Somatic Tinnitus
March 16, 2021
Tinnitus is the perception of a noise or sound without a tangible external acoustic stimulus. The condition is considered a symptom and not a disease. This is because tinnitus is the symptom of an underlying cause. Currently, 11.9 to 30.3% of adults globally suffer from tinnitus. However, just 0.5 to 3% of that number refer to their condition as one that affects the quality of their life.

The prevalence of tinnitus rises in age groups between 65 to 69 years of age, and it drops after it.

There are so many factors that are responsible for the prevalence of tinnitus, such as a recreational and occupational activity that involves loud noise exposure.

Tinnitus is generally associated with loss of hearing as is diagnosed in a large percentage of patients. This is usually because of the harmful use of oxytocic drugs, certain medical conditions, and infections that negatively affect your hearing function and trigger cochlear damage, as well as causing neural changes in your central auditory system.

Tinnitus can also be modulated or evoked due to inputs from the somatomotor, visual motor, and somatosensory systems in certain individuals.

What this means is that your acoustic tinnitus attributes (pitch and loudness) may change, although temporarily, because of external stimuli like forceful muscle contractions of your limbs, neck, head, and pressure on your myofascial trigger points, electrically stimulating the median nerve, cutaneous hand stimulation, etc.

Most sufferers of tinnitus want to know why the condition varies dramatically. For a lot of patients, the noise or sound they experience changes daily or gets worse at a particular time in the day. Some others have the symptoms after taking a nap. Then some are fine after waking up but experience the sounds progressively getting louder as the day goes by.

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 above experiences, such as increased salt usage in meals, stress levels, disease factors, environmental conditions, which are all responsible for short-term tinnitus modulations.

That said, a lot of people who suffer tinnitus with such experiences have what is called somatic tinnitus. But before we go into details about somatic tinnitus, let's have a general understanding of tinnitus.

General Overview of Tinnitus

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

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

Even though it affects the quality of life sometimes and results in significant impairments of everyday activities, it isn't typically life-threatening. And the most usual sensor symptoms are the perception of phantom noises in your ears like:

  • Clicking
  • Humming
  • Hissing
  • Roaring
  • Ringing
  • Buzzing

The phantom noises perceived by the patient may vary in degree of loudness from high to low and can happen in either both or one ear. In certain cases, 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 go and come. That said, there are two major types of tinnitus, with one being more common than the other:

Subjective Tinnitus

This is the type of tinnitus that only the patient can hear, and it is the most common. Subjective tinnitus can happen because of a range of issues:

  • Problems in the middle inner or outer ear
  • Issues with your auditory nerves
  • Complexities with the area of your brain that interprets nerve signals as a sound, that is, your auditory pathways

Objective Tinnitus

This is a type of tinnitus that a doctor can hear when examining a patient, although it is extremely rare. Objective Tinnitus can be caused by:

  • Middle ear bone condition
  • Muscle contractions
  • Blood vessel problems

What is Somatic Tinnitus?

Somatic tinnitus is a type of tinnitus where your body's sensory system can worsen, influence, or cause tinnitus in some way. The term somatic originates from a Greek word that means "of the body."

Somatic signals refer to sensory signals which are generated from muscle position sensors in your tongue, arms, trunk, face, head, neck, and temporomandibular joint (TMJ).

That said, the most general disruptive somatic signal happens when a muscle spasm of the sternocleidomastoid muscle occurs. This muscle is a large one beneath your ear, on both sides of your neck, that helps in your head’s rotation.

For particular patients, any movement that results in the tension of the neck, like bending your neck when using a microscope, sleeping with a pillow, or any of such activities, results in muscle spasm that causes tinnitus.

The resultant tinnitus and spasm might not occur right away but may begin a few hours after your neck is twisted. Also, a few groups of tinnitus sufferers can modulate the condition by certain eye movements. This action is termed gaze-evoked tinnitus.

TMJ dysfunction and dental problems can also cause somatic tinnitus. Common dental problems that cause this condition include impacted wisdom teeth or tooth abscesses. With regards to TMJ dysfunction, it happens when there is a misalignment of the lower jaw with the skull.

That said, somatic tinnitus generally happens in just one ear. And there are a couple of tinnitus symptoms that suggest it is somatic:

  • Daily pattern
  • Location variability
  • Neck, head, or dental issues with no hearing loss beforehand
  • Fluctuations in noise loudness
  • Intermittency

When there is a somatic modulation of tinnitus, it is usually associated with an underlying somatic disorder. When your tinnitus seems to be preceded or strictly linked to somatic disorders, it is likely related to musculoskeletal system problems rather than your ears; it is called somatic tinnitus.

Common Somatic Tinnitus Risk Factors

For regular tinnitus conditions, the typical risk factors are hearing problems, male gender, and age. However, patients suffering from somatic tinnitus show a different set of characteristics, most of which are younger people with a high prevalence of females and have no hearing problems. Most times, somatic tinnitus patients have normal hearing.

That said, the most typical musculoskeletal conditions that cause somatic tinnitus relate to cervical spine disorders and temporomandibular joint disorders. And as we've previously seen, this kind of tinnitus is modulated by pressure to the head, limbs, neck, eye gaze, electrical stimulation of the median nerve, and muscle contraction.

Regardless of the above, modulation of your tinnitus, by itself, cannot be used as the singular indicator for identifying the somatic origin of your tinnitus. This is because this phenomenon is the fundamental characteristic of any kind of tinnitus, just like it's all the other attributes like ringing and buzzing sounds.

Studies also show that somatic modulation appears in about two-thirds of tinnitus patients. That said, TMJ is usually the most generally affected area in patients suffering from somatic tinnitus. And people with this kind of tinnitus influence the condition via pressure applied to their temporomandibular joint, as well as mandibular movements. Patients suffering from this tinnitus type show a significantly higher prevalence of craniomandibular disorder as well.

What Does the Dorsal Cochlear Nucleus (DCN) Have to Do with Somatic Tinnitus

The Dorsal Cochlear Nucleus or DCN is the first relay point or synapse that auditory signals pass through while heading to the auditory cortex for continued processing. The location of the DCN is at the base of your brain. And dorsal means the back of your cochlear nucleus.

Your DCN is the most vital brainstem region in relaying auditory signals to your brain’s auditory cortex segments. This area gets auditory signals coming from the cochlear hair cells, which are responsible for detecting sound and signals associated with eye movements. The DCN receives signals as well 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, TMJ dysfunction, and others.

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

Although the sound sensations seem to be coming from the ear, the nerve impulses aren't generated from the ear but in the DCN.

Because of how important the DCN is, with regards to tinnitus, it is most times said that the condition is predominantly a brain phenomenon.

The proof of the above statement is that tinnitus still occurs even after the removal of the auditory nerve, and patients who are deaf still experience tinnitus.

How Does Somatic Tinnitus Occur?

As we've already seen, somatic or somatosensory tinnitus is a kind of subjective tinnitus that happens as a result of sensory data sent from the jaw or cervical spine to the brain. Part of your central nervous system, the somatosensory system, reacts to certain changes in your body.

This complex sensory neuron network responds to pressure, pain, temperature, and movement. So when changes such as muscle spasms occur in the temporomandibular or cervical regions, somatic tinnitus results.

This kind of tinnitus is also called cervicogenic or conductive tinnitus. It is termed conductive because external functions cause it. And the term cervicogenic means that it originates from the cervical spine, the nerves, and muscles of the neck.

What is the Relationship between Muscle Spasms in your Neck or Jaw and the Ringing or Buzzing Sound in your Ears?

Your body transmits sensory information to your brain through neural fibers in the brain's trigeminal, ganglion, or dorsal root ganglia. And since parts of these fibers project to the auditory system as well, the signals confuse your brain into believing it hears sounds.

Causes of Somatic Tinnitus

Let's see a few of the causes of somatic tinnitus:

Neck Dysfunction

Whatever causes your neck to get strained or twist, like bending over to view a microscope, putting your neck in the wrong position when using a computer keyboard, and using a fat pillow, can result in tinnitus. Besides this, tight neck muscles on their own can lead to tinnitus.

Injury to the Neck

Damages to the neck that come from incidents like athletic mishaps, arthritis, and car accidents can lead to a ringing sound in your ears. During such mishaps, your head may be thrown forward and backward quickly, like in a car accident, which will damage the neck’s nerves, ligaments, and muscles.

Players of sports like American football can also experience such injuries when on the field. Bad work posture or sleeping position can result in a pinched nerve and arthritis and damage the cushion between your neck bones. All of these things can result in somatic tinnitus.

Dental Issues

Dental problems like an impacted wisdom tooth or abscess that results in jaw joint inflammation can lead to tinnitus. And anyone who has been a patient suffering from TMJ dysfunction is aware of where the temporomandibular joint is located and the gravity of pain it can cause.

The temporomandibular joint dysfunction can lead to spasm or tensing of ligaments and facial muscles. To treat TMJ, the patient has to either wear a custom-fitted mouthguard at nighttime, take anti-inflammatories, or get a massage.

Diagnosing Somatic Tinnitus

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 state the diagnosis after giving the neck Bournemouth questionnaire that queries the patient's symptoms and after conducting various cervical spine tests.

Here's an elaborate list for identifying somatic tinnitus. And if present, the list of criteria below strongly suggests that your tinnitus is somatic or the cause of it stems from the somatosensory system.

First Criteria: Tinnitus Modulation:

  • If you can modulate your tinnitus via voluntary movement of your eyes, neck, jaw, or head, it likely stems from the somatosensory system

  • If you are able to modulate your tinnitus through somatic maneuvers like a jaw clench

  • When your tinnitus is modulated through pressure on your myofascial trigger point

  • All these tinnitus modulation abilities strongly indicate that your tinnitus has a somatosensory influence

Characteristics of Somatic Tinnitus:

  • Jaw or neck pain appearing alongside your tinnitus simultaneously
  • Jaw and neck pain and tinnitus symptoms aggravating simultaneously.
  • Your tinnitus is preceded by a neck or head trauma
  • Your tinnitus increases when in a bad posture
  • The tinnitus loudness, pitch, and location vary
  • With regards to unilateral tinnitus, the audiogram doesn't account for unilateral tinnitus

Accompanying Symptoms that Indicate Somatic Tinnitus:

  • Somatic tinnitus is accompanied by consistent pain in your cervical spine, shoulder girdle, or head
  • Somatic tinnitus can be identified by the presence of myofascial trigger points, mostly tender.
  • A rise in muscle tension usually accompanies somatic tinnitus
  • Temporomandibular disorders can identify somatic tinnitus
  • Somatic tinnitus is associated with bruxism or teeth clenching
  • Somatic tinnitus is accompanied by dental issues or diseases

The Best Therapies for Somatic Tinnitus

Many therapies have been used successfully in relieving somatosensory cervicogenic tinnitus. Even though there's no definite cure for the condition, managing the cause of the problem can control your tinnitus symptoms. That said, somatic tinnitus can go away for people who engage in physical therapy or undergo chiropractic treatment.

Here are some of the therapies:

Massage Therapy

Undergoing a massage can help you get relief from your tinnitus symptoms by resolving postural problems, relaxing tense muscles, and reducing stress. Two major places around your neck and ear can be massaged for decreasing tinnitus symptoms:

The Masseter Muscle

This muscle is what attaches your jaw to your skull. It can be found at the jawline near the earlobe, and it is the strongest muscle in the body based on size proportion.

When this muscle is tensed, it causes structural misalignment, which leads to ringing in the ear. Undergoing a massage to ease the tension and realign the bones can relieve you of tinnitus symptoms.

The Mastoid Process

This is your skull’s area behind your ear, and it connects to the muscles surrounding your neck and ear. By massaging the mastoid process using a Swedish massage you can relieve tension in your ear and neck muscles, which will aid in correcting neck alignment.

Neck Exercises

Certain exercises are recommended for easing tinnitus symptoms. Also, stretching and a regiment of posture training will help. Undergoing posture training that strengthens your neck muscles and eases cervical disc pain and troubles as well.

Whatever stretches a tense neck and shoulder muscles might stop neural signals from causing the tinnitus noise.

There is also a simple exercise you can do when you are sitting tall on a chair. Lift your right hand and use it to grab the top of your head’s left-hand side and lightly pull your head in the direction of your right shoulder.

Do this until you feel a slight stretch of the neck muscles on your left side. Do a repeat of the same process with your left hand and right side.

Transcutaneous Electrical Nerve Stimulation (TENS)

This unit utilizes electric current for the stimulation of your nerves, generally for therapeutic processes. The tens unit can be applied near the upper cervical nerve or close to your ear to relax muscles.

Lidocaine and Steroid Injections

A doctor might recommend these injections to stop the inflammation and pain in your body, which could be responsible for somatic tinnitus.

Mechanical Manipulation

A chiropractor or physical therapist might manipulate your somatic structure to normalize the jaw or cervical spine. This is because when structural deviations result in muscle spasms or tightness, correcting them can relieve your tinnitus symptoms.

Acupressure and Acupuncture

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

TMJ and Somatic Tinnitus

As we've already seen in this piece, somatic tinnitus can sometimes be an indication of temporomandibular joint disorders. This means you must inform your physician or doctor of every symptom you're experiencing for adequate treatment of TMJ.

But how do you know that the symptoms of your tinnitus are linked to TMJ? Here's how:

  • Popping or clicking when you close and open your mouth
  • Sustaining injury to your jaw in previous years
  • Trouble in opening your mouth or chewing with it.
  • Arthritis
  • Limited motion range when you open or close your mouth
  • Pain in your face or jaw

Experiencing any of such symptoms means that your tinnitus in every likelihood has its roots in temporomandibular joint disorders. All you need to do is visit the dental professional, and they will guide you as to the appropriate course of treatment.

How to Decrease the Effects of TMJ Associated with Tinnitus using a TMJ Mouthguard

By taking steps to treat your TMJ, you can, in turn, help to relieve the ear-related symptoms you're experiencing, such as somatic tinnitus or hearing loss. So 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 the appropriate method that will fit your specific situation.

What this means is that there are so many ways TMJ can be treated, from relaxation techniques to exercises to TMJ surgery. Your dentist may even choose a mixture of therapies.

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

However, when you have a mouthguard recommended to you for use, here are a few things you need to consider before using one:

  • Is it easy to care for: do I need to soak it when cleaning it, or can I simply use a dishwasher?
  • Is it comfortable for you: can I drink, eat, and talk with the TMJ mouth guard in place?
  • How simple is it to use: can I easily mold it?


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.

Therefore, it is important to visit a physician medical practitioner to properly diagnose the cause of your somatic tinnitus and assign the appropriate treatment for it. It is important to know that tinnitus is not the problem in itself but is the symptom of an underlying problem. So solving the cause of your tinnitus will help relieve the condition.

If you have any comments or questions, feel free to leave them below

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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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