In a subpopulation of patients, tinnitus can be modulated by movements of the jaw or head and neck due to complex somatosensory-auditory interactions. In some of these subjects, tinnitus could be related to an underlying temporomandibular (TMJ) or craniocervical (NECK) dysfunction that, if correctly identified, could streamline treatment and increase chances of tinnitus improvement. However, it is still unclear whether somatic modulation of tinnitus could be used as a screening tool for identifying such patients. In this study, we included 310 tinnitus patients with normal hearing, no psychiatric comorbidities, and a positive history of TMJ and/or NECK dysfunction and/or a positive modulation of tinnitus to evaluate the characteristics of somatic modulation, investigate the relationship between positive history and positive modulation, and identify factors most strongly associated with somatic modulation. Tinnitus modulation was present in 79.67% of the patients. We found a significant association within the same subjects between a positive history and a positive tinnitus modulation for the same region, mainly for TMJ in unilateral tinnitus patients and for TMJ + NECK in bilateral tinnitus patients. A strong correlation between history and modulation in the same somatic region within the same subgroups of subjects was also identified. Most TMJ maneuvers resulted in an increased loudness, while NECK maneuvers showed an increase in tinnitus loudness in about 59% of cases. High-pitched tinnitus and male gender were associated with a higher prevalence of modulation; no differences were found for tinnitus onset, Tinnitus Handicap Inventory score, and age. In this paper, we report a strong association between history and modulation for the same regions within the same patients; such an association should always be investigated to improve chances of a correct diagnosis of somatosensory tinnitus.

Keywords:
Temporomandibular disorders, Somatosensory tinnitus, Tinnitus modulation, Head disorders, Neck disorders
1.
AAO-ACO American Academy of Otolaryngology and American Council of Otolaryngology: Guide for the evaluation of hearing handicap. JAMA 1979;241:2056-2079.
2.
Abel MD, Levine RA: Muscle contractions and auditory perception in tinnitus patients and nonclinical subjects. Cranio 2004;22:181-191.
3.
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.
4.
Baguley D, McFerran D, Hall D: Tinnitus. Lancet 2013;382:1600-1607.
5.
Belli S, Belli H, Bahcebasi T, Ozcetin A, Alpay E, Ertem U: Assessment of psychopathological aspects and psychiatric comorbidities in patients affected by tinnitus. Eur Arch Otorhinolaryngol 2008;265:279-285.
6.
Bernhardt O, Mundt T, Welk A, Köppl N, Kocher T, Meyer G, Schwahn C: Signs and symptoms of temporomandibular disorders and the incidence of tinnitus. J Oral Rehabil 2011;38:891-901.
7.
Björne A: Assessment of temporomandibular and cervical spine disorders in tinnitus patients. Prog Brain Res 2007;166:215-219.
8.
Buergers R, Kleinjung T, Behr M, Vielsmeier V: Is there a link between tinnitus and temporomandibular disorders? J Prosthet Dent 2014;111:222-227.
9.
Cacace AT: Expanding the biological basis of tinnitus: cross-modal origins and the role of neuroplasticity. Hear Res 2003;175:112-132.
10.
Chan SW, Reade PC: Tinnitus and temporomandibular pain dysfunction disorder. Clin Otolaryngol Allied Sci 1994;19:37-80.
11.
Chole RA, Parker WS: Tinnitus and vertigo in patients with temporomandibular disorder. Arch Otolaryngol Head Neck Surg 1992;118:817-821.
12.
Cianfrone G, Mazzei F, Salviati M, Turchetta R, Orlando MP, Testugini V, Carchiolo L, Cianfrone F, Altissimi G: Tinnitus holistic simplified classification (THoSC): a new assessment for subjective tinnitus, with diagnostic and therapeutic implications. Ann Otol Rhinol Laryngol 2015;124:550-560.
13.
Davis A, El Rafaie A: Epidemiology of tinnitus; in Tyler RS (ed): Tinnitus Handbook. San Diego, Singular, Thomson Learning, 2000, pp 1-23.
14.
Dawes P, Fortnum H, Moore DR, et al: Hearing in middle age: a population snapshot of 40- to 69-year olds in the United Kingdom. Ear Hear 2014;35:e44-e51.
15.
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.
16.
Derogatis LR, Savitz KL: The SCL-90-R and the Brief Symptom Inventory (BSI) in primary care; in Maruish ME (ed): Handbook of Psychological Assessment in Primary Care Settings. Mahwah, Erlbaum, 2000, pp 297-334.
17.
Erlandsson SI, Hallberg LR, Axelsson A: Psychological and audiological correlates of perceived tinnitus severity. Audiology 1992;31:168-179.
18.
Ferendiuk E, Zajdel K, Pihut M: Incidence of otolaryngological symptoms in patients with temporomandibular joint dysfunctions. Biomed Res Int 2014;2014:824684.
19.
Fernandes G, Gonçalves DA, de Siqueira JT, Camparis CM: Painful temporomandibular disorders, self reported tinnitus, and depression are highly associated. Arq Neuropsiquiatr 2013;71:943-947.
20.
Ferreira LM, Ramos Júnior AN, Mendes EP: Characterization of tinnitus in the elderly and its possible related disorders. Braz J Otorhinolaryngol 2009;75:249-255.
21.
Fetoni AR, Mancuso C, Eramo SL, Ralli M, Piacentini R, Barone E, Paludetti G, Troiani D: In vivo protective effect of ferulic acid against noise-induced hearing loss in the guinea-pig. Neuroscience 2010;169:1575-1588.
22.
Fetoni AR, Ralli M, Sergi B, Parrilla C, Troiani D, Paludetti G: Protective effects of N-acetylcysteine on noise-induced hearing loss in guinea pigs. Acta Otorhinolaryngol Ital 2009;29:70-75.
23.
Haenggeli CA, Pongstaporn T, Doucet JR, Ryugo DK: Projections from the spinal trigeminal nucleus to the cochlear nucleus in the rat. J Comp Neurol 2005;484:191-205.
24.
Heller AJ: Classification and epidemiology of tinnitus. Otolaryngol Clin North Am 2003;36:239-248.
25.
Khalfa S, Dubal S, Veuillet E, Perez-Diaz F, Jouvent R, Collet L: Psychometric normalization of a hyperacusis questionnaire. ORL J Otorhinolaryngol Relat Spec 2002;64:436-442.
26.
König O, Schaette R, Kempter R, Gross M: Course of hearing loss and occurrence of tinnitus. Hear Res 2006;221:59-64.
27.
Langguth B, Kreuzer PM, Kleinjung T, De Ridder D: Tinnitus: causes and clinical management. Lancet Neurol 2013;12:920-930.
28.
Langguth B, Landgrebe M, Kleinjung T, Sand GP, Hajak G: Tinnitus and depression. World J Biol Psychiatry 2011;12:489-500.
29.
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, 1999a, pp 193-197.
30.
Levine RA: Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis. Am J Otolaryngol 1999b;20:351-362.
31.
Levine RA, Abel M, Cheng H: CNS somatosensory-auditory interactions elicit or modulate tinnitus. Exp Brain Res 2003;153:643-648.
32.
Levine RA, Kiang NYS: A conversation about tinnitus; in Vernon JA, Møller AR (eds): Mechanisms of Tinnitus. Boston, Allyn & Bacon, 1995, pp 149-162.
33.
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.
34.
Manfredini D, Olivo M, Ferronato G, Marchese R, Martini A, Guarda-Nardini L: Prevalence of tinnitus in patients with different temporomandibular disorders symptoms. Int Tinnitus J 2015;19:47-51.
35.
Mazurek B, Olze H, Haupt H, Szczepek AJ: The more the worse: the grade of noise-induced hearing loss associates with the severity of tinnitus. Int J Environ Res Public Health 2010;7:3071-3079.
36.
Modh D, Katarkar A, Alam N, Jain A, Shah P: Relation of distortion product otoacoustic emission and tinnitus in normal hearing patients: a pilot study. Noise Health 2014;16:69-72.
37.
Nelting M, Rienhoff NK, Hesse G, Lamparter U: The assessment of subjective distress related to hyperacusis with a self-rating questionnaire on hypersensitivity to sound. Laryngorhinootologie 2002;81:327-334.
38.
Passi S, Ralli G, Capparelli E, Mammone A, Scacciatelli D, Cianfrone G: The THI questionnaire: psychometric data for reliability and validity of the Italian version. Int Tinnitus J 2008;14:26-33.
39.
Pienkowski M, Eggermont JJ: Reversible long-term changes in auditory processing in mature auditory cortex in the absence of hearing loss induced by passive, moderate-level sound exposure. Ear Hear 2012;33:305-314.
40.
Pinchoff RJ, Burkard RF, Salvi RJ, Coad ML, Lockwood AH: Modulation of tinnitus by voluntary jaw movements. Am J Otol 1998;19:785-789.
41.
Plack CJ, Barker D, Prendergast G: Perceptual consequences of “hidden” hearing loss. Trends Hear 2014;18:2331216514550621.
42.
Ralli M, Altissimi G, Di Stadio A, Mazzei F, Turchetta R, Cianfrone G: Relationship between hearing function and myasthenia gravis: a contemporary review. J Int Med Res 2016, Epub ahead of print.
43.
Roberts LE, Eggermont JJ, Caspary DM, Shore SE, Melcher JR, Kaltenbach JA: Ringing ears: the neuroscience of tinnitus. J Neurosci 2010;30:14972-14979.
44.
Rubinstein B: Tinnitus and craniomandibular disorders - is there a link? Swed Dent J Suppl 1993;95:1-46.
45.
Ryan D, Bauer CA: Neuroscience of tinnitus. Neuroimaging Clin N Am 2016;26:187-196.
46.
Saldanha AD, Hilgenberg PB, Pinto LM, Conti PC: Are temporomandibular disorders and tinnitus associated? Cranio 2012;30:166-171.
47.
Salviati M, Bersani FS, Terlizzi S, et al: Tinnitus: clinical experience of the psychosomatic connection. Neuropsychiatr Dis Treat 2014;10:267-275.
48.
Salviati M, Macrì F, Terlizzi S, et al: The Tinnitus Handicap Inventory as a screening test for psychiatric comorbidity in patients with tinnitus. Psychosomatics 2013;54:248-256.
49.
Sanchez TG, Bezerra Rocha C: Diagnosis of somatosensory tinnitus; in Møller AR, Langguth B, DeRidder D, Kleinjung T (eds): Textbook of Tinnitus. New York, Springer, 2011, pp 429-434.
50.
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.
51.
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.
52.
Schaette R, McAlpine D: Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. J Neurosci 2011;31:13452-13457.
53.
Sheppard A, Hayes SH, Chen GD, Ralli M, Salvi R: Review of salicylate-induced hearing loss, neurotoxicity, tinnitus and neuropathophysiology. Acta Otorhinolaryngol Ital 2014;34:79-93.
54.
Shim HJ, Kim SK, Park CH, Lee SH, Yoon SW, Ki AR, Chung DH, Yeo SG: Hearing abilities at ultra-high frequency in patients with tinnitus. Clin Exp Otorhinolaryngol 2009;2:169-174.
55.
Shore SE: Plasticity of somatosensory inputs to the cochlear nucleus - implications for tinnitus. Hear Res 2011;281:38-46.
56.
Shore SE, Roberts LE, Langguth B: Maladaptive plasticity in tinnitus: triggers, mechanisms and treatment. Nat Rev Neurol 2016;12:150-160.
57.
Shore SE, Zhou J, Koehler S: Neural mechanisms underlying somatic tinnitus. Prog Brain Res 2007;166:107-123.
58.
Simmons R, Dambra C, Lobarinas E, Stocking C, Salvi R: Head, neck, and eye movements that modulate tinnitus. Semin Hear 2008;29:361-370.
59.
Stamper GC, Johnson TA: Auditory function in normal-hearing, noise-exposed human ears. Ear Hear 2015;36:172-184.
60.
Tarsitani L, Battisti F, Biondi M, Picardi A: Development and validation of a stress-related vulnerability scale. Epidemiol Psichiatr Soc 2010;19:178-182.
61.
Terao K, Cureoglu S, Schachern PA, Morita N, Nomiya S, Deroee AF, Doi K, Mori K, Murata K, Paparella MM: Cochlear changes in presbycusis with tinnitus. Am J Otolaryngol 2011;32:215-220.
62.
Tullberg M, Ernberg M: Long-term effect on tinnitus by treatment of temporomandibular disorders: a two-year follow-up by questionnaire. Acta Odontol Scand 2006;64:89-96.
63.
Ventry IM, Weinstein BE: The Hearing Handicap Inventory for the elderly: a new tool. Ear Hear 1982;3:128-134.
64.
Vielsmeier V, Kleinjung T, Strutz J, Bürgers R, Kreuzer PM, Langguth B: Tinnitus with temporomandibular joint disorders: a specific entity of tinnitus patients? Otolaryngol Head Neck Surg 2011;145:748-752.
65.
Vielsmeier V, Strutz J, Kleinjung T, Schecklmann M, Kreuzer PM, Landgrebe M, Langguth B: Temporomandibular joint disorder complaints in tinnitus: further hints for a putative tinnitus subtype. PLoS One 2012;7:e38887.
66.
Weisz N, Hartmann T, Dohrmann K, Schlee W, Norena A: High-frequency tinnitus without hearing loss does not mean absence of deafferentation. Hear Res 2006;222:108-114.
67.
Won JY, Yoo S, Lee SK, Choi HK, Yakunina N, Le Q, Nam EC: Prevalence and factors associated with neck and jaw muscle modulation of tinnitus. Audiol Neurootol 2013;18:261-273.
68.
Wright EF, Bifano SL: The relationship between tinnitus and temporomandibular disorder (TMD) therapy. Int Tinnitus J 1997a;3:55-61.
69.
Wright EF, Bifano SL: Tinnitus improvement through TMD therapy. J Am Dent Assoc 1997b;128:1424-1432.
70.
Wu C, Stefanescu RA, Martel DT, Shore SE: Listening to another sense: somatosensory integration in the auditory system. Cell Tissue Res 2014;361:233-250.
71.
Zagólski O: Management of tinnitus in patients with presbycusis. Int Tinnitus J 2006;12:175-178.
72.
Zhan X, Pongstaporn T, Ryugo DK: Projections of the second cervical dorsal root ganglion to the cochlear nucleus in rats. J Comp Neurol 2006;496:335-348.
73.
Zhou J, Shore SE: Convergence of spinal trigeminal and cochlear nucleus projections in the inferior colliculus of the guinea pig. J Comp Neurol 2006;495:100-112.
© 2017 S. Karger AG, Basel
2017
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.