From the Guidelines
Somatic tinnitus should be managed with a multidisciplinary approach, including physical therapy, stress reduction techniques, and education on managing symptoms, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) guidelines 1.
Key Considerations
- Somatic tinnitus is a type of tinnitus that can be influenced by physical movements of the head, neck, jaw, or limbs, and is often associated with musculoskeletal issues.
- Treatment should focus on addressing underlying musculoskeletal issues through physical therapy, particularly focusing on the neck, jaw, and upper back.
- Specific exercises, such as gentle neck stretches, jaw relaxation techniques, and posture correction, can help manage symptoms.
- Some patients may benefit from temporomandibular joint (TMJ) therapy if jaw issues are contributing factors.
- Muscle relaxants, such as cyclobenzaprine (5-10mg) or tizanidine (2-4mg), may be prescribed for short-term relief of muscle tension.
- Stress reduction techniques, such as progressive muscle relaxation and mindfulness meditation, can help manage symptoms.
Importance of Education and Counseling
- Clinicians should educate patients with persistent, bothersome tinnitus about management strategies, as recommended by the AAO-HNSF guidelines 1.
- Patients should be informed about the importance of maintaining good posture throughout the day and being mindful of teeth grinding or jaw clenching, which can exacerbate symptoms.
Recent Guidelines and Recommendations
- The ACR Appropriateness Criteria® Tinnitus: 2023 update recommends a targeted history and clinical examination as the initial evaluation and determination as to whether the tinnitus is bothersome or not, before any imaging 1.
- The guidelines also recommend a prompt and comprehensive audiological examination in patients with hearing problems or with unilateral persistent tinnitus.
- The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend cognitive-behavioral therapy (CBT) to patients with persistent, bothersome tinnitus, as it has been shown to have a preponderance of benefit over harm 1.
From the Research
Definition and Characteristics of Somatic Tinnitus
- Somatic tinnitus is defined as tinnitus that appears to be preceded or strictly linked to a somatic disorder, and is therefore related to problems of the musculoskeletal system rather than of the ear 2.
- Modulation of tinnitus characteristics such as pitch and loudness has been extensively described following movements of the head, neck and limbs, vertical or horizontal eye gaze, pressure on myofascial trigger points, cutaneous stimulation of the hands, electrical stimulation of the median nerve, and transcranial direct current stimulation 2.
Diagnosis and Treatment of Somatic Tinnitus
- A correct diagnosis and treatment of somatic disorders underlying tinnitus play a central role for a correct management of somatic tinnitus 2.
- The identification of somatic tinnitus may be complex in some cases, and requires a thorough evaluation of the patient's symptoms and medical history 2.
- Treatment approaches for somatic tinnitus may include physical therapy, massage, and other forms of somatic therapy, as well as cognitive behavioral therapy and other psychological interventions 3, 4.
Relationship between Somatic Tinnitus and Other Conditions
- Somatic tinnitus is often comorbid with other conditions, such as insomnia, depression, and anxiety 4.
- The treatment of somatic tinnitus may also involve addressing these comorbid conditions, using a combination of therapeutic approaches such as repetitive transcranial magnetic stimulation and cognitive behavioral therapy 4.
- The relationship between somatic tinnitus and other conditions highlights the importance of a multidisciplinary approach to diagnosis and treatment 5, 4.