dorsi, the obliques, the quadratus lumborum, and the hip abductors. If these relationships are left unattended the tension in the jaw muscles increases tremendously resulting in the aforementioned symptoms. Remember that the tension in these muscles is a result of a faulty relationship with other muscles/functions. To simply release these muscles without first figuring out what they are compensating for, could result in destabilizing functional integrity. Treat the cause not the symptoms."
http://neurokinetictherapy.com/temporomandibular-joint-dysfunction

I'm not sure if they are saying the scalene cause the pterygoid problem.