Tinnitus, commonly described as persistent ringing or buzzing in the ears, is a complex condition that disrupts the lives and mental well-being of millions globally. This article uncovers the intricate anatomy of tinnitus, explores modern diagnostic techniques, and introduces innovative treatments like Motion Specific Release (MSR) and fascial manipulation.
For those whose tinnitus is directly linked to musculoskeletal dysfunctions, the outlook can be even more promising. With individualized, comprehensive multimodal approaches, including targeted manual therapies, the success rate can soar—sometimes exceeding 80%. This highlights the fascinating interplay between sound, sensation, and interdisciplinary care, encouraging a deeper understanding and more effective management of tinnitus.
Article Index:
Anatomy of Tinnitus
The human ear is a marvel of natural engineering, intricately designed to detect a wide range of sounds. It is divided into three essential parts: the outer ear, middle ear, and inner ear, each contributing uniquely to how we perceive sound.
The Outer Ear: This part, which includes the pinna and auditory canal, acts as a funnel that directs sound waves into the ear. Sometimes, blockages or structural issues here can cause the perception of phantom noises, contributing to tinnitus.
The Middle Ear: This section contains the eardrum (tympanic membrane) and three tiny bones called ossicles, which amplify sound vibrations. Problems in these components, such as stiffness or damage, can lead to tinnitus.
The Inner Ear: Here lies the cochlea and auditory nerves, where sound vibrations are converted into electrical signals that are then sent to the brain. Damage or degeneration in the inner ear is often a primary cause of tinnitus.
The Auditory Pathway: The journey of sound through the ear is a fascinating process. Sound waves enter through the outer ear, travel through the middle ear, and reach the inner ear, where the cochlea’s hair cells convert these vibrations into signals that the auditory nerve carries to the brain. Any disruption along this pathway—from injury, illness, or exposure to loud noise—can result in the brain interpreting these disruptions as the persistent, often distressing sounds of tinnitus.
Neurological Factors: Tinnitus isn’t just an ear issue; it’s a complex neurological condition. The auditory cortex, the brain's sound-processing hub, can become overly active or send faulty signals to other parts of the brain, resulting in tinnitus. Changes in brain chemistry, neural pathways, or the presence of neurological disorders can all contribute to this condition.
Fascia Involvement: Though less commonly discussed, the fascia—connective tissue that surrounds and supports every part of the body—may also play a role in tinnitus. Within the ear, fascia helps maintain the proper positioning and function of its various structures. Tension or restrictions in the fascial system might disrupt ear mechanics, potentially leading to tinnitus. The growing interest in fascial manipulation as a treatment highlights the importance of understanding the fascia's role in ear health and the development of tinnitus.
Causes of Tinnitus
Tinnitus is a complex condition characterized by the perception of sound without an external source. Its causes are varied and often interwoven, requiring a multifaceted approach to diagnosis and treatment:
Sensorineural Causes: In cases where tinnitus is related to damage within the cochlea or along the auditory pathways, consulting an audiologist or ENT specialist is crucial. These professionals can provide targeted interventions such as cochlear implants, hearing aids, or other medical treatments tailored to the individual's needs.
Conductive Causes: When tinnitus arises from issues in the middle ear, such as otosclerosis or a perforated eardrum, an ENT specialist's expertise is essential. Surgical procedures like tympanoplasty or stapedectomy may be recommended to address these specific conditions.
Central Causes: Tinnitus linked to central auditory processing disorders or cortical changes requires the attention of neurologists or specialized audiologists. Treatments may include cognitive therapy, sound therapy, or other approaches designed to recalibrate the brain's auditory processing.
Metabolic Factors: Tinnitus can also be influenced by underlying metabolic conditions such as hypothyroidism or diabetes. Collaboration with endocrinologists or internal medicine specialists is necessary to manage these conditions, aligning overall health management with tinnitus care.
Musculoskeletal (MSK) Tinnitus
Tinnitus has a significant connection with musculoskeletal issues, particularly involving the Temporomandibular Joint Disorder (TMJ/TMD) and cervical spine. Research suggests that 10% to 15% of tinnitus cases are directly related to these musculoskeletal dysfunctions, known as somatosensory or somatic tinnitus. In such cases, tinnitus can often be influenced or modulated by movements of the jaw, neck, or head, highlighting the clear relationship between the musculoskeletal system and auditory symptoms.
This strong connection provides a pathway for effective, personalized treatments through manual therapy techniques such as Motion Specific Release (MSR), manipulation, and mobilization. By focusing on the intricate interplay between the auditory system and musculoskeletal structures, these therapies target both the symptoms and underlying causes of MSK-related tinnitus, offering significant potential for relief to those affected by this condition.
Tinnitus and Temporomandibular Joint Disorder (TMJ/TMD)
Tinnitus is closely connected to Temporomandibular Joint Disorder (TMJ/TMD) due to shared neurological pathways and muscular interactions.
Anatomical Proximity: The temporomandibular joint’s close location to the middle ear allows for mechanical interactions that can impact auditory function, potentially leading to tinnitus.
Neuromuscular Factors: The shared nerve innervation and reflex pathways between the jaw and the auditory system mean that dysfunction in the TMJ can influence tinnitus, creating a direct link between these conditions.
Treatment Correlation: Studies indicate that treating TMJ/TMD can result in improvements in tinnitus symptoms, highlighting the interconnected nature of these two conditions.
Tinnitus and Cervical Spine Dysfunction
Cervical spine issues also play a crucial role in some cases of tinnitus:
Somatic Tinnitus: This type of tinnitus is influenced or modulated by somatic structures, particularly those in the cervical spine, indicating a strong musculoskeletal component.
Cervical Inputs: Dysfunction in the cervical spine can disrupt auditory processing through complex neurological pathways, including those involving the dorsal cochlear nuclei and trigeminal cervical complex.
Therapeutic Implications: By addressing cervical spine dysfunction, somatic tinnitus can be improved, supporting a treatment approach that targets the underlying biomechanical causes.
Diagnosis and Differential Diagnosis (DDx)
Clinical Examination
Diagnosing tinnitus requires a thoughtful blend of empathy, clinical skill, and teamwork across disciplines.
History: The process starts with actively listening to the patient's story, focusing on the onset, duration, and daily impact of their tinnitus. This patient-centered approach reveals key insights that guide further evaluation.
Physical Examination: A thorough examination of orthopedic, neurological, and vascular systems is essential. This comprehensive assessment helps identify physical contributors to tinnitus, forming the basis for a tailored treatment plan.
Differential Diagnosis
Accurately diagnosing tinnitus often involves distinguishing it from other conditions with similar symptoms.
Meniere's Disease: Characterized by vertigo, hearing loss, and tinnitus, Meniere's requires careful assessment, often involving an otolaryngologist, to differentiate it from other causes.
Acoustic Neuroma: This benign auditory nerve tumor can cause hearing loss, balance problems, and tinnitus. Collaboration with neurologists is crucial for precise diagnosis and management.
Medication Side Effects: Certain drugs, like high-dose aspirin, can induce or worsen tinnitus. Working with pharmacists is key to identifying and managing these medication-related issues.sical contributors to tinnitus and guides the personalized treatment plan.
Examination Demonstration Videos
TMD Exam: In this video, we provide an in-depth guide on diagnosing temporomandibular disorder (TMD). This process requires meticulously reviewing the patient's medical history and an extensive physical examination.
Cervical Examination - Orthopaedic Testing: In this video, Dr Mylonas performs a cervical orthopedic examination covering palpation, range of motion, and orthopedic examinations.
Cranial Nerve Exam: Performing a cranial nerve examination in the case of tinnitus is essential for identifying underlying issues with the cranial nerves, such as vestibulocochlear nerve disorders, and assessing associated neurological conditions. This examination supports comprehensive treatment planning, including the possibility of manual therapy if the tinnitus is musculoskeletal (MSK) related, and guides future management.
The Multidisciplinary Approach
The complexity of tinnitus calls for an interdisciplinary approach, bringing together various specialists depending on the scope of practice of the MSK practitioner.
Audiometry: Engaging with audiologists or hearing specialists allows for precise hearing loss assessment, an essential step in understanding tinnitus.
Tympanometry or Other Diagnostic Methods: Collaborating with ENT specialists or other professionals who can order and interpret these tests adds depth to diagnosing middle ear problems or other underlying issues.
MRI and CT Scans: This may be required to identify complex structural abnormalities.
Our Approach to Tinnitus
Our approach specifically targets the jaw and cervical spine, the only types of tinnitus directly linked to musculoskeletal (MSK) dysfunction. Utilizing a blend of soft tissue techniques, osseous mobilization/manipulation, acupuncture/acupressure, and functional exercise programs, MSR provides a comprehensive, patient-centered intervention for tinnitus. The following sections will explore the MSR treatment protocols in detail, focusing on alleviating tinnitus symptoms by addressing the underlying musculoskeletal issues in these critical areas.
Jaw Related Dysfunction
Video Demonstration
The following video demonstrates one of the procedures used in the 10-point TMJ/TMD jaw protocol.
Masseter Release:
Releasing trigger points in the masseter muscle can reduce pain and prevent issues in the TMJ and ear, which are linked to tinnitus. Watch Dr. Abelson demonstrate the Motion Specific Release (MSR) technique for masseter muscle relief, potentially alleviating tinnitus symptoms related to TMJ dysfunction.
Fascial Expansion of the Jaw
In this video, Dr. Abelson demonstrates how understanding fascial planes and integrating Traditional Chinese Medicine (Acupuncture/Acupressure) can enhance jaw function. By targeting these fascial connections and specific acupuncture points, practitioners can effectively alleviate TMJ/TMD-related pain and promote healing. This approach is especially beneficial for managing tinnitus, as treating TMJ/TMD can help reduce tinnitus symptoms due to the close link between jaw dysfunction and auditory issues.
Cervical Dysfunction
Cervical dysfunction poses distinct challenges in tinnitus management. MSR protocols offer a thorough treatment approach, combining soft tissue techniques and osseous manipulation to resolve cervical issues. It's important to note that trigger points in the lateral pterygoid muscle may persist until cervical problems are properly addressed.
Neck Mobilization: The choice is yours, whether you use neck adjustments or neck mobilization techniques! Most patients do not realize they have choices in how restrictions in the joints of their necks are addressed. In this video, Dr. Abelson shows you examples of Cervical Joint Mobilization.
Tailored Tinnitus Treatment Regimen
Initial Phase (4-6 Weeks):
MSR Manual Therapy:
2 sessions/week (or 1 session/week for 30 minutes).
Home Exercises:
Daily, as prescribed by MSR practitioner.
Response Assessment (After 2 to 3 Weeks):
Positive Response:
Reduce therapy to 1 session/week.
Continue and adjust daily exercises.
Persistent Symptoms:
Maintain/increase therapy to 2-3 sessions/week.
Reassess and modify exercises.
Ongoing Considerations:
Continue therapy if symptoms improve.
Reconsider or halt if progress plateaus.
Exercise Protocols for TMD and Cervical Dysfunction
In addition to manual therapy, MSR incorporates targeted exercise protocols for both TMD and cervical dysfunction. These exercises are designed to complement manual therapy, enhancing its effects and supporting long-term recovery. Below are a few examples that may be recommended based on the specific needs of each case.
6 Effective Jaw Release Exercises:
The video demonstrates 6 TMJ exercises specifically for temporomandibular joint dysfunction (TMD/TMJ). These exercises, recommended after MSR TMJ procedures, target key areas like the Temporalis, Masseter, Roof Spreading, Internal Masseter, Assisted Opening, and Resisted Opening, potentially alleviating tinnitus symptoms linked to jaw dysfunction.
PNF Neck Stretches:
Extensive research shows that PNF stretching techniques effectively improve flexibility, increase muscle strength, and enhance athletic performance. When applied to the neck area, these stretches may be particularly beneficial for individuals with tinnitus, as they can address muscular tensions and misalignments that contribute to auditory symptoms.
Why Choose Our Approach for Tinnitus Treatment
Our comprehensive approach to treating tinnitus, particularly when related to musculoskeletal (MSK) dysfunction, can achieve success rates of over 80%. Here’s why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, our MSR methodology is backed by over 30 years of clinical experience, with a proven track record of successfully treating more than 25,000 patients.
Thorough Assessments: We perform detailed evaluations to identify all contributing factors, including TMJ/TMD and cervical spine dysfunctions, which are often linked to tinnitus symptoms.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target areas of fascial restrictions and muscular tensions, providing effective relief for MSK-related tinnitus.
Customized Exercise Programs: We develop individualized exercise plans that enhance muscle function, alleviate tension, and support long-term recovery, addressing the root causes of tinnitus.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, targeted exercises, and supportive care, offering a well-rounded and lasting solution for tinnitus.
Choose our proven, patient-centered approach for effective, long-term relief from tinnitus. Take the first step toward better auditory health with confidence.
References
Baguley, D., McFerran, D., & Hall, D. (2013). Tinnitus. *The Lancet*, 382(9904), 1600-1607.
Dossey, L., Keegan, L., & Guzzetta, C. E. (2005). *Holistic Nursing: A Handbook for Practice* (5th ed.). Jones & Bartlett Learning.
Dworkin, S. F., & LeResche, L. (1992). Research Diagnostic Criteria for Temporomandibular Disorders: Review, Criteria, Examinations and Specifications, Critique. Journal of Craniomandibular Disorders*, 6(4), 301-355.
Eggermont, J. J. (2017). *Hearing in Time: Psychological Aspects of Musical Meter* (2nd ed.). Oxford University Press.
Henry, J. A., Roberts, L. E., & Caspary, D. M. (Eds.). (2012). *Tinnitus: Pathophysiology and Treatment.* Elsevier.
Langguth, B., & De Ridder, D. (Eds.). (2015). *Textbook of Tinnitus.* Springer.
McKenna, L., & Irwin, R. (2008). Sound Therapy for Tinnitus--Sacred Cow or Idol Worship?: An Investigation of the Evidence. *Audiological Medicine*, 6(1), 16-24.
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn't. *BMJ*, 312(7023), 71-72.
Schleip, R., & Jäger, H. (2012). Interoception: A new correlate for intricate connections between fascial receptors, emotion, and self-recognition. In *Fascia: The Tensional Network of the Human Body.* Elsevier.
Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2018). *Evidence-Based Medicine: How to Practice and Teach EBM* (5th ed.). Elsevier.
Tyler, R. S. (Ed.). (2000). Tinnitus Handbook. Singular Publishing Group.
Valente, M., Hosford-Dunn, H., & Roeser, R. J. (Eds.). (2008). *Audiology Treatment* (2nd ed.). Thieme.
Effects of Cervico-Mandibular Manual Therapy in Patients with Temporomandibular Pain Disorders and Associated Somatic Tinnitus: A Randomized Clinical Trial. PubMed. Published in 2020.
Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program. PubMed. Published in 2020.
Massimo Ralli, Antonio Greco, Rosaria Turchetta, Giancarlo Altissimi, Marco de Vincentiis, Giancarlo Cianfrone. Somatosensory Tinnitus: Current Evidence and Future Perspectives. NCBI. Published on June 24, 2017.
Niklas K Edvall, Edis Gunan, Eleni Genitsaridi, Andra Lazar, Golbarg Mehraei, Mattias Billing, Marie Tullberg, Jan Bulla, Jonathon Whitton, Barbara Canlon, Deborah A Hall, Christopher R Cederroth. Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress. NCBI. Published in 2019.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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