The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

Abstract

Background Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise.

Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program

“…When this somatosensory influence is one of the major influencing factors, a patient's tinnitus is called somatic or somatosensory tinnitus (ST). This type of tinnitus is present in 12% to 43% of tinnitus patients, depending on the setting (primary care, tertiary care, open population) and diagnostic criteria for ST [5][6][7][8].…”

From Provider to Advocate: The Complexities of Mild Traumatic Brain Injury Prompt the Evolution of Provider Engagement

“…Post-traumatic oromandibular dystonia [69], often associated with bruxism, occurs after TBI. Furthermore, it has been shown that bruxism contributes not only to post-TBI headaches [70] but is also correlated with the presence of tinnitus [71]. While dentists are perhaps most likely to identify bruxism because of secondary tooth wear [72], TBI patients might unfortunately not be guided to include oral health professionals on their care team, so specifically asking patients about bruxism could reveal a treatable and impactful diagnosis.…”

Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus

“…This fluctuation of tinnitus can depend on various factors, such as stress ( Mazurek et al, 2015 ), emotional state ( Probst et al, 2016 ), anxiety ( Bhatt et al, 2017 ), depression ( Bhatt et al, 2017 ), cervical spine dysfunction ( Michiels et al, 2015 ), and temporomandibular disorders (TMD) ( Buergers et al, 2014 ). In these last two cases, tinnitus is called somatosensory (or somatic) tinnitus (ST), which is present in 12–43% of patients with subjective tinnitus ( Michiels et al, 2015 , 2019a ). A physiological explanation for ST can be found in animal studies where connecting fibers between the dorsal cochlear nucleus (DCN) and the somatosensory nuclei are found ( Kanold and Young, 2001 ).…”