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Tinnitus Self-test, explanation and treatment

The auditory system

Eardrum

Sound (moving air) hits the eardrum. As a membrane, the eardrum is under tension and passes the incoming frequencies on to the hammer (malleus), which sits directly on the eardrum. An eardrum can tear and form scars when pressure changes from the outside or the inside.

Hammer, anvil, stirrup (middle ear)

The hammer, anvil and stirrup are three tiny bones that carry the frequencies through the middle ear — from the first membrane (eardrum) to the next membrane (oval window). This system can suffer during middle ear infections. Behind the second membrane lies the cochlea.

Cochlea

The cochlea has many tiny hair cells, each assigned to a frequency — about 20 Hz in the outer part and up to 20,000 Hz in the inner part. Each hair cell is connected to a synapse (a nerve cell) of the auditory nerve (vestibulocochlear nerve).

Vestibulocochlear nerve

The vestibulocochlear nerve carries sound information from the ear to the cranial nerve nucleus in the brainstem. The nucleus is divided into a ventral and a dorsal nucleus.

Cochlear nuclei (ventral and dorsal)

From here, the information is passed on to the thalamus.

Thalamus and cerebrum

The thalamus passes the information on to the cerebrum, where it is processed.

What is tinnitus?

Objective tinnitus

Objective tinnitus is a sound whose source lies outside the auditory system. This includes the rushing or pulsing of arteries, noises from the jaw and so on. It is rather rare [1].

Subjective tinnitus

Subjective tinnitus can have many causes. It is classified as acute, subacute or chronic: acute 2–3 weeks, subacute 1–3 months, chronic from about 4 months.

A common cause is noise exposure. Under heavy noise, the hair cells bend over and can no longer pick up sound properly — this can lead to partial deafness. The hair cells stand up again after a while, but the synapse, the connection between nerve cell and hair cell, can be damaged. It is assumed that losing this function leads to deafness in the affected frequency range and, at the same time, to tinnitus in that same range. One hypothesis is that these damaged synapses send a constant signal, which increases the flow of information in the dorsal cochlear nucleus [2]. With chronic tinnitus caused by noise exposure, the chances of successful treatment are not quite as good — here the aim is to learn to live with the tinnitus.

Somatosensory tinnitus

Here it is important to understand the brainstem irritation syndrome [3]. The brainstem is the oldest part of the brain; all the sensory nerves that are vital for survival come together here — including the twelve cranial nerves and the nucleus of the vestibulocochlear nerve. Neural connections have been shown between the dorsal nucleus and the trigeminal nerve, the nerves C1–C3, the trapezius muscle, the splenius capitis, the facial muscles and the jaw joint [2] [4] [5].

It is assumed that overloading these structures (tension in the neck, face and jaw) can overload the dorsal cochlear nucleus and so trigger a subjective somatosensory tinnitus that is not caused by noise exposure [4] [6]. Here it is worth acting early in the acute phase, as these causes respond well to manual therapy [1] [7] [8] [9].

Interdisciplinary treatment

ENT doctor

Diagnosis, ruling out other causes, treatment and advice [1].

Manual therapy

Supporting treatment by physiotherapists and osteopaths [1] [8].

Psychotherapy

Reducing strain and stress [2].

Tinnitus Handicap Inventory Self-test

Privacy notice: Your answers to the Tinnitus Handicap Inventory are evaluated only in your browser on your device. They are not sent to us or to anyone else and are not stored – they are deleted when you close or reload the page. If you do not trust your device, you can add up the points yourself (Yes = 4, Sometimes = 2, No = 0) and check your result against the table below the questionnaire.

QuestionYes (4)Sometimes (2)No (0)
Scoring
PointsGradeHandicap
0–161none or slight
18–362mild
38–563moderate
58–764severe
78–1005catastrophic

This self-test is for your own assessment of how much the tinnitus affects you and does not replace a medical diagnosis.

Tinnitus and osteopathy

Tinnitus is the perception of sounds without an external sound source [10]. Common causes are neurological processes, muscular tension or stress [2].

Studies show that somatosensory influences in particular, such as jaw or neck problems, can play a role [6] [8] [10].

Sources