March, 2013 Tinnitus: Ringing in Your Ears

Potsdam Fibromyalgia Support Group

Newsletter

March, 2013

Tinnitus: Ringing in Your Ears

Does it feel like you have a marching band in your ear? Tinnitus can sound like ringing, hissing, humming, buzzing whistling or water running in your ear. It can be so subtle that you only notice it in a quiet room, or so loud it’s like having a jack-hammer inside your head. The word ‘tinnitus’ is derived from the Latin root ‘tinnire’ which means ‘to ring.’ It affects about 10% of adults, or 50 million people in the US. This article will discuss some of the many causes of tinnitus, with an emphasis on musculoskeletal causes likely to be common among people with FM. Please note that the following is a simplified presentation of a very complicated topic. If you experience tinnitus, discuss your personal situation with your health care provider.

Tinnitus is either objective or subjective. Objective tinnitus occurs when a real physiological sound that normally cannot be heard is amplified so it can be heard. Examples include blood pulsing through the arteries or muscle spasm ‘clicking’ in or near the ear. Objective tinnitus is rare.

Help PT Students

Learn About FMS!

Physical Therapy students have their yearly fibromyalgia lab on Friday, April 19^th, 10:30-12:00. If you are able to come work with students, please contact Leslie at [e-mail] or 268-3761. Participants will talk with students for about 1 hour and do some PT tests for 30 min. (things like range of motion, balance, etc.). This is a great chance for you to help educate the next generation of health care providers!

Subjective tinnitus is not associated with physical sound and is heard only by the affected individual. Subjective tinnitus is divided into 5 types: otologic (due to structures in the ear), neurologic, infectious, drug-related, and somatosensory (e.g., trigger points).

The most common reasons for tinnitus are otologic: hearing loss due to loud noise exposure, aging, earwax, Meniere’s disease, and problems with the structures or sensory cells that process hearing.

Injuries or diseases affecting neural structures can also lead to tinnitus: head injury, whiplash, multiple sclerosis and several neurological diseases.

Infections can lead to tinnitus: middle ear infection (otitis media), Lyme disease, meningitis or syphilis.

Drugs can also be a cause: salicylates (aspirin derivatives) are most often the cause, followed by non-steroidal anti-inflammatory medications (NSAIDs), antibiotics, diuretics (water pills), antidepressants, oral contraceptives, heart medications and chemotherapy drugs. (web site with comprehensive list of drugs is at end of this article)

Although not as well recognized, trigger points in muscles of the face and neck can also cause ‘somatosensory’ tinnitus. The most common muscles responsible include the masseter, lateral pterygoid, sternocleidomastoid or upper trapezius. Temporomandibular joint (TMJ) and problems, in neck joints or muscles, might play a role as well. More about masseter TrP below.

Stress, insomnia, depression and anxiety can aggravate tinnitus. Addressing these issues can help.

Treatment begins with determining the cause, if possible; however, it is not possible to determine a cause in many people. Medications generally do not help much in treating tinnitus.

Masking devices can drown out the ringing with another sound. Hearing aids allow normal sound to overpower the background sound, thus diverting attention from the ringing. Tinnitus retraining therapy uses sound to habituate the patient so the ringing sound is not as noticeable. Biofeedback can reduce the stress associated with tinnitus. Cognitive behavioral therapy (CBT) teaches patients coping strategies and distraction skills to reduce the distress associated with tinnitus. Tinnitus retraining therapy tries to override the brain’s perception of the tinnitus; benefit is limited and can take 1-2 years to take effect.

For somatosensory tinnitus, a variety of treatments may be beneficial: postural training, relaxation practice (breathing, meditation, biofeedback, imagery, etc.), stretching, manual therapy, massage or heat. Sanchez & Rocha (2011) reviewed research and found moderate success for these methods.

As always, talk with your health provider…

Resources used in writing this article:

• 
  Chan Y. Tinnitus: etiology, classification, characteristics, and treatment. Discovery Medicine. 2009;8(42):133-6.
  
• 
  Sanchez TG, Rocha CB. Diagnosis and management of somatosensory tinnitus: review article. Clinics. 2011;66(6):1089-1094.
  
• 
  American Tinnitus Association at www.ata.org
  
• 
  www.tinnitusformula.com/library/prescription-drugs-that-can-cause-tinnitus/ list of tinnitus-causing medications
  

Trigger Pointers: The Masseter

Masseter TrP can refer to the TMJ (temporomandibular joint), jaw and eyebrow. It can also cause toothache in either the upper or lower molars, as well as hypersensitivity of the teeth to pressure and temperature. Masseter TrP generally make it difficult to open the mouth fully (you should normally be able to get 2 knuckles between your front teeth).

Masseter TrP can also cause ringing in the ear (tinnitus), fullness in the ear or earache. Other muscles that can produce tinnitus include the SCM (sternocleidomastoid, see October 2007 newsletter) and the lateral pterygoid.

Factors that aggravate masseter TrP include:

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  Clenching or grinding the teeth, or teeth not meeting properly
  
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  Constant gum chewing, forceful biting, chewing pens
  
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  Forward head posture
  
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  Mouth breathing (as with sinus congestion)
  
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  Emotional tension
  
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  Overstretch during dental procedure
  
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  Instability due to hypermobility (normally able to get 3 knuckles between front teeth)
  
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  Trigger points in other muscles (e.g., SCM)
  

Managing masseter TrP starts with figuring out what is causing them. Stress reduction is almost always helpful: diaphragmatic breathing, meditation, biofeedback (see past newsletters for info on each of these). If you grind or clench your teeth at night, you may benefit from a dental appliance (a special tooth guard). Exercises to improve posture and stretch tight neck muscles can also help. Jaw stretches can sometimes help, but should be done carefully to avoid overstretch.

Moist heat can help relax the masseter. Massage and manual therapy can be helpful if provided by someone with training to treat the TMJ.

Potsdam Support Group Meeting:

The next meeting of the Potsdam Fibromyalgia Support Group will be at 5:00 pm on Monday, March 25^th. The topic will be “Knowledge is Power: How Learning About Chronic Pain Helps You Manage It.” Research consistently shows that learning about pain can decrease pain and improve quality of life. Leslie will briefly present some of the research about this then group members will share what they have found most helpful: books, handouts, web-sites, etc. Bring your favorite resources with you to show others. Meetings are in Clarkson Hall, at 59 Main St. For information about meetings, contact CPH Physical Therapy Department at 261-5460.

Massena Support Group:

For information about the Massena Fibromyalgia Support Group, contact Massena Memorial Hospital at 764-1711.

Save the Dates: Tai Chi Workshop!

The April 22^nd and May 20^th support group meetings will be special sessions exploring tai chi, chi gung (qigong) and meditation as healing arts. Our guest speaker will be Pam March, certified instructor trained at The Boston Kung Fu Tai Chi Institute. She started practicing tai chi while in college and has been teaching since the late 1990s. This will be a participatory workshop; no experience needed. Pam will be running regular tai chi classes starting in June: these sessions can help you decide if it might benefit you and get you familiar with basic movements.

For information about the benefits of these arts in managing FM, see past newsletters: March, 2012 (meditation); August, 2010 (tai chi); September, 2008 (tai chi and chi gung) at www.people.clarkson.edu/~lnrussek/FMSG.

This newsletter is a joint effort of Clarkson University and Canton-Potsdam Hospital. If you would prefer to receive these newsletters electronically, please send your email address to [e-mail]. You can access current and previous Potsdam Fibromyalgia Support Group Newsletters on our web site: www.people.clarkson.edu/~lnrussek/FMSG