I Need Your Theories on My Somatic Tinnitus

[Melike]

Hi all! It's been a long time since I posted in threads on Tinnitus Talk. I was trying to move on with my life and I did successfully, but I still have questions about what might be causing my tinnitus and tinnitus related symptoms and whether there is a possibility that it might be treatable, at least to some extent.

My tinnitus started almost two years ago, one night in dead silence, totally out of nowhere and never went away. There has been a few silent hours (I mean zero ringing) in the past two years I must say or it sometimes decreases crazily, but 95% of the time it's there with varying degrees from 1-7 (very rarely 9-10).

These are my symptoms. I actually have two different noises;

1) Regular high pitched ringing on left, which half of the time feels like a hissing sound now. I can modulate this ringing in some ways. I can increase this particular ringing if I clench, move my jaw backwards (retraction), yawn and sometimes if I chew hard temporarily.

2) Typewriter or morse code on left. It comes and goes in bouts. It is sometimes here for 3 days and then gone, sometimes for 1 month and gone. It has started 1 month after the regular tinnitus onset. It has a characteristic like; brrrbbbb... brrrrrrb... brb... brrrrrrb (very similar to morse code). It sometimes turns into a regular tone for a few seconds; brrrbbbb... brb... brbb... brrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr (lol). Here is the most interesting part; I can stop this typewriter sound if I push right in front of my TMJ or I can modulate it by moving my ear canal (every side that I move my ear canal creates different noises). If I sleep on my left side it is non existent (because there is the pressure from my pillow), if I turn to left or try to sleep on my back, it is existent. This tinnitus is very strange and I feel like it is caused by 100% somatic reasons. This morse code went thru the roof when I got a middle ear infection 5 months ago, it felt like somebody is pressing every single key of a piano but sometimes alternating fingers. Once the infection cleared up, it went away.

3) I have TTTS on my left side. Not only the noises, additionally I most of the time get ear spasms (this fluttering thing) if I touch the area around my left ear, my left cheek, chin or the area near my eyes.

4) I have TMJ on my left side, but some of the specialists said it is very mild. But I hear a clicking noise everytime I open my mouth and my jaw sometimes get locked if I am eating something big and hard to chew (green apples). No pain whatsoever but difficulty chewing, tired jaw muscles etc. I am not sure if I clench while sleeping or not but my tongue is generally pushing against my palate and I have malocclusion (my upper front teeth is never in line with my lower front teeth). The TMJ MRI report said everything is fine with my TMJ though.

5) I have neck issues as well, started 2 years before that tinnitus onset. I have a straightened cervical spine but no herniation as far as I know.

6) I also have a small lesion (7mm) on my left parotid gland. We found out about it very recently and actually have no idea whether it is benign or malign. Most doctors said it is nothing to worry about and would not cause tinnitus, but it is actually very close to the tinnitus ear and problematic TMJ area of my left side.


Now, I need some theories on this complicated set of symptoms. I would appreciate if some of you have any knowledge / experience with any of this and come up with something. Because I am drowning myself in theories right now.


Sorry for the long post and thank you in advance.

 

[Melike]

No one? Really

 

[JohnAdams]

No one? Really

Well, what's the theory you feel like makes the most sense?

 

[Melike]

Well, what's the theory you feel like makes the most sense?

I have some nerve entrapment somewhere. But I don't have the time, energy and will power to invest 100+ hours to research a million possible cause and their potential treatment. I feel exhausted. So I thought since this is a support forum, somebody could help me by contributing his/her theory but apparently no one is interested.

 

[Tinniger]

Somatic tinnitus is a difficult matter.

I sometimes believe that at least some of my complaints are due to a shift in attention. Or it is due to the fact that at some point one has started to modify the ear noise by somatic measures.

In your description I notice that you name both TMJ and TTTS as causes. But to have both symptoms is very unlikely.

When opening the mouth and especially when swallowing, the ears crack in all people due to the pressure equalization in the middle ear via the Eustachian tube.
Once you have started to listen to your hearing, it becomes difficult to get away from it. And at the end you don't know if this "beeping" has always been there when the lower jaw is moved.

Excuse me, but I myself am also trapped in this tinnitus insanity. Also only in the left ear, a hiss that is mild on some days and unbearably loud on other days....

 

[Greg Sacramento]

It may be the straighten c spine from cervical muscular spasms causing upper front teeth not inline with lower front teeth. I have recently mentioned several times from who I consider the best therapy researchers that non alignment of front upper and lower teeth as a cause. Also nerve entrapments in several areas of upper anatomy.

It may take months with focused attention to keep lips closed and front teeth inline. Along with this - freeing
up disc space for the c spine may be needed by gentle upward motions of neck. A MRI may be needed before aggressive treatment, so go easy with cervical treatment. Consider that any pain increases may have nerve involvement as nerves may be pressured against other anatomy. The vestibular nerve, occipital nerves and complex are probably in play.

 

[spedgas]

It may be the straighten c spine from cervical muscular spasms causing upper front teeth not inline with lower front teeth. I have recently mentioned several times from who I consider the best therapy researchers that non alignment of front upper and lower teeth as a cause. Also nerve entrapments in several areas of upper anatomy.

It may take months with focused attention to keep lips closed and front teeth inline. Along with this - freeing
up disc space for the c spine may be needed by gentle upward motions of neck. A MRI may be needed before aggressive treatment, so go easy with cervical treatment. Consider that any pain increases may have nerve involvement as nerves may be pressured against other anatomy. The vestibular nerve, occipital nerves and complex are probably in play.

This teeth non alignment is the first I'm hearing on this. I'll have to dig through your old posts to check this out. I'm treating my tinnitus like it's TMJ derived. My front teeth are not inline. I have a decent overbite. When I close my mouth I only have four teeth that touch. The top and bottom two in the back are the only ones that touch. I brux on those all night. I'm thinking that's what got me to this point.

 

[Melike]

I sometimes believe that at least some of my complaints are due to a shift in attention. Or it is due to the fact that at some point one has started to modify the ear noise by somatic measures.

In your description I notice that you name both TMJ and TTTS as causes. But to have both symptoms is very unlikely.

When opening the mouth and especially when swallowing, the ears crack in all people due to the pressure equalization in the middle ear via the Eustachian tube.
Once you have started to listen to your hearing, it becomes difficult to get away from it. And at the end you don't know if this "beeping" has always been there when the lower jaw is moved.

Hi Tinniger. I know how it is to be drown in self doubt, paranoia and hypochondria, I've been there. But I am sure as hell that this beeping hasn't been always beet with me.

And this 'Clicking' sound is different from what you describe as the 'cracking' we hear when we swallow due to eustachian tube movements. It is directly the sound of the disk in your TMJ being dislocated every time you move your lower jaw.

In your description I notice that you name both TMJ and TTTS as causes. But to have both symptoms is very unlikely.

I don't actually know why they are unlikely to be present together?

Excuse me, but I myself am also trapped in this tinnitus insanity. Also only in the left ear, a hiss that is mild on some days and unbearably loud on other days....

I hope you'll be in a better mood soon. I agree that somatic tinnitus is poorly understood. It is quite annoying because you feel somehow trapped in between the possibilities that you think might help your Tinnitus and you have to consistently apply each one of them, it gets crazily difficult to measure the outcome. It is darn exhausting for me with a starting career, last semester at school, a home to take care of and an upcoming wedding ceremony.

 

[Melike]

It may be the straighten c spine from cervical muscular spasms causing upper front teeth not inline with lower front teeth. I have recently mentioned several times from who I consider the best therapy researchers that non alignment of front upper and lower teeth as a cause. Also nerve entrapments in several areas of upper anatomy.

It may take months with focused attention to keep lips closed and front teeth inline. Along with this - freeing
up disc space for the c spine may be needed by gentle upward motions of neck. A MRI may be needed before aggressive treatment, so go easy with cervical treatment. Consider that any pain increases may have nerve involvement as nerves may be pressured against other anatomy. The vestibular nerve, occipital nerves and complex are probably in play.

Thanks Greg. Then I should go over your last postings and have a look at the articles you mentioned. I'll give Magnesium a try although I don't think it will do some significant change because the last time I got a blood test, I was not deficient.

I actually found a pretty good dentist / TMJ specialist in my area who has a understanding in Tinnitus and nerve entrapment possibilities but not quite sure she %100 understands the neck issues. And finding a similar specialist for the neck is quite difficult, may be impossible in Turkey.

How are you doing?

 

[Greg Sacramento]

@spedgas
https://trainingandrehabilitation.com/true-cause-solution-temporomandibular-dysfunction-tmd/

Close your jaw with full occlusion (molar contact). Relax the jaw without moving it. Try to retract (pull back) the mandible.

I recommend the full series of articles from this source for treatment ideas.

 

[Tinniger]

I don't actually know why they are unlikely to be present together?

I only meant that it is unlikely that two rare tinnitus causes should be present at the same time.

It is well known that the probabilities have to be multiplied by each other...
All in all, the question "somatic" is obviously totally in the dark anyway...

 

[Greg Sacramento]

@Melike I came back here because of the need to use more words. If you wish we could also talk by PM.

First, don't worry because physical treatment will help.

The reason I asked about dental procedures and headaches is to question your body posture while in the dental chair. Suspecting more increased loss of normal c spine curve, ankylosing spondylitis or TOS.

TOS may lead to migraines in the absence of vertebral artery compression. Tightness (due to weakness) of the scalenus muscles will compress the subclavian artery, especially during ipsilateral rotation and extension of the neck. As the subclavian artery compresses, the blood that is supposed to enter the arm is forced to redirect into the head. In result, intermittent or sometimes even chronic hyper perfusion of the carotid an vertebral arteries may occur. For you the carotid artery would not be involved. TOS has development as discussed, but when the neck is lifted and slightly turned with TOS, muscle spasms of neck will straighten or straighten the c spine more. With this there's a compression reaction to subclavian and vertebral arteries. I have a reward winning study on this - the only online study about this that I will post later.

This link is from a site, that I valuable when I'm posting research/treatment.
https://trainingandrehabilitation.com/how-truly-treat-thoracic-outlet-syndrome/

We will talk more about treatment and it's not difficult. You are young.
With mention to prior discussion of last few days, an infection may have came and is now gone.
I would focus on the cranial jaw cradle.

 

[Melike]

@Melike I came back here because of the need to use more words. If you wish we could also talk by PM.

First, don't worry because physical treatment will help.

The reason I asked about dental procedures and headaches is to question your body posture while in the dental chair. Suspecting more increased loss of normal c spine curve, ankylosing spondylitis or TOS.

TOS may lead to migraines in the absence of vertebral artery compression. Tightness (due to weakness) of the scalenus muscles will compress the subclavian artery, especially during ipsilateral rotation and extension of the neck. As the subclavian artery compresses, the blood that is supposed to enter the arm is forced to redirect into the head. In result, intermittent or sometimes even chronic hyper perfusion of the carotid an vertebral arteries may occur. For you the carotid artery would not be involved. TOS has development as discussed, but when the neck is lifted and slightly turned with TOS, muscle spasms of neck will straighten or straighten the c spine more. With this there's a compression reaction to subclavian and vertebral arteries. I have a reward winning study on this - the only online study about this that I will post later.

This link is from a site, that I valuable when I'm posting research/treatment.
https://trainingandrehabilitation.com/how-truly-treat-thoracic-outlet-syndrome/

We will talk more about treatment and it's not difficult. You are young.
With mention to prior discussion of last few days, an infection may have came and is now gone.
I would focus on the cranial jaw cradle.

Thanks a million times again @Greg Sacramento ! It feels really great to have somebody trying to help you figuring out the potential causes after rejections from various specialists, doctors, experts whatever with zero solution.

I am fairly new to the neck anatomy and I even figured out I have TOS yesterday! Before then the only thing I knew was the weakness of my left arm, continuous pins and needles and the fact that I can't do squats with weights or shoulder exercises because when I raise my hands above my head ( especially with weights) my left arm gets purple and numb, basically no blood flow. I even have a picture with a purple arm while squatting It happened after a nasty rotator cuff injury and I hear lots of crackling noises when I move my shoulders since then. Anyways, since I am new to neck anatomy, I'll have to thoroughly read what you wrote and the article as well and definitely will do it.

I am actually familiar with trainingandrehabilitation.com, I actually contacted its author, Kjetil, about my TMJD and was planning to purchase a Skype consultation with him, but I can't afford it at the moment. But his articles are one of the most detailed ones with trustworthy treatment suggestions I believe.

I am trying to figure out if my TOS can relate to my problems on my T side. Regular T, typewriter T that can be modulated moving the ear canal, TTTS, exploding head syndrome at certain places...All on the left. I remember my T almost disappearing for a few minutes two times after yoga sessions. I found out this ;

Tinnitus, by definition, is a latin word meaning "ringing" in the ears. Tinnitus in patients with TOS and/or costoclavicular compression is the result of compression of the inferior bicuspid valve of the internal jugular vein. This results in turbulence of the venous return, like pouring water in a glass. The blood backs up into the sigmoid sinus adjacent to the tympanic membrane of the ear that the patient interprets as a low-pitched sound and/or ringing in the ear - that has been described as a swooshing sound. 6.

I would like to know what you think and I am passionately waiting for this award winning article . Thanks again !

 

[Greg Sacramento]

"The subclavian artery feeds the vertebral arteries in the neck, and thus disorders of the subclavian can interact with vertebral blood flow. The thoracic outlet syndrome would be unlikely to affect vertebral blood flow as narrowing of the subclavian in TOS occurs after the vertebral arteries take off from the subclavian."

"The subclavian steal syndrome is provoked by movement of the arm, rather than turning the head on neck. Thus it is also an unlikely cause of cervical dizziness. A very narrowed subclavian that reduced blood flow to the vertebral, might cause a vascular type of cervical dizziness but one would think that this syndrome would be dominated by poor blood flow to the arm."

"All of these mechanisms would presumably be associated with blockage of flow on turning the neck to one side or the other. It is usually of significance only in persons who have a substantial asymmetry in their vertebral circulation -- one being much smaller, or one being absent or terminating in PICA."

"It is presently considered a problem when there is mechanical compression during head rotation due to muscular and tendinous insertions, osteophytes, and arthritis around the C1-C2 level. As the vertebral arteries enter the vertebrae around C4, it can also occur at lower levels. As about 50% of cspine rotation occurs around C1, this is likely the reason for the predominance at this level. Araz Server et al (2018) reported reduced flow in the ipsilateral vertebral artery when the head was both hyperextended and rotated. Perhaps a position mainly encountered in dental offices."

https://www.dizziness-and-balance.com/disorders/central/cervical/cervical.html
---------------------------------------------------------------------------------------------------------------------------

I am actually familiar with trainingandrehabilitation.com, I actually contacted its author, Kjetil, about my TMJD and was planning to purchase a Skype consultation with him, but I can't afford it at the moment. But his articles are one of the most detailed ones with trustworthy treatment suggestions I believe

I would try some of the PT mentioned in his article to treat TOS.
I know a couple of PT departments of major hospitals that use his methods for TOS among his methods for other things such as TMJ.

 

[Melike]

"The subclavian artery feeds the vertebral arteries in the neck, and thus disorders of the subclavian can interact with vertebral blood flow. The thoracic outlet syndrome would be unlikely to affect vertebral blood flow as narrowing of the subclavian in TOS occurs after the vertebral arteries take off from the subclavian."

"The subclavian steal syndrome is provoked by movement of the arm, rather than turning the head on neck. Thus it is also an unlikely cause of cervical dizziness. A very narrowed subclavian that reduced blood flow to the vertebral, might cause a vascular type of cervical dizziness but one would think that this syndrome would be dominated by poor blood flow to the arm."

"All of these mechanisms would presumably be associated with blockage of flow on turning the neck to one side or the other. It is usually of significance only in persons who have a substantial asymmetry in their vertebral circulation -- one being much smaller, or one being absent or terminating in PICA."

"It is presently considered a problem when there is mechanical compression during head rotation due to muscular and tendinous insertions, osteophytes, and arthritis around the C1-C2 level. As the vertebral arteries enter the vertebrae around C4, it can also occur at lower levels. As about 50% of cspine rotation occurs around C1, this is likely the reason for the predominance at this level. Araz Server et al (2018) reported reduced flow in the ipsilateral vertebral artery when the head was both hyperextended and rotated. Perhaps a position mainly encountered in dental offices."

https://www.dizziness-and-balance.com/disorders/central/cervical/cervical.html
---------------------------------------------------------------------------------------------------------------------------

I would try some of the PT mentioned in his article to treat TOS.
I know a couple of PT departments of major hospitals that use his methods for TOS among his methods for other things such as TMJ.

Unlikely to directly to cause T then. Worth treating to prevent it getting worse over time & contributing to jaw& neck problems anyways.

What do you think about neural therapy or lidocaine injections to muscle trigger points?

 

[Greg Sacramento]

What do you think about neural therapy or lidocaine injections to muscle trigger points?

Weird, I was reviewing articles - lidocaine and various injections 30 minutes ago for the both of us.
I go for it. For myself with all my degenerate diseases of neck and trauma of nerves in jaw - regular, somatic and pulse tinnitus maybe from my soft palate, I might do the same.

I did use lidocaine once and it helped.
Didn't you try it and it helped also for a short time?

 

[Melike]

Weird, I was reviewing articles - lidocaine and various injections 30 minutes ago for the both of us.
I go for it. For myself with all my degenerate diseases of neck and trauma of nerves in jaw - regular, somatic and pulse tinnitus maybe from my soft palate, I might do the same.

I actually found an incredible dentist & tmj specialist in Turkey who have case reports of resolving tinnitus, chronic pain, neuralgia, dizziness, migraines etc. Some of them were published as medical scientific articles here. I went for an examination but she wanted to be sure that the mass on my parotis was harmless before starting treatment. Also I need my remaining two wisdom teeth to be extracted as well before treatment. ( Tho one of them is touching my sinus right now and an ENT suggested not removing it because it is risky). I think I'll give it a try. I'll let you know.

 

[Tinniger]

I did use lidocaine once and it helped.

How and where did you use lidocaine?
Lidocaine is known to be a sodium channel blocker and thus a local anaesthetic that blocks the transmission of action potentials in nerve cells.

 

[Melike]

Weird, I was reviewing articles - lidocaine and various injections 30 minutes ago for the both of us.
I go for it. For myself with all my degenerate diseases of neck and trauma of nerves in jaw - regular, somatic and pulse tinnitus maybe from my soft palate, I might do the same.

I did use lidocaine once and it helped.
Didn't you try it and it helped also for a short time?

I am not quite sure about that. It was not an injection, only a numbing cream and it did not work when I tried it for the second and third time. It cannot be absorbed like an injection anyways so I didn't have too much expectations.

How did you try it and how did it help? For how long? To which area it was applied ?

 

[Mathew Gould]

Weird, I was reviewing articles - lidocaine and various injections 30 minutes ago for the both of us.
I go for it. For myself with all my degenerate diseases of neck and trauma of nerves in jaw - regular, somatic and pulse tinnitus maybe from my soft palate, I might do the same.

I did use lidocaine once and it helped.
Didn't you try it and it helped also for a short time?

If these injections help would they be something you would have to do forever or just most likely over a period of time?

 

[Greg Sacramento]

I don't often mention injection therapy if at all other to say that it has its risks. One being possible travel to other areas and another possible is more damage within specific locations . If I decided to use any of the different types injection therapy treatments it would be for temporary pain management. I have cervical and facial pain and very severe pain within my oral cavity.

 

[Melike]

I don't often mention injection therapy if at all other to say that it has its risks. One being possible travel to other areas and another possible is more damage within specific locations . If I decided to use any of the different types injection therapy treatments it would be for temporary pain management. I have cervical and facial pain and very severe pain within my oral cavity.

I seriously don't know anymore. Risks...Killing myself because of the suffering is a risk for me too.

 

[Greg Sacramento]

If these injections help would they be something you would have to do forever or just most likely over a period of time?

Hi Matthew: It depends on the condition, location, method and type of therapy medication. One needs to really do their homework and then have a discussion with a pain management doctor or specialized dentist. The doctor needs to know both the honest level of tinnitus and pain and if physical therapy or other treatments have been tired. This whole subject is controversial and different studies of conditions state differences of values or concerns. Some doctors who specialize in certain conditions may be bias and promote success, while other doctors may not have the skills and knowledge needed for a particular procedure.

It depends on all factors mentioned above as to length of time for pain relief.

 

[Jazzer]

Thanks a million times again @Greg Sacramento ! It feels really great to have somebody trying to help you figuring out the potential causes after rejections from various specialists, doctors, experts whatever with zero solution.

I am fairly new to the neck anatomy and I even figured out I have TOS yesterday! Before then the only thing I knew was the weakness of my left arm, continuous pins and needles and the fact that I can't do squats with weights or shoulder exercises because when I raise my hands above my head ( especially with weights) my left arm gets purple and numb, basically no blood flow. I even have a picture with a purple arm while squatting It happened after a nasty rotator cuff injury and I hear lots of crackling noises when I move my shoulders since then. Anyways, since I am new to neck anatomy, I'll have to thoroughly read what you wrote and the article as well and definitely will do it.

I am actually familiar with trainingandrehabilitation.com, I actually contacted its author, Kjetil, about my TMJD and was planning to purchase a Skype consultation with him, but I can't afford it at the moment. But his articles are one of the most detailed ones with trustworthy treatment suggestions I believe.

I am trying to figure out if my TOS can relate to my problems on my T side. Regular T, typewriter T that can be modulated moving the ear canal, TTTS, exploding head syndrome at certain places...All on the left. I remember my T almost disappearing for a few minutes two times after yoga sessions. I found out this ;

Tinnitus, by definition, is a latin word meaning "ringing" in the ears. Tinnitus in patients with TOS and/or costoclavicular compression is the result of compression of the inferior bicuspid valve of the internal jugular vein. This results in turbulence of the venous return, like pouring water in a glass. The blood backs up into the sigmoid sinus adjacent to the tympanic membrane of the ear that the patient interprets as a low-pitched sound and/or ringing in the ear - that has been described as a swooshing sound. 6.

I would like to know what you think and I am passionately waiting for this award winning article . Thanks again !

I want to butt in here folks, and say thank you to @Greg Sacramento , who never stops trying his utmost to help many very serious sufferers of these wretched hateful conditions, despite being under extreme pressure from nerve pain and screaming Tinnitus himself.
With his study, knowledge, experience and unending kindness, he is quite simply a gem on this Tinnitus Talk site.
I have thought this for a long time,
and it needed to be said and acknowledged.
I know you all value him folks. xx

 

[Melike]

Could not agree more. Thanks a billion times @Greg Sacramento. Thank you.

I want to butt in here folks, and say thank you to @Greg Sacramento , who never stops trying his utmost to help many very serious sufferers of these wretched hateful conditions, despite being under extreme pressure from nerve pain and screaming Tinnitus himself.
With his study, knowledge, experience and unending kindness, he is quite simply a gem on this Tinnitus Talk site.
I have thought this for a long time,
and it needed to be said and acknowledged.
I know you all value him folks. xx

 

[Mathew Gould]

Hi Matthew: It depends on the condition, location, method and type of therapy medication. One needs to really do their homework and then have a discussion with a pain management doctor or specialized dentist. The doctor needs to know both the honest level of tinnitus and pain and if physical therapy or other treatments have been tired. This whole subject is controversial and different studies of conditions state differences of values or concerns. Some doctors who specialize in certain conditions may be bias and promote success, while other doctors may not have the skills and knowledge needed for a particular procedure.

It depends on all factors mentioned above as to length of time for pain relief.

I will probably lay off for now with that injection... I've had a good month for having less annoying tinnitus. I think that NUCCA is helping me. Hopefully the tinnitus goes away. I go to a massage therapist tomorrow for the 1st time and then Wednesday back to the NUCCA for probably what is my 11th appointment.

 

[Dr. Jay Hobbs]

Hi @Melike ,
Did you get your answers covered. Somatic tinnitus is my primary tinnitus focus. It continues to amaze me, but there are only a few mysteries left related to it.
Here's an old video I did on it, and a couple followup ones in this playlist. I'm working on a new series of videos specifically related to TMJ and tinnitus treatments, but haven't published them yet:
Somatic Tinnitus Playlist: starting at video #21 in the "Tinnitus Questions Answered" playlist.
The real key for somatic tinnitus is not can it be classified as related to the soma (body), but is it somatic-caused, and even moreso, will it improve when the soma is treated successfully.