Somatic Tinnitus

Tinnitus is the perception of a noise or sound without a real external acoustic stimulus. The condition is considered a symptom and not a disease. This is because tinnitus is the symptom of another underlying condition. Currently, 11.9 to 30.3% of adults suffer from tinnitus. However, just 0.5 to 3% of those adults consider their condition something that affects their quality of life.

Most people who experience tinnitus want to know why the condition varies so dramatically. For many patients, the noise or sound they experience changes daily or gets worse at a particular time in the day. Others have symptoms after taking a nap. Some are fine after waking up, but experience sounds progressively getting louder throughout the day.

Certain patients even experience a rise in tinnitus symptoms when they move their jaw, head, or body in a specific way. There are so many reasons for the many triggers of tinnitus, such as increased salt usage in meals, stress levels, disease factors, and environmental conditions, all of which are responsible for short-term tinnitus modulations.

That said, a lot of people who experience tinnitus have somatic tinnitus. Before we go into detail about somatic tinnitus, let's develop a general understanding of tinnitus.

General Overview of Tinnitus

As we've learned, tinnitus generally refers to the perception of sound or ringing in a patient's ears.

Often, tinnitus results from underlying issues like circulatory system disorder, hearing loss, or ear injury.

Even though it can affect your quality of life or result in significant impairments to everyday activities, tinnitus typically isn't life-threatening. The most common symptom is the perception of phantom noises in your ears, like:

  • Clicking

  • Humming

  • Hissing

  • Roaring

  • Ringing

  • Buzzing

These phantom noises may vary in loudness from high to low and can happen in one ear or both. In some instances, the sound can be so loud that it hampers the patient's ability to hear external sounds or concentrate. Also, tinnitus can be present consistently, or it can come and go. 

There are two significant types of tinnitus, one being more common than the other: objective tinnitus and subjective tinnitus.

Subjective Tinnitus

Only the patient can hear this type of tinnitus. Subjective tinnitus is the most common form of this condition, and it can happen due to a range of issues, such as:

  • Problems in the middle inner or outer ear.

  • Issues with your auditory nerves.

  • Complexities in your auditory pathways, the area of your brain that interprets nerve signals as sound.

Objective Tinnitus

A doctor can hear this type of tinnitus while examining a patient, but it is extremely rare. Objective Tinnitus can be caused by:

  • Middle ear bone conditions

  • Muscle contractions

  • Blood vessel problems

What Is Somatic Tinnitus?

Somatic or somatosensory tinnitus (ST) is a subtype of subjective tinnitus caused by sensory information transmitted from the cervical spine or jaw to the brain.  

Your somatosensory system is part of your sensory nervous system, and it responds to changes in your body like movement, pressure, temperature, and pain. 

Like muscle spasms, somatic tinnitus can result from cervical (neck) or temporomandibular (jaw) changes.

Somatic tinnitus is also called conductive tinnitus or cervicogenic tinnitus. Conductive simply means “caused by outer functions.” The term cervicogenic means originating from your cervical spine or the nerves and muscles in the neck.

Common Somatic Tinnitus Risk Factors

Typical risk factors for other forms of tinnitus include hearing problems, being male, and your age. However, patients with somatic tinnitus show a different set of characteristics. Somatic tinnitus patients are usually younger females with no known hearing problems. 

The most typical musculoskeletal conditions that cause somatic tinnitus are cervical spine disorders and temporomandibular joint disorders. These patients show a significantly higher prevalence of craniomandibular disorder as well.

This makes sense since somatic tinnitus is modulated by pressure to the head, limbs, neck, eye, electrical stimulation of the median nerve, or muscle contraction.

Studies also show that somatic modulation appears in about two-thirds of tinnitus patients. 

What Does the Dorsal Cochlear Nucleus (DCN) Have To Do With Somatic Tinnitus?

Your body transmits sensory information to your brain through neural fibers in the brain's trigeminal, ganglion, or dorsal root ganglia. Because these fibers project to the auditory system, the signals can confuse somatic tinnitus patients’ brains into believing they hear sounds.

The Dorsal Cochlear Nucleus (DCN) is the first relay point or synapse that auditory signals pass through while heading to the auditory cortex for continued processing. The DCN is located at the base of your brain, and “dorsal” means the back of your cochlear nucleus.

Your DCN is the most vital brainstem region for relaying auditory signals to your brain’s auditory cortex segments. This area receives auditory signals from the cochlear hair cells responsible for detecting sound and signals associated with eye movements. 

The DCN also receives signals from muscle position sensors and sends them to other sections of your brain. Acoustic data emanating from your ears and sensory data from muscles are sent to the brain simultaneously in the brainstem.

This DCN can get damaged in various ways. For example, blows to the head, noise trauma, teeth grinding, whiplash, muscle spasm, and TMJ dysfunction can harm your DCN.

Once your DCN is damaged, your neuronal structures shift into a hyperactive state that initiates acoustics between sensory and auditory signals. At this point, sensory input affects auditory input and can worsen, cause, or modulate your tinnitus.

Although the sounds seem to be coming from the ear, the nerve impulses are generated in the DCN.

Because the DCN is so important for tinnitus, tinnitus is often considered a brain phenomenon. Tinnitus even occurs after the auditory nerve is removed, and deaf patients still experience tinnitus.

What Causes Somatic Tinnitus?

Specific triggers like muscle spasms, dental problems, and TMJ can cause somatic tinnitus. 

Muscle Spasm in the Neck

A spasm is an involuntary tightening of muscles in the body, which causes severe pain that can last for minutes or days. Spasms happen in any part of the body where there are muscles, including the neck.

One of the most common muscles around the neck is affected by spasms in the Sternocleidomastoid (SCM) muscle. The sternocleidomastoid muscle is located on either side of the neck behind the ears at the base of the skull.

The SCM goes down the front of the neck and attaches to the top of the collarbone and sternum.

The sternocleidomastoid muscle is responsible for:

  • Side to side head rotation

  • Chewing and swallowing

  • Bending the neck forward to bring the chin to the chest

  • Aiding respiration and breathing

  • Turning the neck to bring the ear to the shoulder

  • Stabilizing the head when it drops backward

Muscle tension or tightness in other parts of the body often causes sternocleidomastoid spasms.

Repeated activities like turning your head when using a computer, bending forward to type, poor posture, looking down at your phone, whiplash, sudden movements, sleeping on your stomach with your head turned to one side, and tight shirt collars or ties can cause sternocleidomastoid spasm or pain.

Severe health conditions like bronchitis, pneumonia, meningitis, herniated discs, and asthma can also cause this neck muscle spasm.

Asides from the above causes of sternocleidomastoid pain, the following can cause neck spasm:

  • Carrying heavy objects

  • Placing a lot of weight on one of your shoulders

  • Poor posture like head tilting and slouching

  • Holding the neck in an unnatural position for a long time

  • Dehydration

  • Trauma from falls or accidents

  • Emotional stress

Spasms from any of these causes can, in turn, cause somatic tinnitus

Muscle Spasm in the Ear

Muscle spasm in the ear, such as eardrum spasms, can cause somatic tinnitus.

The stapedius muscles and tensor tympani muscles found in the middle ear are responsible for the dampening and reduction of sounds coming from outside the ear and inside the body, respectively. The spasm of these muscles results in Middle Ear Myoclonus (MEM) tinnitus. The synchronized and repetitive contractions of the two muscles cause somatic tinnitus.

Other health conditions like neurologic diseases and multiple sclerosis can cause the middle ear muscles to spasm, causing a repetitive clicking noise.

Dental Problems

Dental problems can also cause or aggravate somatic tinnitus. Below are some dental issues linked to tinnitus.

Impacted Wisdom Teeth

Impacted wisdom teeth are third molars at the back of the mouth that do not emerge or develop normally due to a lack of enough space for the teeth to grow.

Wisdom teeth are often the last to grow; they emerge between the ages of 17 and 25. If the mouth is already crowded, wisdom teeth may get trapped and not develop properly.

In some cases, the tooth may partially emerge with a visible crown and be partially impacted. In other cases, it can be fully impacted; this means that it didn't grow through the gum.

The tooth can also grow at an angle towards the back of the mouth, grow straight or down but get trapped within the jawbone, grow toward the second molar, or grow at a right angle towards the other teeth.

Some impacted wisdom teeth cause no immediate problems but some cause damage to other teeth, excruciating pain, tinnitus, and other dental problems.

It is always advisable to have an impacted wisdom tooth removed whether or not it causes any immediate problems because it can get infected in the future and cause serious dental challenges.

Bruxism / Teeth Grinding

Bruxism is the formal term for teeth clenching and grinding. Teeth grinding can cause ear pain, tinnitus, or damaged teeth.

The temporomandibular joint is very close to the middle and inner ear, so any problem in the jawbone can affect the ear and cause tinnitus.

The majority of teeth grinding occurs while sleeping, and the grinding can be so hard that it cracks the crown of the teeth, fractures teeth fillings, or destroys dental implants. Most people who grind their teeth are unaware that they are nocturnal grinders.

Bruxism is associated with improper tooth lining, stress, and anxiety. Medications like Zoloft and Prozac can also cause teeth grinding.

Toothache

Toothache is another major cause of tinnitus and ear pain. It is often caused by an abscess, a cavity, gum disease, or tooth injury.

Tinnitus caused by dental problems like toothaches often disappears when the toothache’s underlying cause is identified and treated.

TMJ Dysfunction/Disorder

Tinnitus can be linked to problems in the temporomandibular joint. As stated earlier, the temporomandibular joint (TMJ) is located close to the middle and inner ear, so the hearing can be affected if it malfunctions.

The TMJ connects the jawbone to the skull and enables the free movement of the skull.

The TMJ can be damaged by teeth grinding and clenching, direct injury to the jaw and neck, and spinal injuries.

TMJ dysfunction is characterized by pain around and in the ear, headache, earache, migraine, hearing loss, difficult or painful chewing, inability to open and close the mouth, reduced movement of the jaw, persistent pain in the jaw, and somatic tinnitus that occurs when chewing or when the mouth is opened.

Mild TMJ disorders often go away without treatment, but you need to seek professional medical help if the pain is severe and persistent.

After proper examination, the dentist may treat the problem using muscle relaxing medications, moist heat, relaxing muscle therapies, rest, or an oral splint. An oral splint will help reposition your jaw and bite so the TMJ can heal.

How Is Somatic Tinnitus Diagnosed?

Somatic tinnitus is diagnosed by a healthcare professional when the buzzing and ringing noise in the ear coincides with jaw or neck pain. A physical therapist or doctor may make the diagnosis after giving a neck Bournemouth questionnaire about the patient's symptoms and conducting various cervical spine tests.

This list explains how to identify somatic tinnitus. If these criteria are present, it strongly suggests that your tinnitus is somatic or its cause stems from the somatosensory system. However, you cannot self-diagnose somatic tinnitus, and you will need to visit a healthcare professional to receive an official diagnosis.

These tinnitus modulation abilities strongly indicate that your tinnitus has a somatosensory influence:

  • If you can modulate your tinnitus via voluntary movement of your eyes, neck, jaw, or head.

  • If you can modulate your tinnitus through somatic maneuvers like a jaw clench.

  • If your tinnitus is modulated through pressure on your myofascial trigger point.

What’s the Best Therapy for Somatic Tinnitus?

Various therapies have successfully treated somatosensory cervicogenic tinnitus. Although there is no definitive cure, managing the cause manages the tinnitus symptoms. Somatic tinnitus can go away in patients who participate in physical therapy or seek chiropractic treatment.

Massage Therapy

Massage may help relieve tinnitus symptoms by reducing stress, resolving postural problems, and relaxing tensed muscles. Two places around the ear and neck can be massaged to alleviate tinnitus: 

1) The mastoid process: The part of the skull behind the ear connects to muscles surrounding the ear and neck. Massaging the mastoid process with a gentle Swedish massage can relieve tension in the neck and ear muscles and help correct neck alignment.

2) The masseter muscle: This muscle attaches the jaw to the skull. Located close to the earlobe at the jawbone's hinge, the masseter muscle is the strongest in the body in proportion to its size. When tense, it contributes to structural misalignment and ringing in the ear. Massage releases tension and realigns bones to relieve tinnitus.   

Transcutaneous Electrical Nerve Stimulation

A TENS unit uses an electric current to stimulate the nerves for therapeutic purposes. It can be applied close to the upper cervical nerve or near the ear to relax muscles.

Steroids and Lidocaine Injections

Your doctor may recommend these injections to stop the pain and inflammation in your body that may contribute to your somatic tinnitus.

Mechanical Manipulation

A physical therapist or chiropractor may manipulate your skeletal structure to normalize the cervical spine or jaw. If structural deviations cause muscle tightness or spasms, correcting them may alleviate your tinnitus symptoms.

Acupressure and Acupuncture

Acupuncture has been proven to treat many types of tinnitus effectively. This is also true for acupressure, as it can relieve tinnitus through a massage on the right pressure points.

A TMJ Mouthguard

By taking steps to treat your TMJ, you can help relieve the ear-related symptoms you're experiencing, such as somatic tinnitus or hearing loss

When you book an appointment with the dental professional to talk about your TMJ, you must inform them of every symptom you experience so they can help pick an appropriate treatment.

One effective and popular way to get relief from TMJ is the use of a TMJ mouthguard. This will be recommended if bruxism is the cause of your TMJ.

Neck Exercises

Another treatment for somatic tinnitus is aimed at reducing muscular tension in the jaw and neck-through neck exercises.

Stretching of the suboccipital muscles and rotation movements in the atlanto-occipital joint often helps relieve somatic tinnitus.

Aside from easing neck stiffness, spasms, and soreness, exercising can help increase your heart rate, which helps boost blood circulation in your ear, reducing the tinnitus noise.

If you have somatic tinnitus, here is one neck exercise that can give you some relief:

  • Sit up straight on a chair

  • Bend your left arm to prevent you from pulling your shoulder up during the exercise

  • Using your right hand, reach over your head to the left ear

  • Bring your head to a stretching position

  • Remain in this position for two to three minutes

  • Change sides

Conclusion

As we've seen in this piece, somatic tinnitus is caused by problems in the somatosensory system, which translates to tinnitus challenges that exhibit themselves as a ringing, buzzing, or humming sound void of an external source.

“A good choice may be an Audien hearing aid because of its low cost and ease of use.” - Drew Sutton, MD, Board-Certified Otolaryngologist.

It’s important to visit a physician to properly diagnose the cause of your somatic tinnitus and assign the appropriate treatment. It is important to know that tinnitus is not the problem in itself but is the symptom of an underlying problem. Solving the cause of your tinnitus will help relieve the condition, as can masking through the use of hearing aids

Sources:

Tinnitus: Characteristics, Causes, Mechanisms, and Treatments | NCBI

The dorsal cochlear nucleus as a contributor to tinnitus: mechanisms underlying the induction of hyperactivity | NCBI

Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress | NCBI

 

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Drew Sutton M.D.

Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.

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