Somatic Tinnitus and Treatment ⁠— New Evidence

[Hazel]

Dearest members,

As you may know, Tinnitus Talk contributes to tinnitus research through collecting patient data and sharing it freely with researchers. This has already led to a number of academic publications co-authored by us. Just last month a paper was published based our data about tinnitus heterogeneity. And now our second co-authored research paper of 2019 has just been published! You can find the full publication here.

The paper covers the topic of somatic tinnitus, i.e. tinnitus that can be modulated through neck or jaw movements. Little is yet known about how common this form of tinnitus is and how it influences tinnitus severity and fluctuations in tinnitus; this paper addresses these questions. The main author is Sarah Michiels, a physiotherapist from the University of Antwerp.

The data for this paper was gathered by us back in 2017, when over 6,000 tinnitus patients (mostly members of this forum) filled in a survey with questions about head and neck pain, jaw discomfort, tinnitus severity, and the effects of exercise on tinnitus. We have attached the full results of the survey below. If anyone is interested to do some statistical analysis on this or other datasets, let us know! I'm sure there is more to be learned from this data.

Of course you may wonder: How does this knowledge help me, even if I do have somatic tinnitus? Indeed, the next step is to develop treatments suitable for this group. To this end, we are working with Sarah to develop a self-help physiotherapy programme, based on her experience treating tinnitus patients. Following the right set of (simple) neck exercises can alleviate tinnitus loudness for some, particularly if they suffer from frequent neck pain AND are able to modulate their tinnitus with neck movements.

Please let us know what you think of this research and whether a treatment programme for somatic tinnitus would be of help to you!

Best regards,
Hazel and Markku

 

[JohnAdams]

Good work. Fire whoever picked the colors for the bar charts.

 

[Hazel]

Fire whoever picked the colors for the bar charts.

Yeah that looks awful

But it's just what data looks like when you extract it from SurveyMonkey unfortunately. We could've made our own nice-looking charts from the raw data, but maybe our time was better spent elsewhere

Thanks for the positive feedback!

 

[Chriscom]

I don't have anything constructive to add since I don't believe this is the source my affliction--but I did want to say how lucky we are to have you and the rest of the volunteers running Tinnitus Talk. Well done and thank you!

 

[Mathew Gould]

My main tinnitus noise is NOT somatic. However I have a secondary lesser noise I can create with neck movements. My tinnitus 100% started with neck and jaw issues...

Is my tinnitus somatic??

 

[Rb86]

It's odd, my tinnitus is most definitely noise induced, I can trace it back to a specific event, however I can make it louder if I push my jaw out.

 

[GregCA]

It's odd, my tinnitus is most definitely noise induced, I can trace it back to a specific event, however I can make it louder if I push my jaw out.

That is not odd: it is the basis for bimodal stimulation. Many etiologies for T end up with a common maladaptive plasticity process that this kind of treatments targets. When that process happens, it turns out that muscle movement can often be perceived as a sound modulation.

 

[Autumnly]

It's odd, my tinnitus is most definitely noise induced, I can trace it back to a specific event, however I can make it louder if I push my jaw out.

Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss

"2.2 Changes in Somatosensory innervation to the CN after cochlear damage
Multisensory neurons in general have a propensity for receiving cross-modal compensation following sensory deprivation (Allman et al., 2009). This susceptibility is manifest in the CN as an increase in the number of VGLUT2-positive terminals in CN regions that receive somatosensory inputs. In contrast, the number of VGLUT1-positive terminals decreased (Fig. 6). Together, these changes signify an enhanced somatosensory influence on the CN after auditory nerve denervation of the CN (Zeng et al., 2009). This altered balance of inputs from auditory and somatosensory structures affects bimodal integration, imparting greater strength to the somatosensory inputs. One physiological consequence of the increased number of VGLUT2- positive inputs is that DCN neurons become more responsive to somatosensory stimulation following cochlear damage (Shore et al., 2008).

[...]

Consistent with strengthened somatosensory inputs to the CN shown by Zeng et al., (2009) and Shore et al., (2008), FMRI results showed that jaw movements evoked more activity in the CNs of tinnitus subjects than in non-tinnitus subjects (Fig. 5; (Lanting et al., 2010)."
- Plasticity of somatosensory inputs to the cochlear nucleus – implications for tinnitus

 

[Rb86]

Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss

"2.2 Changes in Somatosensory innervation to the CN after cochlear damage
Multisensory neurons in general have a propensity for receiving cross-modal compensation following sensory deprivation (Allman et al., 2009). This susceptibility is manifest in the CN as an increase in the number of VGLUT2-positive terminals in CN regions that receive somatosensory inputs. In contrast, the number of VGLUT1-positive terminals decreased (Fig. 6). Together, these changes signify an enhanced somatosensory influence on the CN after auditory nerve denervation of the CN (Zeng et al., 2009). This altered balance of inputs from auditory and somatosensory structures affects bimodal integration, imparting greater strength to the somatosensory inputs. One physiological consequence of the increased number of VGLUT2- positive inputs is that DCN neurons become more responsive to somatosensory stimulation following cochlear damage (Shore et al., 2008).

[...]

Consistent with strengthened somatosensory inputs to the CN shown by Zeng et al., (2009) and Shore et al., (2008), FMRI results showed that jaw movements evoked more activity in the CNs of tinnitus subjects than in non-tinnitus subjects (Fig. 5; (Lanting et al., 2010)."
- Plasticity of somatosensory inputs to the cochlear nucleus – implications for tinnitus

Thanks Autumnly. For whatever it's worth, as my symptoms fluctuate, during less intrusive periods, jutting out my jaw only barely increases my hiss. When it's more bothersome, the jaw push out is more noticeable. I tend to refrain from doing it because, why make it louder after all.

 

[Rb86]

Forgive my not knowing, but am I correct in reading that bimodal stimulation benefits don't last once you stop doing the process?

 

[ChrisBoyMonkey]

Forgive my not knowing, but am I correct in reading that bimodal stimulation benefits don't last once you stop doing the process?

No the benefits last for at least a year for Neuromod Lenire. Some users on here who have been in trials with similar devices' benefits appear to have lasted indefinitely.

 

[Jan124]

It's odd, my tinnitus is most definitely noise induced, I can trace it back to a specific event, however I can make it louder if I push my jaw out.

Did the tinnitus start immediately after the event or days after?

 

[GoatSheep]

Forgive my not knowing, but am I correct in reading that bimodal stimulation benefits don't last once you stop doing the process?

@linearb was in a Michigan trial and Susan Shores lab tech told him the devices were continuous use. Check the Michigan thread. I screenshotted where he told me that from another thread and posted it there. He also said that was his experience. That he was having his tinnitus begin to go back up after 48 hrs cessation. Perhaps this has changed as I think he was in the first Trial.

 

[ChrisBoyMonkey]

@linearb was in a Michigan trial and Susan Shores lab tech told him the devices were continuous use. Check the Michigan thread. I screenshotted where he told me that from another thread and posted it there. He also said that was his experience. That he was having his tinnitus begin to go back up after 48 hrs cessation. Perhaps this has changed as I think he was in the first Trial.

Last I emailed her she said the effects appear to be cumulative, so further use brings further reduction. If we have to keep using the device daily, so long as it keeps the noise suppressed/ eliminated, no problem here.

 

[Rb86]

Did the tinnitus start immediately after the event or days after?

Definitely days after.

 

[Greg Sacramento]

We know that hearing loss can cause tinnitus and most likely it would not involve a somatic reaction. Somatic tinnitus can happen on it's own without hearing loss. When someone with hearing loss tinnitus gets somatic issues, injury to the neck and stress with the spinal trigeminal often happened.

If you have hearing loss tinnitus and gain somatic tinnitus, 95% of the time it's the neck and then often the jaw. Somatic tinnitus happening regardless of cause is more likely to happen when having regular tinnitus, than not.

If you don't have regular tinnitus and get somatic tinnitus - only 65% of the time it's the neck and then jaw. The other 35% is most likely sinus and/or ETD or something other than neck/jaw.

https://en.wikipedia.org/wiki/Spinal_trigeminal_nucleus

 

[linearb]

We know that hearing loss can cause tinnitus and most likely it would not involve a somatic reaction.

Er, unless I'm misunderstanding something you're saying, I don't think this is correct. Specifically, all the bimodal devices are working on this basic principle:

when hearing loss occurs and auditory input to the DCN is reduced, the DCN sometimes rewires itself such that touch-sensing neurons are cross-wired into the feed from the DCN to the auditory cortex to make up for the lost input.

The entire way the bimodal tech is supposed to work is (transiently) reversing this cross-wiring, and as far as I know, 80% of people with tinnitus can manipulate the sound with neck/jaw movement. I don't think this is because they have serious somatic issues, I think it's because their touch-sensing neurons are generating audio percepts.

With this as a hypothesis, it makes a great deal of sense that people with neck/jaw/shoulder tension or injuries would experience louder tinnitus when those conditions are not managed, because those nerve pathways are generating more data, and hence more audio percepts.

I am not disputing that there may be "true" somatic tinnitus, IE when a TMJ issue is compressing a nerve in a non-destructive way which can be remediated with a bite split. But, I think this has to represent a minority of tinnitus cases (and such people will not benefit from bimodal stimulation, I would suspect).

 

[Greg Sacramento]

@linearb Yes, I'm referring to those with actual physical tinnitus. This can be somatic and often is, but I mention the possible base physical problems neck/jaw. ETD, sinus without including the word physical. I don't disagree with the theories discussed in the last several posts above as I have often gave links myself.

There are many articles and research that include the stats for those having physical problems and tinnitus. My stats are based on a cross section average noted in a past Tinnitus Journal article where I gave a link to before.

Susan Shore with reference to somatic physical tinnitus and devices has mentioned if there's an actual physical problem such as with the jaw - the physical problem must be fixed before lasting relief would happen. This would refer to looping and so much more.

For those with physical tinnitus - pain also uses the pathways to the brain. This would include all the professional study links provided by me that describe the many processes of biological physical input. I believe that device use will help many, but I'm more interested in restoring hair cell damage/ear damage and medications (brain) when there's pain associated to physical cause of tinnitus or not.

 

[Halsy]

I much prefer the term somatosensory tinnitus to somatic. Somatic tinnitus is a combination of hearing loss and/or damage and/or neck/spine problems and/or TMJ issues. Where you can have one or even two of these issues and it may not set off the tinnitus but then something occurs and that's the proverbial straw that breaks the camel's back. In my case I had some hearing loss in the upper range - nothing unusual for my age. Some advanced disc generation throughout my CTL spines, again nothing bad enough to warrant surgery. Then because of abscessed tooth which became an acute sinus infection boom, that's when my tinnitus started - an overload of the CNS via the trigeminal nerves. That sort of thing is classic somatosensory tinnitus. Ultimately you can say it's a result of neuromuscular inflammation.

What most people don't know is that when the brain undergoes a significant event - not necessarily trauma - the subconscious registers it as an important event and tells the conscious mind to lay down a path to recall said event. The fault is that the conscious mind basically says, 'Well if it's that important we'll just keep the experience going.' And it creates neural pathways that do just that. That's what causes confusion in the DCN. Your brain doesn't know how to let go. Even though the physical issue(s) that started the tinnitus are resolved - which should resolve the tinnitus - it doesn't stop.

I work out regularly - every other day. And exercise always makes my tinnitus worse for a couple of hours. Particularly when I'm focusing on back and neck work. However, it's really anything that engages those muscle groups at all modifies my tinnitus - makes it louder. Yawning puts my tinnitus through the roof though trying to stretch my jaw barely moves it all.

I don't think that resolving somatic tinnitus really has anything to do with exercise and has everything to do with resetting the brain to allow the tinnitus neural pathways to decay - which is what resolves tinnitus. And that can be accomplished via neuromodulation and increasing neuroplasticity, or via Dr. Shore's method of resetting the DCN via microbursts of electricity. It may be that a combination of two - if one of them doesn't resolve it alone - may, in fact, be the best bet for resolving somatic tinnitus. At the end of the day tinnitus is a neurological condition regardless of how it started and that's how it needs to be resolved.

Edit: That's why CBT has been effective in resolving tinnitus for a lot of people and why it's so effective for so many - 85% on average. By retraining your brain you're actually bringing about physical changes within it.

 

[Simon Czt]

@Halsy Do you think that pulsating tinnitus that have a somatic base can also be regulated by bimodulation? I wonder a lot about that.

 

[Halsy]

@Halsy Do you think that pulsating tinnitus that have a somatic base can also be regulated by bimodulation? I wonder a lot about that.

So do I. For a condition like mine where the PT is due to deteriorating bone in the inner ear canal we won't know until the tinnitus resolves. For "classic" PT I doubt it. The damnable thing about PT is it's - in most cases at any rate - caused by a physical obstruction - collapsed vein, blood turbulence from atherosclerosis, impinged artery, etc. So the only way to resolve it is to physically correct it. I know some people here have said they had a good deal of success in resolving their PT through a combination of exercise and physical therapy - osteopath, chiropractor, et al. suggesting that maybe there was a kink somewhere impeding an artery and when it was removed the artery could get back to work as normal.

For example my traps - my left one in particular - is always knotted and hard as a brick - and it definitely plays into my somatic tinnitus. After I've been to a really good massage where they've worked the shit out that thing my tinnitus will initially increase for an hour or so but than drop down to a 1 or 2 for the next day or so. So that's part of the neuromuscular aspect of it I mentioned. I may try an osteopath for a bit this Spring and see if that makes a difference - I won't go near chiropractors myself.

 

[GregCA]

For a condition like mine where the PT is due to deteriorating bone in the inner ear canal we won't know until the tinnitus resolves.

Which bone exactly is deteriorating for you?
Have you been put on any meds that help preserve bone mass?

 

[mikki_]

If anyone is interested to do some statistical analysis on this or other datasets, let us know! I'm sure there is more to be learned from this data.

Hello Hazel,
Can you share this data? I am interested in the bad vs. good day variations. For example can we predict the individuals with higher day to day to variations. I'll post some results here.

 

[Adrianfox]

If anyone is interested to do some statistical analysis on this or other datasets, let us know! I'm sure there is more to be learned from this data.

@Hazel - If you require any further statistical analysis in the future please feel free to get in contact with me. I'm a Six Sigma Black Belt by industry, I live and breathe data analysis!

Although I feel that my tinnitus will end up temporary (here's hoping), I have experienced enough pain and desperation to want to drive change.

 

[Rajin]

@Hazel thank you so much for the work you and @Markku do!

Do you know of any event, small or big, for tinnitus in Europe. Anywhere besides England, for Tinnitus Week?

Can you let me know. I see there's something in England but for other countries I am not finding anything.

What is the big thing where lot of people go to every year on February 3 to 9?

Thanks.

 

[Hazel]

@Hazel thank you so much for the work you and @Markku do!

Do you know of any event, small or big, for tinnitus in Europe. Anywhere besides England, for Tinnitus Week?

Can you let me know. I see there's something in England but for other countries I am not finding anything.

What is the big thing where lot of people go to every year on February 3 to 9?

Thanks.

Hey Rajin, thanks for the positive feedback! Unfortunately, I don't know of any events outside the UK either. It seems the British Tinnitus Association is the only one organising events for tinnitus patients.

Tinnitus Week takes place mostly online.

Where in Europe are you? Is there a national tinnitus association where you live? Perhaps they might organise something.

 

[Alberte]

Dearest members,

As you may know, Tinnitus Talk contributes to tinnitus research through collecting patient data and sharing it freely with researchers. This has already led to a number of academic publications co-authored by us. Just last month a paper was published based our data about tinnitus heterogeneity. And now our second co-authored research paper of 2019 has just been published! You can find the full publication here.

The paper covers the topic of somatic tinnitus, i.e. tinnitus that can be modulated through neck or jaw movements. Little is yet known about how common this form of tinnitus is and how it influences tinnitus severity and fluctuations in tinnitus; this paper addresses these questions. The main author is Sarah Michiels, a physiotherapist from the University of Antwerp.

The data for this paper was gathered by us back in 2017, when over 6,000 tinnitus patients (mostly members of this forum) filled in a survey with questions about head and neck pain, jaw discomfort, tinnitus severity, and the effects of exercise on tinnitus. We have attached the full results of the survey below. If anyone is interested to do some statistical analysis on this or other datasets, let us know! I'm sure there is more to be learned from this data.

Of course you may wonder: How does this knowledge help me, even if I do have somatic tinnitus? Indeed, the next step is to develop treatments suitable for this group. To this end, we are working with Sarah to develop a self-help physiotherapy programme, based on her experience treating tinnitus patients. Following the right set of (simple) neck exercises can alleviate tinnitus loudness for some, particularly if they suffer from frequent neck pain AND are able to modulate their tinnitus with neck movements.

Please let us know what you think of this research and whether a treatment programme for somatic tinnitus would be of help to you!

Best regards,
Hazel and Markku

Hey Rajin, thanks for the positive feedback! Unfortunately, I don't know of any events outside the UK either. It seems the British Tinnitus Association is the only one organising events for tinnitus patients.

Tinnitus Week takes place mostly online.

Where in Europe are you? Is there a national tinnitus association where you live? Perhaps they might organise something.

1

@Halsy Do you think that pulsating tinnitus that have a somatic base can also be regulated by bimodulation? I wonder a lot about that.

@Hazel thank you so much for the work you and @Markku do!

Do you know of any event, small or big, for tinnitus in Europe. Anywhere besides England, for Tinnitus Week?

Can you let me know. I see there's something in England but for other countries I am not finding anything.

What is the big thing where lot of people go to every year on February 3 to 9?

Thanks.

 

[ThomasC]

Am I the only one who can stop the tinnitus by clenching the jaw ? It just stops for one second

 

[Time4fix]

Am I the only one who can stop the tinnitus by clenching the jaw ? It just stops for one second

I have the same, sometimes it stops for a couple of seconds.

 

[Rajin]

I am in USA but I went to a support group here. I was looking for big events in Europe. Thanks.