Logan Steele
Tinnitus is the perception of sound in the absence of an acoustic external stimulus, and it affects 10-17% of the world's population. It is a complex symptom with multiple causes, influenced by pathways other than the auditory one. While the exact process of producing tinnitus is not yet fully understood, it has been associated with various etiologies, including idiopathic causes, vascular abnormalities, trauma, infections, and muscle spasms. Muscle spasms can result from dehydration, stress, vitamin deficiencies, certain medications, or underlying health conditions, and they have been linked to tinnitus in some cases. This raises the question of whether there is a causal relationship between muscle spasms and tinnitus, and if so, what mechanisms are involved.
| Characteristics | Values |
|---|---|
| What is tinnitus? | Tinnitus is the perception of sound in the absence of an acoustic external stimulus. |
| How common is tinnitus? | Tinnitus affects 10–17% of the world's population. |
| What causes tinnitus? | There are multiple causes of tinnitus, including trauma to the ear, overexposure to loud noises, certain medications, and diseases or infections of the ear such as multiple sclerosis, TMJ, and hearing loss. |
| Can muscle spasms cause tinnitus? | Yes, muscle spasms can cause tinnitus, especially in the neck, jaw, and head muscles. This is often due to the strain on the muscles and interconnected nerves and tissues in these areas. |
| How are muscle spasms and tinnitus treated? | Treatment options for muscle spasms and tinnitus include medication, tinnitus masking, retraining therapy, and relief therapy. Reducing muscular tension through stretching exercises and relaxation techniques can also help alleviate symptoms. |
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What You'll Learn
Tensor Tympani Syndrome (TTS)
TTS can cause a range of symptoms in and around the ears, including a sensation of blockage, pressure, or fullness. These symptoms can be intermittent, occurring randomly, or they may be triggered or aggravated by exposure to intolerable sounds. The tensor tympani muscle plays a crucial role in auditory processes, such as regulating the movement of the eustachian tube and stiffening the tympanic membrane to dampen sound transmission in response to high-intensity sounds. This protective mechanism of TTS can cause uncomfortable and painful symptoms, leading to anxiety and distress.
The exact pathophysiology of TTS is not yet fully understood, but various etiologies have been associated with the condition. These include idiopathic causes, vascular abnormalities, demyelinating disorders, trauma, tumours, and infections. Bilateral TTS has been observed in patients with multiple sclerosis, suspected to be due to the demyelination of innervating nerves leading to muscle spasms. An underlying anxiety disorder has also been implicated in TTS, as it is believed to reduce the threshold required to trigger the tensor tympani muscle reflex.
TTS can be challenging to diagnose due to its episodic nature and similarities to other auditory conditions. It is often misdiagnosed as middle or inner ear pathology or TMJ dysfunction. Consulting an Ear, Nose, and Throat Specialist or a TMJ Specialist is recommended to rule out these possibilities. Effective management of TTS involves understanding the condition, pain management, stress and anxiety reduction, and achieving tinnitus habituation or hyperacusis desensitisation.
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Muscle tension and tinnitus
Tinnitus is the perception of sound when there is no external source. It affects 10–17% of the world's population and is influenced by pathways other than the auditory one. The psychoacoustic attributes of tinnitus (loudness and pitch) might be changed immediately, though only temporarily, by different stimuli, including forceful muscle contractions of the head, neck, and limbs.
Tonic tensor tympani syndrome (TTTS) is described as causing tensor tympani spasms, which can lead to tinnitus and hyperacusis. An underlying anxiety disorder is believed to cause a reduction in the threshold required to trigger the tensor tympani muscle reflex, leading to the belief that TTTS is an involuntary condition. Tensor tympani syndrome (TTS) is a rare condition characterized by spasmodic contractions of the tensor tympani muscle, which leads to the rare phenomenon of "objective tinnitus": tinnitus that can also be heard by another person if auscultating the affected ear during an episode of myoclonus.
Strain on the muscles, especially the neck muscles, jaw muscles, nerves, joints, and other tissues in the head, neck, and shoulders, has been reported to trigger tinnitus. Tight neck muscles can disrupt the function of the Eustachian tube, which is the opening that connects the middle ear to the nasal sinus cavity. This can cause a ringing in the ears. One of the most common ways neck tension causes a ringing in the ears is due to a disruption in Eustachian tube function.
Muscle tension in the jaw and neck can be reduced by performing regular stretching exercises of the suboccipital muscles, rotation movements in the atlanto-occipital joint, and relaxing exercises involving breathing with the diaphragm. Such treatment of muscle tension in the jaw and neck can reduce tension-related symptoms such as tinnitus, vertigo, aural fullness, and pain in the jaw, neck, or headaches.
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Vitamin deficiencies
While tinnitus is not a condition in itself, it is a symptom of another condition, causing a high-pitched whine, ringing, buzzing, or clicking in the ears. Tinnitus has been linked to vitamin B12 and vitamin D deficiencies.
Vitamin B12 helps create myelin, which is the insulative and protective cover that surrounds the nerves. A vitamin B12 deficiency can irritate and hamper the function of nerves in the ear. Research has shown that people with tinnitus experienced improvement in symptoms after undergoing vitamin B12 supplemental therapy. Foods rich in vitamin B12 include meat, fish, and dairy products.
Vitamin D deficiency has been linked to several diseases, including infections, autoimmune and cardiovascular diseases, neuromuscular, musculoskeletal, and psychiatric disorders, diabetes, cancers, pain, and headaches. Due to the presence of vitamin D receptors in the inner ear, vitamin D deficiency may influence vestibular and auditory function. Studies have reported a high prevalence of vitamin D deficiency in patients with inner ear diseases, including benign paroxysmal positional vertigo, Menière’s disease, vestibular neuritis, idiopathic facial paralysis, and idiopathic acute hearing loss.
In a recent study, researchers found that lower levels of serum vitamin D correlated with higher tinnitus severity scores. Thus, vitamin D deficiency and tinnitus are linked, and lower vitamin D levels may directly contribute to increased tinnitus severity. Deficiency in this essential vitamin can affect the healthy functioning of the brain, hearing nerve, and inner ear, making tinnitus worse. Low vitamin D can lead to neuroinflammation and weaken the bones of hearing.
For elderly patients with age-related hearing loss and tinnitus, low vitamin D levels are associated with low-frequency hearing difficulties. A recent cohort study showed that 70% of people with sudden sensorineural hearing loss were vitamin D deficient. This is important because idiopathic acute hearing loss is a common cause of new-onset tinnitus.
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Neurological conditions
Tinnitus is the perception of sound in the absence of an acoustic external stimulus. It affects 10–17% of the world's population and is a complex symptom with multiple causes, influenced by pathways other than the auditory one.
Tinnitus can be related to neurological conditions such as epilepsy or Tourette syndrome, or other neurological disorders. It is also associated with tensor tympani syndrome (TTS), a rare condition characterised by spasmodic contractions of the tensor tympani muscle, which results in the patient perceiving a fluttering noise. TTS can be caused by various etiologies, including vascular abnormalities, demyelinating disorders, trauma, tumours, and infections. Bilateral TTS has been documented in patients with multiple sclerosis, suspected to be due to the demyelination of innervating nerves, leading to muscle spasms. Tonic tensor tympani syndrome (TTTS) is a similar condition that causes tensor tympani spasms, leading to tinnitus and hyperacusis. An underlying anxiety disorder may cause a reduction in the threshold required to trigger the tensor tympani muscle reflex, leading to the belief that TTTS is an involuntary condition.
The psychoacoustic attributes of tinnitus (loudness and pitch) can be changed immediately, though only temporarily, by different stimuli such as forceful muscle contractions of the head, neck, and limbs. This is known as somatosensory tinnitus and is believed to be a good example of central integration of the central nervous system, as an auditory symptom like tinnitus may be modulated immediately after various non-audiology stimuli are presented.
Tinnitus has also been linked to temporomandibular disorder, which often presents with muscular tension in the jaw and neck, as well as vertigo/dizziness and aural fullness. Treatment for somatosensory tinnitus aims to reduce this muscular tension, which can help alleviate tinnitus symptoms. Regular stretching exercises of the suboccipital muscles and rotation movements in the atlanto-occipital joint, especially on the restricted side, can help reduce tension-related symptoms.
Additionally, vitamin B12 and vitamin D deficiencies have been associated with both muscle twitching and tinnitus. While occasional tinnitus can be a normal physiological response to a startle reflex or sudden loud noise, persistent tinnitus accompanied by muscle twitching may warrant further investigation, including a neurological evaluation.
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Somatosensory tinnitus
Somatic or somatosensory tinnitus (ST) is a type of subjective tinnitus. It is a generally agreed subtype of tinnitus associated with the activation of the somatosensory, somatomotor, and visual-motor systems. A key characteristic of somatosensory tinnitus is that it is modulated by physical contact or movement. It is influenced by pathways other than the auditory one.
The somatosensory system is a complex network of sensory and neurons that respond to changes at the surface or inside the body. These changes can include movement, pressure, touch, temperature, or pain. Somatic testing should receive further attention considering the evidence on the ability of patients to modulate their tinnitus through maneuvers.
The existence of a tinnitus subtype where tinnitus is influenced by somatosensory information from the cervical spine or temporomandibular area is widely accepted. Once diagnosed, ST can be treated successfully with cervical spine physiotherapy or with orofacial physiotherapy combined with splint treatment. The first aim of treatment for somatosensory tinnitus is the reduction of muscular tension. Many patients benefit from performing regular stretching exercises of their suboccipital muscles at home, as well as rotation movements in the atlanto-occipital joint, especially on the restricted side, and relaxing exercises involving breathing with the diaphragm.
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Frequently asked questions
Tinnitus is a condition where you hear sounds like ringing or buzzing that are not from an outside source.
Muscular tinnitus is a rare type of tinnitus where you hear sounds caused by muscle spasms in your middle ear.
The symptoms of muscular tinnitus may vary by person and may include sounds like clicking, ringing, buzzing, hissing, roaring, or whooshing in one or both ears.
Muscular tinnitus can be caused by various factors, including degenerative diseases affecting the head or neck, palatal myoclonus, a patulous eustachian tube, otosclerosis, stress, anxiety, dehydration, and certain medications.
Treatment options for muscular tinnitus include sound-masking devices, tinnitus retraining therapy (TRT), background noise, stretching exercises, muscle relaxants, and in rare cases, surgery.
