SS02: TINNITUS: MECHANISMS AND TREATMENT

SOMATOSENSORY TINNITUS: MECHANISMS, CLINICAL CHARACTERISTICS AND MANAGEMENT

Tanit Sanchez

Otolaryngology  University of São Paulo, São Paulo, Brazil.

It is well known that tinnitus is a symptom of many different diseases. In order to have success in treating this multifaceted problem, it is important to separate tinnitus in different subgroups, acting with a targeted approach, instead of generalizing the actions to all patients just because they have similar complaints. Researchers are presently working on the identification and differentiation of such subgroups, but somatosensory tinnitus is definitely one of them.

Although the relation between tinnitus, TMJ and cervical spine is an old and controversial subject, recent findings have demonstrated that jaw movements and other muscular contractions of head, neck and limbs can elicit tinnitus modulation (temporary change in loudness, pitch or localization during such movements) more often than expected. Moreover, the pressure of myofascial trigger points in the muscles of head, neck and shoulder girdle - which are characteristics of myofascial pain syndrome (chronic pain) - can also evoke tinnitus modulation almost as often as the jaw movements do. Thus, the type of tinnitus that starts with – or is aggravated by - bony and or muscular problems in TMJ and neck has been named somatosensory tinnitus or somatosensory modulated tinnitus. This specific subgroup deserves a different attention within the whole concept of tinnitus approaches because the diagnosis and treatment approaches are different.

Tinnitus is, by nature, a symptom that requires a multidisciplinary team. When somatosensory modulation is present in patients with tinnitus and frequent regional pain, and nothing is found in the otologic field that may justify tinnitus, it is worth to refer the patient to a well trained dentist/physiotherapist. A treatment attempt directed to it should be carried out before indicating other treatments to simply “manage” tinnitus.

If the underlining problem can not be treated, then the stimulation of the somatosensory pathways may help to control tinnitus. The objectives of this lecture will be: 1. to update knowledge on the subgroup of somatosensory tinnitus; 2. to give clinical clues to identify and treat patients with this subgroup of tinnitus.