Link Between High Psychological Tension, Tensor Tympani Muscle, Hyperacusis and Tinnitus

[Josh59]

Hello,

Do you think that a high psychological tension (stress, anxiety, hypervigilance) can indirectly/unconsciously tighten the middle ear muscles (tensor muscle of the tympanum) and that during a sound input, the muscle being already tightened, triggers hyperacusis (discomfort, pain), and thus sends a tinnitus signal (sound reactive tinnitus)?

What do you think about this?

This would prove that hypervigilance and chronic stress would maintain and/or aggravate the symptoms?

 

[MindOverMatter]

Yes @Josh59, personally I do believe there is a clear link.

Speaking of my own personal experience.

This is also something my counsellor/audiologist have explained/confirmed to me.

Not a very scientific answer though - I'll leave that to experts on the field...

 

[addot]

Hello,

Do you think that a high psychological tension (stress, anxiety, hypervigilance) can indirectly/unconsciously tighten the middle ear muscles (tensor muscle of the tympanum) and that during a sound input, the muscle being already tightened, triggers hyperacusis (discomfort, pain), and thus sends a tinnitus signal (sound reactive tinnitus)?

What do you think about this?

This would prove that hypervigilance and chronic stress would maintain and/or aggravate the symptoms?

I take it you have probably read this paper?

An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock

I'm assuming you have, since a lot of what you're saying is basically what these researchers say as well. Namely, that prolonged stress and hypervigilance may lower the threshold for tensor tympani contractions.

Worth noting that, in a follow up paper, the same authors examined some 11 patients and shed some more light on how the TTM contracts. If I'm interpreting it correctly, it was previously thought that in periods of auditory stress, the TTM did a looong, sustained (tonic) contraction; it basically stayed contracted the whole time, like you described. But in that study, none of the patients had these contractions. Rather what happened was simply that their TTM had a lower volume threshold for contraction. These were much shorter (phasic) contractions, usually in response to a sound that caused them distress, like a pen dropping or a baby crying.

Anyway, as far as I know this model hasn't been proven yet. If the model is right, than you would be right, but keep in mind that the model describes anxiety/stress/hypervigilance as one part of a complex chain of events that happen following an acoustic shock, including inflammation, vasoconstriction, and trigeminal nerve activation. So anxiety wouldn't really be The Thing that leads to pain; only one among many factors.

If you hadn't read that paper though... those were some good instincts!

 

[Josh59]

I take it you have probably read this paper?

An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock

I'm assuming you have, since a lot of what you're saying is basically what these researchers say as well. Namely, that prolonged stress and hypervigilance may lower the threshold for tensor tympani contractions.

Worth noting that, in a follow up paper, the same authors examined some 11 patients and shed some more light on how the TTM contracts. If I'm interpreting it correctly, it was previously thought that in periods of auditory stress, the TTM did a looong, sustained (tonic) contraction; it basically stayed contracted the whole time, like you described. But in that study, none of the patients had these contractions. Rather what happened was simply that their TTM had a lower volume threshold for contraction. These were much shorter (phasic) contractions, usually in response to a sound that caused them distress, like a pen dropping or a baby crying.

Anyway, as far as I know this model hasn't been proven yet. If the model is right, than you would be right, but keep in mind that the model describes anxiety/stress/hypervigilance as one part of a complex chain of events that happen following an acoustic shock, including inflammation, vasoconstriction, and trigeminal nerve activation. So anxiety wouldn't really be The Thing that leads to pain; only one among many factors.

If you hadn't read that paper though... those were some good instincts!

Thank you for your feedback.

I will read this article.

I have already been on the phone with Arnaud Norena and his team.

To date, as you mention, it remains complex.

For me, and this is what is difficult, is that I cannot know the cause of the aggravation of my tinnitus and hyperacusis, whereas since 2017 (appearance of a central/left tinnitus), I pay attention and I do not go to noisy places anymore. And if I go to a noisy place I protect myself.

Now it's several high frequencies, some of which can be modulated with the jaw, neck and posture.

And the thresholds of tolerance to sound have dropped.

To date, I have an occlusal mouthpiece (because I also have a TMJ problem which has also worsened during these 5 years) to try but for the little that I use it (at night), the tinnitus is more intense or different. So I don't dare try it for fear of making it worse.

 

[Aleph]

Namely, that prolonged stress and hypervigilance may lower the threshold for tensor tympani contractions.

I don't think there is a "threshold for tensor tympani contractions". It doesn't work as a digital machine which measures the intensity of sounds and reacts when it detects a certain value. That is absurd.

What keeps tensing the tensor tympani is the mind and the particularities of those muscles. But is has nothing to do with a "threshold".

 

[SonOfUhtred]

I've had a pretty good day on the whole with my hyperacusis but having just had a stressful hour with my family it's just flared up. Came onto Tinnitus Talk and this is the first post I see. I'm noticing it more and more that it's triggered by these kinds of episodes. Not all the time but I'd say a large percentage.

 

[addot]

I don't think there is a "threshold for tensor tympani contractions". It doesn't work as a digital machine which measures the intensity of sounds and reacts when it detects a certain value. That is absurd.

What keeps tensing the tensor tympani is the mind and the particularities of those muscles. But is has nothing to do with a "threshold".

But that's what I mean. It's also literally what the authors say; I'm using their words. I don't think they're using "threshold" in the sense that it's a super accurate, machine-like system that will contract if a sound is 70 dB but won't contract if it's 69.9999 dB. It just means that your brain (presumably) needs less sound to trigger contractions compared to normal people. It is very much a process mediated by the mind; in fact, the example I related from one of their studies (the fact that hyperacusis patients involuntarily contract their TTM in response to sounds that they identify as distressing, like a pen dropping and a baby crying) supports that idea.

 

[addot]

Thank you for your feedback.

I will read this article.

Most welcome! I hope you find it enlightening.

For me, and this is what is difficult, is that I cannot know the cause of the aggravation of my tinnitus and hyperacusis, whereas since 2017 (appearance of a central/left tinnitus), I pay attention and I do not go to noisy places anymore. And if I go to a noisy place I protect myself.

Now it's several high frequencies, some of which can be modulated with the jaw, neck and posture.

And the thresholds of tolerance to sound have dropped.

I'm sorry to hear that. I have often times found it difficult to process that I have caused and worsened my own hyperacusis (obviously non intentionally), but I have also thought that having this happen to you with no discernible cause might feel just as devastating. I am sorry that we have to go through this, and I hope we can both find some measure of relief.

 

[Aleph]

But that's what I mean. It's also literally what the authors say; I'm using their words. I don't think they're using "threshold" in the sense that it's a super accurate, machine-like system that will contract if a sound is 70 dB but won't contract if it's 69.9999 dB. It just means that your brain (presumably) needs less sound to trigger contractions compared to normal people. It is very much a process mediated by the mind; in fact, the example I related from one of their studies (the fact that hyperacusis patients involuntarily contract their TTM in response to sounds that they identify as distressing, like a pen dropping and a baby crying) supports that idea.

Ok, I understand your point. I was just talking about the concept. I read the paper you mention more than two years ago, and I don't remember exactly what words they used.

Normally, this tensor tympani shouldn't contract. It could move only subtlety in a way that we don't notice it. Or it could move or contract when we yawn, for example, but in a way that is not uncomfortable.

But once the abnormal contraction is made, things could be different.

"Fullness" seems to be muscle tension. I think it persists psychosomatically. But it also has to do with the particularities of the tensor tympanis. When they are tensed up, they don't relax immediately. It is like they are swollen or "erected". That is at least the impression we have. It is like a vicious circle.

Do you have "spasms"? I am OK now, I don't suffer anymore. But sometimes, when I am around a lot of harsh and loud sounds, I could get these spasms in one ear. They seem like a rapid movement of the tensor tympani, with a swooshing sound. I think the movement might be similar than when we yawn, but this one is much more rapid. It is not about a threshold, but about a certain abnormal, "nervous" state of this mechanism. In this state, the tensor tympani (or whatever it is) can react like that. But it is not about a reduced threshold just because this "spasm" is never present normally. That is my point.

So, in conclusion, "fullness" and "spasms" are only abnormal things only present in an abnormal state of this mechanism. There is no "reduced threshold" compared to a normal situation. These things are not present normally.

 

[Josh59]

Hello,

I wanted to mention the link between the (chronically) tight tympanic tensor muscle in relation to the rather mechanical problems of the body, especially of the muscles of the jaw or the neck.

What do you think about this?

And do you think there may be a link between hyperacusis and somatosensory modulated tinnitus?

I ask this question because beyond the sound, I wonder if my hyperacusis (different between the two ears) is also accentuated with the pressures, muscular tensions of the jaw, the neck...

I saw that Dr. Laure Jacquemin from the University of Antwerp in Belgium is doing an exploration on the role of somatic modulation in hyperacusis.

To talk about the low thresholds mentioned earlier in the discussion, what is strange is that sometimes sounds at 40/50 dB can cause the eardrum to vibrate with pain or not, while sometimes sounds at 70/80 dB will not cause any problem.

Is this normal? Is it a question of the frequency of the sound? Or is it a problem of tensor muscle tension as mentioned earlier in the discussion?

 

[Aleph]

@Josh59, how was your noise trauma?

I think in most cases, the problem begins when the Tensor tympani mechanism is abnormally tensed up. And in general this is not a consequence of sound by itself. The sounds produce discomfort or fear and this makes us contract or "frown" the Tensor tympani mechanism. In cases of acoustic shocks, that is, sudden sounds close to the ear, people make an abrupt contraction of different muscles of the face, and the Tensor tympani could be tensed up abnormally. Also, people with TTTS after these incidents, usually experience not one, but several more or less consecutive acoustic shocks, and that is what produces this abnormal Tensor tympani state, because every shock adds up a bit of tension.

Also, people can end up having this Tensor tympani state for reasons different from sounds. Like jaw issues or a concussion like a punch in the face.

So, when we have this abnormal state of this mechanism, we can experience sound discomfort with certain sounds, especially the ones with fast attack or with certain texture. That is why sounds with lower volume can be more bothersome than stronger ones. Or there could be vibrations or thumps or pain with sounds at low decibels.

So, sound intolerance is a consequence of the state of this mechanism, not a cause.

And what keeps this mechanism from recovering is the attention we give to the problem, but also the physical particularities of the mechanism.

And I think that tinnitus could also depend on the physical tension of the mechanism and the attention we give to the problem.

Now, I don't know if what is tensed up is the Tensor tympani, or the veli palatine or whatever... Or how the Eustachian tube function is affected… Or if my "spasms" are movements of the Tensor tympani... It must be difficult to know. I am just guessing based on Klockhoff and subsequent studies and what is usually called TTTS.

 

[Josh59]

Hello @Aleph,

I must have had several small sound traumas without realising it by listening to music on headphones for many years.

I would get tinnitus after listening but then it would disappear within a few hours.
But the strange thing is that since July 2017 (and the arrival of chronic tinnitus), although I no longer go to noisy places, all the symptoms have worsened.
Much more somatosensory modulated tinnitus frequencies, more reactive, and hyperacusis (different between the two ears) more pronounced.

That's why I wonder if my TMJ problems (which have also worsened), have not accentuated the phenomenon of hyperacusis and reactive tinnitus, in addition to the nervous tensions.

Or is it a problem with the surrounding sound which could explain a degeneration of the auditory areas in the brain?

I'm planning to move to a quieter, more sound-secure place soon to reduce the emotional load.

I will therefore see if this will have an effect on the hyperacusis, the tinnitus or if it is more of a mechanical cause linked to my posture/jaw problems which sensitise the muscles of the middle ear and which cause tinnitus.

In any case it remains complicated because my hyperacusis and especially the tinnitus remain sensitive either to sound or to the jaw problem.

 

[Rafaa]

Interested that I've found people who have the same symptoms as me. I've had all imaging, and there's no diagnosis.

I want to get my ME muscles lasered away but how do I know it will solve it? The best in the UK has confirmed no microcompression. So what else could it be other than those damn middle ear muscles? For the record my ear rumbles when I scratch the right side of the back of my head. Sometimes on a flare up, even my forehead and eyelid. I notice when having hypertension there's that thumping in the ear. I hear internal sounds, I can make a drum sound by tapping on my neck. This is all in one side. Even though both sides have tinnitus. The only difference between both sides of my head, is apparently larger arteries and veins, slight high pitched hearing loss, and previous goitre on the problem side.

I also have temple pain, around the eye, and just above the jaw. When I touch the temple its usually accompanied with a spasm of some sort. I'm willing to try things before going for the laser route. But don't know what.

Because of this, I avoid stress, exertion. Life basically. Anyone else feel the same?

 

[Dougie Kyle]

Interesting question. I have been getting very stressed and panicky since a trauma to one ear during noisy DIY some weeks back.

I find that, in the mornings, when I get stressed out at the prospect of going out, the sound sensitivity increases very much and my ear rings more in reaction to speech.

My doctor says I have intermittent tinnitus and hyperacusis but that it should 'resolve' itself given time.

Strange thing is the ringing is not continuous like so many describe here. From what I've read it seems they classify any ear ringing as tinnitus.

 

[Kirara]

Do you think that a high psychological tension (stress, anxiety, hypervigilance) can indirectly/unconsciously tighten the middle ear muscles (tensor muscle of the tympanum) and that during a sound input, the muscle being already tightened, triggers hyperacusis (discomfort, pain), and thus sends a tinnitus signal (sound reactive tinnitus)?

What do you think about this?

This would prove that hypervigilance and chronic stress would maintain and/or aggravate the symptoms?

I strongly believe there is a link.

It wasn't until I received some face relaxing massages and try to relax/calm that my hyperacusis started to calm down.

Also the quality of sleep I was having had an impact on my recovery.

 

[MaxRabbit]

100% stress can be the trigger that causes tinnitus. There are papers on this and in particular to women who endure extreme mental trauma for long period getting tinnitus. I also have reactive tinnitus and constant ear crackles. Stress over long periods raises cortisol. Your brain cells become toxic after cell death. MS, Parkinson's, Alzheimer's and tinnitus are diseases noted in these articles that are now allowed to function in the brain.

It's a very ugly thing but I'm quite certain my super high anxiety over all of my life killed my ears (blood flow trauma). I'm trying to get a ultrasound scan on my neck and head vessels. Certain they are a mess.

Stress & Hyperacusis Paper:

Acute Stress Induces Hyperacusis in Women with High Levels of Emotional Exhaustion

 

[Guest48603]

I'm 100% certain this is true. I had an ear injury from a diving accident many years ago. Everything returned to normal. My hearing was above normal.

Then I got a kiss on the ear canal, and tinnitus and hyperacusis were the result.

Everything calms down, but sudden new exposures to loud sounds trigger it again. The thing is, it can occur in either ear, even the one that hasn't had any issues.

The more I stress about it, the worse it gets. I'm convinced it is psychosomatic.

 

[NancyR3394]

Yes definitely

 

[Rafaa]

I don't think there is a "threshold for tensor tympani contractions". It doesn't work as a digital machine which measures the intensity of sounds and reacts when it detects a certain value. That is absurd.

What keeps tensing the tensor tympani is the mind and the particularities of those muscles. But is has nothing to do with a "threshold".

I don't agree with this.

I certainly believe and experience a lower threshold for what causes my middle ear muscles to contract as a result of whatever damage happened to this ear. It doesn't have to be a particular value.

 

[Josh59]

Hello,

I'm coming back to you on this subject to inform you that my somatosensory tinnitus (which I can modulate) is much stronger. The intensity and volume have increased. They remain strong and persist over time.

As I have painful hyperacusis which also tends to get worse, do you think that hyperacusis can increase the volume of somatosensory tinnitus? Or do you think that somatosensory tinnitus only increases through triggering effects from the head and neck?

The problem is that somatosensory tinnitus (very annoying) tends to increase without being in "harmful" sound environments.

I'm confused as I don't know if this is due to hyperacusis (the sound not being loud), or only due to tension, bad posture of the head, jaw and neck.

Finally, the cracking (noise in the ear or Eustachian tube), while swallowing my saliva, increases the tinnitus. I can even make it crack/crunch on purpose, as if I were contracting a muscle. This creates this noise in the Eustachian tubes/ears and increases the tinnitus. Is it this noise that accentuates the tinnitus or the muscle tension in the Eustachian tube/eardrum?

What do you think?