We know tinnitus to be the perception of a sound in either the ear or head that is not due to external stimuli. This means tinnitus is hearing a sound that isn’t due to any existing sound in our environment. Tinnitus is common, with more than 50 million people in the United States having tinnitus.
One common subtype of tinnitus is called somatic tinnitus, or somatosensory tinnitus. This tinnitus is caused by certain movements or pressure to an area of the body and is typically in the head, neck, or jaw, but can also occur from movements and pressure on our eyes or limbs.
Common conditions that may cause somatic tinnitus include diseases such as TMDs (jaw disorders like TMJ), cervical spine disorder, Paget’s disease of the bone, and restless legs syndrome.
One of the most common disruptive somatic signals happens with a muscle spasm of the sternocleidomastoid muscle (SCM) – the large muscle under your ear on both sides of your neck that rotates your head. What causes tinnitus in some patients is when this muscle spasms, which can be from any movement that causes twisting of the neck, including using a pillow at night, bending to look at a phone or computer, or any number of activities. In fact, the spasm and tinnitus may not occur immediately, but start several hours after the neck is twisted.
Causes Of Somatic Tinnitus
The real root cause of this tinnitus lies in the dorsal cochlear nucleus (DCN). This is part of our brainstem and is the first relay point in our brains that auditory signals go through on their way to the auditory cortex in the main part of the brain for further processing.
The DCN is the most important part of the brainstem for sending auditory signals to the auditory cortex area of the brain. It receives auditory signals from the hair cells in the cochlea, a part of our ears where sound is detected, as well as signals related to eye movements. It also receives signals from muscle position sensors and sends these to other areas of the brain. This means that sensory data from muscles and sound data from ears are relayed to the brain at almost the same point in the brainstem.
"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
– Steve D.
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Researchers currently believe that once inputs to the DCN or the DCN itself is damaged, neurons and their structures coming from the DCN enter a hyperactive state which can cause tinnitus. Because there is cross-talk between sensory and auditory signals, sensory input can cause or worsen tinnitus.
The DCN can be damaged in a number of different ways. Noise trauma causes damage, as do blows to the head, whiplash, TMJ dysfunction, grinding teeth (bruxism), muscle spasms, and some diseases.
Even though the sound and physical sensations of tinnitus appear to be emanating from the ear, researchers believe that the nerve impulses are generated not in the ear itself, but in the DCN. Because the DCN is so important in tinnitus, it is often said that tinnitus is primarily a brain phenomenon. Proof of this is that tinnitus can still occur after the auditory nerve has been cut. About 50% of those patients, who are now completely deaf, still experience tinnitus.
Orthodontic treatment, especially those dating back to one’s childhood, can position the teeth in such a way that stresses the maxillary and mandibular systems, which then causes a loss in sensorimotor integrity and can ultimately lead to somatic tinnitus.
Head And Neck Inflammation
Head and neck inflammation from tooth and root canal treatments, tonsil surgery, and sinus infections can all end up aggravating the trigeminal nerve, which reaches all the way to the brain stem and can trigger somatic tinnitus.
Any kind of dental surgery, such as tooth extraction, can put pressure on the jaw that creates rotation of the lower jaw and unwanted compression on the temporomandibular joint. The masticator muscles and TMJ joint are very sensitive organs, and we often see patients report the onset of somatic tinnitus six to 12 months after dental treatments.
Injuries And Accidents
Injuries and accidents — especially those to the head or neck area, including whiplash — can create undue tension and asymmetry in the neck’s muscles, and thus can trigger the onset of somatic tinnitus. This tension and asymmetry can even result from injuries in the shoulder or trunk region, as physical trauma in these areas can create similar muscle imbalances.
Medical injections in the shoulders, chest, neck, or head can cause inflammation and create a loss in sensorimotor integrity, which can then lead to somatic tinnitus.
Sitting with bad posture for long periods of time can create asymmetries in the body’s musculature and also create a loss in sensorimotor integrity.
How Can You Determine If You Have Somatic Tinnitus?
Somatic tinnitus usually occurs in one ear only. There are a number of other symptoms that show it may be somatic tinnitus:
1 – Intermittency
2 – Large fluctuations in loudness
3 – Variability of location
4 – Daily pattern
5 – No hearing loss, but a head, neck, or dental injury
You may notice a change in your tinnitus sometimes when you turn your head or move your jaw. Does this mean your tinnitus is somatic? A change in tinnitus due to somatic manipulation is a well-documented phenomenon. There are a variety of movements, called somatic maneuvers, that can help screen for somatic tinnitus.
These maneuvers work by performing a specific motion of movements or pressure to body parts such as the jaw, eye, head, neck, and limbs. This is done under the guidance of a professional to see if tinnitus is affected. Each maneuver is held for around five seconds.
Somatic maneuver methods for each body part:
- Clench teeth together
- Open mouth with and without pressure
- Protrude jaw with and without pressure
- Slide jaw to left with and without pressure
- Slide jaw to right with and without pressure
- Retract jaw
- Head in neutral position, with resistance to a force applied by the patient to each of the following:
- The occiput (back of head)
- The forehead
- The vertex (top of head)
- The mandible (lower jaw)
- The right and left temporal bones (sides of head)
- Left and right mastoid attachment of the sternocleidomastoid (near the protruding bone behind your ears)
- Forward and backward flexion of the neck
- Turning head to left and right
- With the head turned to the right, resist maximal torsional force applied by the examiner to the right zygoma (the outer part of your cheekbones)
- With the head turned to the left, resist maximal torsional force applied by the examiner to the left zygoma
- With the head turned to the right and tilted to the left, maximally resist full force applied by the examiner to the left temple
- With the head turned to the left and tilted to the right, maximally resist full force applied by the examiner to the right temple
- Movement of eyes horizontally and vertically
- Movement of eye diagonally to the upper and lower corners of the visual field
- Locking the patient’s flexed fingers of the two hands together and pulling them apart as forcefully as possible
- Right shoulder abduction (pushing away from the body) against resistance applied by the patient
- Left shoulder abduction against resistance applied by the patient
- Flexion of the right hip against resistance applied by the patient
- Flexion of the left hip against resistance applied by the patient
- Abduction of both hips against resistance applied by the patient
Several studies found that these methods did have an effect. One study looked at 310 patients with TMDs or neck dysfunction who had tinnitus. They found that 80% of these patients had modulation of tinnitus when somatic maneuvers were done. Studies also found a link between somatic tinnitus and somatic disorders, such as TMDs.
Other studies show that there is not a connection between somatic maneuvers and somatic tinnitus. Since the research is unclear, further research is needed to see if there are any specific maneuvers to reliably identify somatic tinnitus. Our team at Treble Health believes that this supports the idea that tinnitus can be a normal human experience.
What Treatments Are Available For Somatic Tinnitus?
When treating somatic tinnitus, it is crucial to first locate the trigger and then repair the situation accordingly. This is sometimes as easy as treating muscle scarring or inflammation, or as hard as addressing structural issues created by expensive dental procedures. There are a number of treatments for tinnitus. They may not always cure tinnitus for everyone, but treatment is possible.
The first step is to see a doctor for a medical workup to see if there are any issues present. This visit may need a follow-up with a physical therapist or a dental specialist. Treatments for TMJ, for example, can include wearing mouthguards at night, physical exercise, botox, or orthodontic work to realign things in the mouth.
Some studies have shown that treating related disorders can help alleviate somatic tinnitus. One study showed that six weeks of cervical therapy, which included manual therapy, exercise therapy, and home exercise, helped significantly with tinnitus in 20 of 38 patients with cervical somatic tinnitus. Another showed that nine weeks of lifestyle guidance, physical therapy, and facial treatment helped greatly for those with jaw-related tinnitus.
Another important note is that research keeps finding counseling is useful to improve somatic tinnitus. It is used primarily to understand more about how the body and mind work, as well as how your reactions and thoughts around tinnitus affect you and the tinnitus. One of our favorite things to say is that tinnitus itself isn’t harmful, so managing your stress and negative reactions to your tinnitus is key to an enjoyable life with tinnitus.
Biofeedback is also useful for this specific type of tinnitus in some cases. Biofeedback is when you use an instrument to monitor signals from your body and you can adjust them from there. In this case, muscle signals are used. The patient can then eventually learn to control these muscles again. This can be done at a biofeedback clinic.
Finally, another popular treatment is Transcutaneous Electrical Nerve Stimulation (TENS). These are little devices that connect electrodes to your skin. As a small electric current is sent through the electrodes, they help the inhibitory action of your DCN. This may reduce tinnitus. One study showed that 46% of participants had improved or resolved tinnitus by using the TENS unit. In this specific case, they used it at home for two hours a day for two weeks. It worked particularly well for those with intermittent and somatic tinnitus who didn’t have ear disease.
We hope we’ve demystified somatic tinnitus and shown that it does have the potential to be managed. It can be caused by a number of diseases, conditions, and incidents. Doctors can help treat the underlying condition causing it, the somatic tinnitus itself, or both of these if needed.