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Tinnitus

Tinnitus

What is Tinnitus or Ringing in the Ears?

Tinnitus is an annoying sensation of hearing sounds even in the absence of external sounds. However, it can also be a feeling of pressure in one or both ears. Patients have used different vocabulary to describe the sound they hear such as: high or low pitched, hissing, shh-ing, buzzing – there is no single sound that defines tinnitus. 

Does Tinnitus Cause Hearing Loss?

Tinnitus is often associated with hearing loss, but there is no evidence that tinnitus causes the loss or that hearing loss causes tinnitus. In fact, some people with tinnitus experience no difficulty hearing.

What Are the Causes of Tinnitus?

The causes of tinnitus are not clear, but could range from systemic or vascular causes or from mechanical stress or  injury. There is no one factor that causes or increases tinnitus.

Is There Treatment for Tinnitus?

Yes, tinnitus can improve or disappear once the underlying cause has been treated. People should seek care instead of just accepting constant or intermittent sounds or noises in their ear(s). 

A physician (typically an ENT or internist) can diagnose and treat systemic or vascular causes of tinnitus. However, mechanical stress factors are frequently not evaluated.  The physical therapists at PhysioPartners Renaissance CranioFacial Group can help by increasing the postural awareness and decreasing the mechanical stresses that are contributing to tinnitus.

How can posture affect or cause tinnitus?  Poor posture and head, neck and jaw imbalances increase resting muscle tension. Additionally, inefficient tongue posture can increase stress on the inner ear and contribute to tinnitus.

Clenching increases compression in the TMJ (the joint that connects your jaw to your skull), which is very close to the ear and can contribute to tinnitus. Loss of vertical height in the TMJ/jaw joint also increases compression around the ear. The physical therapists at PhysioPartners Renaissance CranioFacial Group will improve the mobility of the structures around your ears. At times, as an additional support, we may recommend a nighttime dental appliance to help maintain the joint space and progress through therapy.

Dr. Jennifer Hobson, PT, DPT explains physical therapist care for tinnitus 

How Can a Physical Therapist Help with Tinnitus?

Each patient is unique and that what helps one patient with tinnitus does not always help another patient with tinnitus.  Your physical therapist will evaluate the factors that may be contributing to your tinnitus symptoms. 

What Treatments May Help Tinnitus?

  • Postural Re-Education: Stretching and strengthening of the upper body can improve alignment of the head, neck and jaw, as well as improve chest position for optimal breathing and posture.
  • Manual Therapy: Your physical therapist will apply specialized manual techniques (hands-on techniques) to release a tight muscle or improve joint mobility, including joint mobilization, trigger point release, and deep tissue mobilization.
    • Common muscles treated include:
      • Masseters
      • Lateral pterygoids
      • Sternocleidomastoids
      • Upper trapezius
      • Pectoralis major and minor
      • Cervical spine multifidii
      • Temporalis
      • Scalenes
      • Tongue
    • Common joints treated include:
      • Cervical spine
      • Thoracic spine
      • Temporomandibular joint
      • Cranial sutures with osteopathic functional manual treatment and specialized manual therapy. Gentle, non-painful, temporal bone mobilization, along with surrounding cranial bones, can help relieve tinnitus.
  • Dry Needling: Dry needling can alleviate muscle trigger points, sensitive areas that are located in a tight band. The most common muscles treated with dry needling for tinnitus are the sternocleidomastoid and deep masseter, which can both refer symptoms to the ears. Other common muscles treated are the upper trapezius, scalene, and temporalis. 
  • Myofunctional TherapyA program used to correct the proper function and posture of the tongue and facial muscles used at rest, chewing, and during swallowing. A series of exercises are issued each week for the patient to perform at home. Many tinnitus patients demonstrate a clenching habit with resultant facial tension, and Myofunctional Therapy can help alleviate the tension that may be contributing to tinnitus.
  • Restorative Breathing: Restoring proper breathing mechanics utilizing the nose and the diaphragm correctly. We also train to restore the proper ratio of carbon dioxide and oxygen in the blood through breathing techniques, proper volume and breath rate.
  • Vestibular Therapy:  Restoring balance in the inner ear along with the head, neck and jaw, vestibular and Balance Therapy can help with tinnitus. Exercises performed to strengthen the vestibular ocular reflex can help patients who have balance vertigo and inner ear pathology that contribute to tinnitus. Your physical therapist will determine if this treatment may help your tinnitus symptoms.  
  • Nasal Release Technique:  This technique utilizes a decompressive balloon treatment in the nose to mobilize the nasal bones, which helps alleviate tinnitus symptoms in some patients.
  • Restoration of Cervical Lordosis:  Many of patients have lost the normal curve of the cervical spine, which is important for absorb forces from the weight of our heads and helps us maintain good posture. Specific manual therapy and exercises can help restore the normal curvature of the spine which can help reduce pain, headaches, TMJ issues, tinnitus, shoulder pain and other issues. Restoring optimal alignment in the body helps reduce abnormal stress and strain on our joints and muscles.
  • Functional Manual Medicine:  Craniosacral FMM usually involves the placement of the practitioner’s hands on the patient’s head with light pressure guide the cranial bones into improved alignment and mobility.  This soothing and relaxing technique is theorized to balance tension in the dural membranes and optimize cerebral fluid flow. The specialized physical therapists or PhysioPartners Renaissance CranioFacial Group will assess any patterns that may be contributing you tinnitus.
  • Dental Appliance:  Our patients have reported that creating space between the teeth, especially if you are clenching and grinding at night, can help reduce tinnitus.  We can recommend over-the-counter appliances or refer you to a dentist who will create a longer lasting nighttime dental appliance to reduce compression around the ears.

What is the Goal of Treatment for Tinnitus patients?

Every physical therapist in the clinic is dedicated to our patients' and utilizes his or her best professional knowledge and judgment to evaluate and treat each patient with a customized treatment plan. For patients with tinnitus, the first goal is to determine if the treatment is creating a change in tinnitus.  Any change in frequency or intensity, including a temporary increase in symptoms, is a sign that mechanical factors may be contributing to the symptoms and improves the patient's prognosis.  The ultimate goal is to eliminate the tinnitus and many patients have reported elimination or considerably reduced ringing in their ears.

Your physical therapist will evaluate and reevaluate throughout your treatment course and incorporate different treatment options based on response to prior treatments.

How Long Are Sessions?

Typical sessions are 45 to 60 minutes in length.

What is the Frequency of Treatment?

A typical treatment plan consists of twice per week for approximately one to two months. If symptoms are improving and progressing appropriately, frequency tapers to once per week for an additional one to two months.  Changing these automatic habits of the body, such as proper mouth and body posture and breathing habits, takes time. Less frequent treatment may slow progress due to regression between sessions.

Our Patients Say It Best:

Glen’s Story:

“I developed a hissing sound in my ears and was told that there was nothing I could do and to just get used to it.  After getting a second opinion which recommended treatment at Renaissance, my tinnitus is now nearly undetectable after the hands-on treatment approach to the head and neck.”

Glen

Useful Links:

Mayo Clinic Tinnitus Resource   -   Northwestern Tinnitus Clinic Director, Dr. Matsuoka 

Please call (312) 986-9833 for more information or schedule an onsite or virtual appointment.

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