Forceful contractions of neck and jaw muscles have consistently been shown to modulate tinnitus and can be used to screen patients who are responsive to somatic stimulation and, therefore, optimal candidates for somatosensory-based treatment. To identify the factors associated with somatic modulation of tinnitus, 163 patients underwent 19 neck and jaw maneuvers after an extensive physiological and audiological profile was compiled. Overall, tinnitus was modulated in 57.1% of ears tested. Unilateral tinnitus showed greater prevalence of modulation. Neck maneuvers generally decreased tinnitus loudness, whereas jaw maneuvers increased loudness. Female gender and buzzing tinnitus were associated with a high prevalence of modulation and a decrease in tinnitus loudness. Loud tinnitus and low-pitched tonal tinnitus were associated with exacerbation of the condition as a result of somatic testing. Use of these characteristics to select optimal candidates for somatosensory-based tinnitus therapies may be essential for the development of an effective approach for tinnitus treatment.

Abel MD, Levine RA: Muscle contractions and auditory perception in tinnitus patients and nonclinical subjects. Cranio 2004;22:181-191.
An YH, Choi A, Yoon S, Shim H: Comparison of clinical characteristics and somatic modulation between somatic tinnitus and otic tinnitus. Audiol Neurotol Extra 2011;1:9-19.
Argstatter H, Grapp M, Hutter E, Plinkert P, Bolay HV: Long-term effects of the ‘Heidelberg Model of Music Therapy' in patients with chronic tinnitus. Int J Clin Exp Med 2012;5:273-288.
Axelsson A, Andersson S, Gu LD: Acupuncture in the management of tinnitus: a placebo-controlled study. Int J Audiol 1994;33:351-360.
Björne A: Assessment of temporomandibular and cervical spine disorders in tinnitus patients. Prog Brain Res 2007;166:215-219.
Boniver R: Temporomandibular joint dysfunction in whiplash injuries: association with tinnitus and vertigo. Int Tinnitus J 2002;8:129-131.
Dehmel S, Cui YL, Shore SE: Cross-modal interactions of auditory and somatic inputs in the brainstem and midbrain and their imbalance in tinnitus and deafness. Am J Audiol 2008;17:S193-S209.
Eggermont JJ, Roberts LE: The neuroscience of tinnitus. Trends Neurosci 2004;27:676-682.
Engelberg M, Bauer W: Transcutaneous electrical stimulation for tinnitus. Laryngoscope 1985;95:1167-1173.
Estola-Partanen M: Muscular Tension and Tinnitus. Tampere, University of Tampere, 2000.
Hansen P, Hansen J, Bentzen O: Acupuncture treatment of chronic unilateral tinnitus - a double‐blind cross‐over trial. Clin Otolaryngol Allied Sci 1982;7:325-329.
Herraiz C, Toledano A, Diges I: Trans-electrical nerve stimulation (TENS) for somatic tinnitus. Prog Brain Res 2007;166:389-553.
Kanold PO, Davis KA, Young ED: Somatosensory context alters auditory responses in the cochlear nucleus. J Neurophysiol 2011;105:1063-1070.
Kanold PO, Young ED: Proprioceptive information from the pinna provides somatosensory input to cat dorsal cochlear nucleus. J Neurosci 2001;21:7848-7858.
Koehler SD, Pradhan S, Manis PB, Shore SE: Somatosensory inputs modify auditory spike timing in dorsal cochlear nucleus principal cells. Eur J Neurosci 2011;33:409-420.
Lanting CP, de Kleine E, Eppinga RN, van Dijk P: Neural correlates of human somatosensory integration in tinnitus. Hear Res 2010;267:78-88.
Levine RA: Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis. Am J Otolaryngol 1999a;20:351-362.
Levine RA: Somatic modulation appears to be a fundamental attribute of tinnitus; in Hazel JPW (ed): Proceedings of the Sixth International Tinnitus Seminar. Cambridge, British Society of Audiology, 1999b, pp 193-197.
Levine RA: Somatic tinnitus; in Snow JB (ed): Tinnitus: Theory and Management. Lewiston, Decker, 2004, pp 108-124.
Levine R, Abel M, Cheng H: CNS somatosensory-auditory interactions elicit or modulate tinnitus. Exp Brain Res 2003;153:643-648.
Levine RA, Nam EC, Oron Y, Melcher JR: Evidence for a tinnitus subgroup responsive to somatosensory based treatment modalities. Prog Brain Res 2007;166:195-207.
Lyttkens L, Lindberg P, Scott B, Melin L: Treatment of tinnitus by external electrical stimulation. Scand Audiol 1986;15:157-164.
Moller AR, Rollins PR: The non-classical auditory pathways are involved in hearing in children but not in adults. Neurosci Lett 2002;319:41-44.
Moller AR, Moller MB, Yokota M: Some forms of tinnitus may involve the extralemniscal auditory pathway. Laryngoscope 1992;102:1165-1171.
Montazem A: Secondary tinnitus as a symptom of instability of the upper cervical spine: operative management. Int Tinnitus J 2000;6:130-133.
Pinchoff RJ, Burkard RF, Salvi RJ, Coad ML, Lockwood AH: Modulation of tinnitus by voluntary jaw movements. Am J Otol 1998;19:785-789.
Rocha CAC, Sanchez TG: Myofascial trigger points: another way of modulating tinnitus. Prog Brain Res 2007;166:209-214.
Rocha CAC, Sanchez TG, Tesseroli de Siqueira JT: Myofascial trigger point: a possible way of modulating tinnitus. Audiol Neurotol 2008;13:153-160.
Sanchez TG, da Silva Lima A, Brandao AL, Lorenzi MC, Bento RF: Somatic modulation of tinnitus: test reliability and results after repetitive muscle contraction training. Ann Otol Rhinol Laryngol 2007;116:30-35.
Sanchez TG, Guerra GCY, Lorenzi MC, Brandão AL, Bento RF: The influence of voluntary muscle contractions upon the onset and modulation of tinnitus. Audiol Neurotol 2002;7:370-375.
Shore S, Zhou J, Koehler S: Neural mechanisms underlying somatic tinnitus. Prog Brain Res 2007;166:107-123.
Shore SE: Multisensory integration in the dorsal cochlear nucleus: unit responses to acoustic and trigeminal ganglion stimulation. Eur J Neurosci 2005;21:3334-3348.
Shore SE: Plasticity of somatosensory inputs to the cochlear nucleus - implications for tinnitus. Hear Res 2011;281:38-46.
Shore SE, El Kashlan H, Lu J: Effects of trigeminal ganglion stimulation on unit activity of ventral cochlear nucleus neurons. Neuroscience 2003;119:1085-1101.
Shore SE, Zhou J: Somatosensory influence on the cochlear nucleus and beyond. Hear Res 2006;216-217:90-99.
Simmons R, Dambra C, Lobarinas E, Stocking C, Salvi R: Head, neck, and eye movements that modulate tinnitus. Semin Hear 2008;29:361-370.
Stouffer JL, Tyler RS: Characterization of tinnitus by tinnitus patients. J Speech Hear Disord 1990;55:439-453.
Vanneste S, Plazier M, Van de Heyning P, De Ridder D: Transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for the treatment of somatic tinnitus. Exp Brain Res 2010;204:283-287.
Vielsmeier V, Kleinjung T, Strutz J, Burgers R, Kreuzer PM, et al: Tinnitus with temporomandibular joint disorders: a specific entity of tinnitus patients? Otolaryngol Head Neck Surg 2011;145:748-752.
Vielsmeier V, Strutz J, Kleinjung T, Schecklmann M, Kreuzer PM, et al: Temporomandibular joint disorder complaints in tinnitus: further hints for a putative tinnitus subtype. PLoS One 2012;7:e38887.
Wright DD, Ryugo DK: Mossy fiber projections from the cuneate nucleus to the cochlear nucleus in the rat. J Comp Neurol 1996;365:159.
Wright E, Bifano S: The relationship between tinnitus and temporomandibular disorder (TMD) therapy. Int Tinnitus J 1997;3:55-62.
Young ED, Nelken I, Conley RA: Somatosensory effects on neurons in dorsal cochlear nucleus. J Neurophysiol 1995;73:743-765.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.