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Somatosensory Tinnitus: Recent Developments in Diagnosis and Treatment

Journal of the Association for Research in Otolaryngology (2023)Cite this article

Abstract

Somatosensory tinnitus (ST) is a type of tinnitus where changes in somatosensory input from the head-neck area are one of the influencing factors of a patient’s tinnitus. As there are often several influencing factors, identifying a clear somatosensory influence on an individual patient’s tinnitus is often a challenge. Therefore, a decision tree using four clinical criteria has been proposed that can help diagnose ST with an accuracy of 82.2%, a sensitivity of 82.5%, and a specificity of 79%. Once correctly diagnosed, patients can be successfully treated using a musculoskeletal physical therapy treatment. This type of treatment can either be directed at cervical spine dysfunctions, temporomandibular disorders, or both and consists of a combination of counseling, exercises, and manual techniques to restore normal function of the cervical spine and temporomandibular area. Other techniques have been suggested but need further investigation in larger RCTs. In most cases, ST treatment shows a decrease in tinnitus severity or loudness, but in rare cases, total remission of the tinnitus is achieved.

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References

  1. Baguley D, McFerran D, Hall D (2013) Tinnitus. Lancet 382(9904):1600–1607. https://doi.org/10.1016/S0140-6736(13)60142-7

    Article  PubMed  Google Scholar 

  2. Hiller W, Janca A, Burke KC (1997) Association between tinnitus and somatoform disorders. J Psychosom Res 43(6):613–624. https://doi.org/10.1016/s0022-3999(97)00188-8

    Article  CAS  PubMed  Google Scholar 

  3. Pinchoff RJ, Burkard RF, Salvi RJ, Coad ML, Lockwood AH (1998) Modulation of tinnitus by voluntary jaw movements. Am J Otol 19(6):785–789

    CAS  PubMed  Google Scholar 

  4. van Dijk P, Vanneste S (2016) Neuroimaging as a window on the heterogeneity of tinnitus. ENT Audiol News 24:73–74

    Google Scholar 

  5. Elgoyhen AB, Langguth B, De Ridder D, Vanneste S (2015) Tinnitus: perspectives from human neuroimaging. Nat Rev Neurosci 16(10):632–642. https://doi.org/10.1038/nrn4003

    Article  CAS  PubMed  Google Scholar 

  6. Levine RA (1999) Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis. Am J Otolaryngol 20(6):351–362

    Article  CAS  PubMed  Google Scholar 

  7. Shore S, Zhou J, Koehler S (2007) Neural mechanisms underlying somatic tinnitus. In: Langguth B, Hajak G, Kleinjung T, Cacace A, Møller AR (eds) Tinnitus: pathophysiology and treatment. Progress in Brain Research volume 166, pp 107–123; Elsevier

  8. Zhou J, Shore S (2006) Convergence of spinal trigeminal and cochlear nucleus projections in the inferior colliculus of the guinea pig. J Comp Neurol 495(1):100–112. https://doi.org/10.1002/cne.20863

    Article  PubMed  Google Scholar 

  9. Kanold PO, Young ED (2001) Proprioceptive information from the pinna provides somatosensory input to cat dorsal cochlear nucleus. J Neurosci 21(19):7848–7858

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Zhou J, Shore S (2004) Projections from the trigeminal nuclear complex to the cochlear nuclei: a retrograde and anterograde tracing study in the guinea pig. J Neurosci Res 78(6):901–907. https://doi.org/10.1002/jnr.20343

    Article  CAS  PubMed  Google Scholar 

  11. Wright DD, Ryugo DK (1996) Mossy fiber projections from the cuneate nucleus to the cochlear nucleus in the rat. J Comp Neurol 365(1):159–172. https://doi.org/10.1002/(SICI)1096-9861(19960129)365:1%3c159::AID-CNE12%3e3.0.CO;2-L

    Article  CAS  PubMed  Google Scholar 

  12. Shore SE, Vass Z, Wys NL, Altschuler RA (2000) Trigeminal ganglion innervates the auditory brainstem. J Comp Neurol 419(3):271–285. https://doi.org/10.1002/(sici)1096-9861(20000410)419:3%3c271::aid-cne1%3e3.0.co;2-m

    Article  CAS  PubMed  Google Scholar 

  13. Zhan X, Pongstaporn T, Ryugo DK (2006) Projections of the second cervical dorsal root ganglion to the cochlear nucleus in rats. J Comp Neurol 496(3):335–348. https://doi.org/10.1002/cne.20917

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shore SE (2005) Multisensory integration in the dorsal cochlear nucleus: unit responses to acoustic and trigeminal ganglion stimulation. Eur J Neurosci 21(12):3334–3348. https://doi.org/10.1111/j.1460-9568.2005.04142.x

    Article  CAS  PubMed  Google Scholar 

  15. Jain R, Shore S (2006) External inferior colliculus integrates trigeminal and acoustic information: unit responses to trigeminal nucleus and acoustic stimulation in the guinea pig. Neurosci Lett 395(1):71–75. https://doi.org/10.1016/j.neulet.2005.10.077

    Article  CAS  PubMed  Google Scholar 

  16. Lanting CP, de Kleine E, Eppinga RN, van Dijk P (2010) Neural correlates of human somatosensory integration in tinnitus. Hear Res 267(1–2):78–88. https://doi.org/10.1016/j.heares.2010.04.006

    Article  CAS  PubMed  Google Scholar 

  17. Michiels S, Ganz Sanchez T, Oron Y, Gilles A, Haider HF, Erlandsson S et al (2018) Diagnostic criteria for somatosensory tinnitus: a Delphi process and face-to-face meeting to establish consensus. Trends Hear 22:2331216518796403. https://doi.org/10.1177/2331216518796403

    Article  PubMed  PubMed Central  Google Scholar 

  18. Van de Heyning P, Gilles A, Rabau S, Van Rompaey V (2015) Subjective tinnitus assessment and treatment in clinical practice: the necessity of personalized medicine. Curr Opin Otolaryngol Head Neck Surg 23(5):369–375. https://doi.org/10.1097/MOO.0000000000000183

    Article  PubMed  Google Scholar 

  19. Cederroth CR, Gallus S, Hall DA, Kleinjung T, Langguth B, Maruotti A et al (2019) Editorial: towards an understanding of tinnitus heterogeneity. Front Aging Neurosci 11:53. https://doi.org/10.3389/fnagi.2019.00053

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sanchez TG, Rocha CB (2011) Diagnosis and management of somatosensory tinnitus: review article. Clinics (Sao Paulo, Brazil) 66(6):1089–1094

    Article  PubMed  Google Scholar 

  21. Biesinger E, Groth A, Hoing R, Holzl M (2015) Somatosensoric tinnitus. HNO 63(4):266–271. https://doi.org/10.1007/s00106-014-2971-9

    Article  CAS  PubMed  Google Scholar 

  22. Ward J, Vella C, Hoare DJ, Hall DA (2015) Subtyping somatic tinnitus: a cross-sectional UK cohort study of demographic, clinical and audiological characteristics. PLoS ONE 10(5). https://doi.org/10.1371/journal.pone.0126254

  23. Michiels S, Van de Heyning P, Truijen S, De Hertogh W (2015) Diagnostic value of clinical cervical spine tests in patients with cervicogenic somatic tinnitus. Phys Ther 95(11):1529–1535. https://doi.org/10.2522/ptj.20140457

  24. Michiels S, Cardon E, Gilles A, Goedhart H, Vesala M, Schlee W (2022) Somatosensory tinnitus diagnosis: diagnostic value of existing criteria. Ear Hear 43(1):143–149. https://doi.org/10.1097/AUD.0000000000001105

    Article  PubMed  Google Scholar 

  25. Michiels S, Cardon E, Gilles A, Goedhart H, Vesala M, Van Rompaey V et al (2022) The rapid screening for somatosensory tinnitus tool: a data-driven decision tree based on specific diagnostic criteria. Ear Hear. https://doi.org/10.1097/AUD.0000000000001224

    Article  PubMed  Google Scholar 

  26. Cohen SP, Hooten WM (2017) Advances in the diagnosis and management of neck pain. BMJ 358:j3221. https://doi.org/10.1136/bmj.j3221

  27. Cote P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K et al (2016) Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 25(7):2000–2022. https://doi.org/10.1007/s00586-016-4467-7

    Article  Google Scholar 

  28. Martins WR, Blasczyk JC, Aparecida Furlan de Oliveira M, Lagôa Gonçalves KF, Bonini-Rocha AC, Dugailly PM et al (2016) Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: a systematic review with meta-analysis. Man Ther 21:10–7. https://doi.org/10.1016/j.math.2015.06.009

  29. Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A (2016) Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: systematic review and meta-analysis. Phys Ther 96(1):9–25. https://doi.org/10.2522/ptj.20140548

    Article  PubMed  Google Scholar 

  30. Calixtre LB, Moreira RF, Franchini GH, Alburquerque-Sendin F, Oliveira AB (2015) Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil 42(11):847–861. https://doi.org/10.1111/joor.12321

    Article  CAS  PubMed  Google Scholar 

  31. Côté C, Baril I, Morency C, Montminy S, Couture M, Leblond J et al (2019) Long-term effects of a multimodal physiotherapy program on the severity of somatosensory tinnitus and identification of clinical indicators predicting favorable outcomes of the program. J Am Acad Audiol 30(8):720–730. https://doi.org/10.3766/jaaa.17147

    Article  PubMed  Google Scholar 

  32. Delgado de la Serna P, Plaza-Manzano G, Cleland J, Fernández-de-Las-Peñas C, Martín-Casas P, Díaz-Arribas MJ (2020) Effects of cervico-mandibular manual therapy in patients with temporomandibular pain disorders and associated somatic tinnitus: a randomized clinical trial. Pain Med 21(3):613–24. https://doi.org/10.1093/pm/pnz278

  33. Michiels S, Van de Heyning P, Truijen S, Hallemans A, De Hertogh W (2016) Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? Man Ther 26:125–131. https://doi.org/10.1016/j.math.2016.08.005

    Article  CAS  PubMed  Google Scholar 

  34. Oostendorp RA, Bakker I, Elvers H, Mikolajewska E, Michiels S, De Hertogh W et al (2016) Cervicogenic somatosensory tinnitus: an indication for manual therapy plus education? Part 2: A pilot study. Man Ther 23:106–113. https://doi.org/10.1016/j.math.2016.02.006

    Article  PubMed  Google Scholar 

  35. Van der Wal A, Michiels S, Van de Heyning P, Braem M, Visscher C, Topsakal V et al (2020) Treatment of somatosensory tinnitus: a randomized controlled trial studying the effect of orofacial treatment as part of a multidisciplinary program. J Clin Med 9(3). https://doi.org/10.3390/jcm9030705

  36. Eladl HM, Elkholi SM, Eid MM, Abdelbasset WK, Ali ZA, Bahey El-Deen HA (2022) Effect of adding a supervised physical therapy exercise program to photobiomodulation therapy in the treatment of cervicogenic somatosensory tinnitus: a randomized controlled study. Medicine (Baltimore) 101(31):e29946. https://doi.org/10.1097/MD.0000000000029946

  37. Campagna CA, Anauate J, Vasconoelos LGE, Oiticica J (2022) Effectiveness of dry needling in bothersome chronic tinnitus in patients with myofascial trigger points. Int Arch Otorhinolaryngol 26(2):e233–e242. https://doi.org/10.1055/s-0041-1730429

    Article  PubMed  Google Scholar 

  38. Michiels S, Van de Heyning P, Truijen S, Hallemans A, De Hertogh W (2017) Prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus. Musculoskelet Sci Pract 29:33–37. https://doi.org/10.1016/j.msksp.2017.02.008

    Article  CAS  PubMed  Google Scholar 

  39. Atan T, Atan D, Özel S (2020) Effectiveness of Kinesio taping in the treatment of somatosensory tinnitus: a randomized controlled trial. Complement Ther Clin Pract 39:101100. https://doi.org/10.1016/j.ctcp.2020.101100

  40. Sajadi S, Forogh B, ZoghAli M (2019) Cervical trigger point acupuncture for treatment of somatic tinnitus. J Acupunct Meridian Stud 12(6):197–200. https://doi.org/10.1016/j.jams.2019.07.004

    Article  PubMed  Google Scholar 

  41. Wu D, Ham D, Rosedale R (2020) Physiotherapy assessment and treatment of chronic subjective tinnitus using mechanical diagnosis and therapy: a case report. J Man Manip Ther 28(2):119–126. https://doi.org/10.1080/10669817.2020.1714160

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rocha CB, Sanchez TG (2012) Efficacy of myofascial trigger point deactivation for tinnitus control. Braz J Otorhinolaryngol 78(6):21–26

    Article  PubMed  Google Scholar 

  43. Womack A, Butts R, Dunning J (2020) Dry needling as a novel intervention for cervicogenic somatosensory tinnitus: a case study. Physiother Theory Pract 38:1319–1327. https://doi.org/10.1080/09593985.2020.1825579

  44. Bonaconsa A, Mazzoli M, Magnano SLA, Milanesi C, Babighian G (2010) Posturography measures and efficacy of different physical treatments in somatic tinnitus. Intl Tinnitus J 16(1):44–50

    Google Scholar 

  45. Mielczarek M, Konopka W, Olszewski J (2013) The application of direct current electrical stimulation of the ear and cervical spine kinesitherapy in tinnitus treatment. Auris Nasus Larynx 40(1):61–65. https://doi.org/10.1016/j.anl.2012.05.006

    Article  PubMed  Google Scholar 

  46. Bechter K, Wieland M, Hamann GF (2016) Chronic cervicogenic tinnitus rapidly resolved by intermittent use of cervical collar. Front Psych 7:43. https://doi.org/10.3389/fpsyt.2016.00043

    Article  Google Scholar 

  47. Stidham KR, Solomon PH, Roberson JB (2005) Evaluation of botulinum toxin A in treatment of tinnitus. Otolaryngol Head Neck Surg 132(6):883–9. https://doi.org/10.1016/j.otohns.2005.02.015

  48. McCormick ZL, Walega DR (2015) Cervical epidural steroid injection for refractory somatic tinnitus. Pain Pract 15(2):e28-33. https://doi.org/10.1111/papr.12255

    Article  PubMed  Google Scholar 

  49. Marks KL, Martel DT, Wu C, Basura GJ, Roberts LE, Schvartz-Leyzac KC et al (2018) Auditory-somatosensory bimodal stimulation desynchronizes brain circuitry to reduce tinnitus in guinea pigs and humans. Sci Transl Med 10(422). https://doi.org/10.1126/scitranslmed.aal3175

  50. Jones GR, Martel DT, Riffle TL, Errickson J, Souter JR, Basura GJ et al (2023) Reversing synchronized brain circuits using targeted auditory-somatosensory stimulation to treat phantom percepts: a randomized clinical trial. JAMA Netw Open 6(6):e2315914. https://doi.org/10.1001/jamanetworkopen.2023.15914

  51. Ostermann K, Lurquin P, Horoi M, Cotton P, Herve V, Thill MP (2016) Somatic tinnitus prevalence and treatment with tinnitus retraining therapy. B-ENT 12(1):59–65

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, BE, Belgium

    Sarah Michiels

  2. Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium

    Sarah Michiels

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  1. Sarah Michiels
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Correspondence to Sarah Michiels.

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Michiels, S. Somatosensory Tinnitus: Recent Developments in Diagnosis and Treatment. JARO (2023). https://doi.org/10.1007/s10162-023-00912-3

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