What Do You Think About the Somatosensory Approach of Tinnitus Explanation?

Discussion in 'Dr. Stephen Nagler (MD)' started by Tinniger, Dec 4, 2019.

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    1. Tinniger

      Tinniger Member Benefactor

      Location:
      Germany
      Tinnitus Since:
      06/2017
      Cause of Tinnitus:
      increasingly uncertain, maybe noise, maybe somatic ?
      I only have tinnitus on my left side. I can make a noise in my left ear much louder than the continuous tinnitus by various methods (pressure on the scalp, on the root of the nose, on the cheek, by moving the jaw, by negative pressure in the mouth...).

      My persistent tinnitus seems to be only a subset of the noise I can provoke by moving myofascial structures.

      In a well-known German tinnitus clinic the term "somatic tinnitus" was unknown or dismissed as insignificant.

      What do you think about the somatosensory approach of tinnitus explanation?

      Regards,
      Tinniger
       
    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      @Tinniger, thank you for your question.

      You know, if you ask five tinnitus authorities about "somatic tinnitus" or the "somatosensory approach," you will likely get five different opinions. Well, I do not consider myself to be an authority, and what I am about to say is by no means written in stone. It’s just an opinion.

      OK, with that disclaimer out of the way, as I see it strictly from a pragmatic standpoint, tinnitus is tinnitus is tinnitus is tinnitus. Period.

      I specifically make reference to a "pragmatic standpoint" because all I am concerned about is the tinnitus sufferer (i.e., the fine folks who seek support and advice on this site) and not the tinnitus researcher (most of whom have little or no interest in sites like this at all). I suspect, indeed I sincerely hope, that it would be very important for a researcher who is searching for a cure for tinnitus or for an approach to achieving lasting mitigation of tinnitus intensity to identify the various causes of tinnitus. But from a practical standpoint, in 2019 once a person actually has tinnitus, there are only a handful of causes that can be corrected with the reasonable expectation that the tinnitus will be eliminated or lastingly reduced in intensity. And we already know what those causes are! That's why you go to an ENT: (1) to identify the (unfortunately, quite rare) causes that can be corrected with the reasonable expectation that the tinnitus will be eliminated or lastingly reduced in intensity, and (2) to identify the (fortunately, even rarer) causes that represent a threat to health or life. A very simplistic example of (1) would be impacted earwax causing a conductive hearing loss. If the ENT finds impacted earwax causing a conductive hearing loss and removes that wax, there is a reasonable expectation (no guarantees!) that the tinnitus will be for all intents and purposes eliminated. An example of (2) would be - and please don't look this up - leptomeningeal carcinomatosis, which is incredibly rare and uniformly fatal. The thing to keep in mind is that it takes at most two or three visits to the ENT (and audiologist) to rule out all of (1) and all of (2), and after that has been done, the specific cause (permanent hair cell damage from aminoglycosides, somatic tinnitus, whatever) becomes clinically irrelevant. Sure, you can try massage, etc. for somatic tinnitus, but other than the relaxation benefit, most folks have found no lasting value in terms of tinnitus improvement. So the reason I say that tinnitus is tinnitus is tinnitus is tinnitus is that once the ENT has gone through (1) and (2) and until such time that research comes up with effective treatments directed at correcting the cause of any given person's tinnitus with the reasonable reasonable expectation that his or her tinnitus will be eliminated or lastingly reduced in intensity, then the focus of folks like myself must be directed at how to help tinnitus sufferers suffer less (or not at all!) in spite of having tinnitus rather than contemplating stuff like the "somatosensory approach of tinnitus explanation." More to the point, I personally would discourage that sort of contemplation because the net result is your spending more and more time unnecessarily attending to your tinnitus, when you necessarily attend to it enough as is.

      Now before you throw your hands up in frustration and disgust, please please please re-read the paragraph above that starts with the words "You know ..."

      All the best -

      Stephen M. Nagler, M.D.
       
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