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Somatic modulation in tinnitus has been demonstrated by several studies although few investigations have been published on the efficacy of physical treatments in tinnitus subjects.
40 consecutive tinnitus patients, aged 18-65, were randomly selected for treatment (once a week for 2 months): 20 tinnitus subjects were treated with osteopathic manipulations, 20 with InterX®. In our population, tinnitus sufferers presented more frequently musculoscheletal strains assessed with osteopathic visit and postural problems assessed with posturography measures in comparison with controls. This study indicates the benefit of physical, manipulation therapy for those patients with somatic modulation of their tinnitus, further studies are needed to establish the diagnostic or prognostic role of posturographic measurements. Tinnitus is an auditory sensation of sound in the ears or in the brain in the absence of external sounds1. Other studies have shown that tinnitus can be evoked or modulated by pressure on painful trigger points10 in the upper back, neck or shoulders11.
An abnormal activity in the somatosensory system may result from such peripheral problems and the interaction of the somatosensory systems with the auditory system can provide a powerful feedback mechanism that may interfere with peripheral sensitivity1. Recently, connections between the dorsal cochlear nucleus and afferent pathways from the cervical somatosensory system, respiratory and vocal centres as well as reticular formation have been demonstrated15-17.
These evidence have suggested to use therapeutic methods for tinnitus that are in the area of therapies for musculoskeletal disorders, such as electrical stimulation applied to skin or the use of manipulations or exercising11,18-24.
The Transcutaneous Electrical Nervous Stimulation (TENS) is a clinical form of electrical stimulation of the somatosensory system. The efficacy of this treatment for tinnitus could be justified by the fact that tinnitus has many similarities with the symptoms of neurological disorders such as paresthesia and central neuropathic pain. Also it has been shown by differentially blocking cutaneous and deep tissue primary afferents that TENS analgesia is primarily mediated by the activation of large diameter primary afferents from deep somatic tissues, rather than the cutaneous afferents28, and for this reason it might interfere with the mechanisms of somatic modulation of tinnitus.
InterX® is an interactive non-invasive skin neurostimulator for pain management (Figure 1). In the few studies that used TENS as treatment in tinnitus, improvement21,22,24 as well as worsening of tinnitus in participants was described24. Many of the manipulative treatments used for musculoskeletal disorders such as chiropractic manipulations, osteopathy, and massages may be considered in tinnitus treatment not only in patients with somatic tinnitus, but also in some other patients because these therapies may elicit reflex effects on non-musculoskeletal symptoms. In published data, chiropractic manipulations are used mainly for musculoskeletal disorders, but improvements of non-musculoskeletal symptoms after chiropractic manipulations have been described to occur in 2% to 10% of all patients treated and by 3% to 27% of those who complained to have non-musculoskeletal problems29,30.
In some cases, cervical problems, such as cervical degeneration or cervical instability, can present with symptoms mimicking Meniere's disease: dizziness, fluctuating hearing loss, and tinnitus18,19,31. 40 consecutive individuals with tinnitus and otherwise healthy, aged 18-65, have been enrolled for the study. Individuals in current treatment with psycotropic medications or psychiatric disorders were excluded from the study. The transcutaneous electrical stimulations were all performed by the same physician with the InterX® 5000 equipment for 60 min once a week for each subject at 70 Hz stimulation. The InterX® is an alcaline battery supplied device for transcutaneous electrical neurostimulation with impulse duration 68-668, frequency ranging 15,3-350 Hz and variable output voltage of 20-450, with output current bifasic 2-90 mA.
The normality of data distribution was verified before comparing patient-group averages, by means of the Kolmogorov-Smirnov test at the 0.05 p-level. The audiometrical tests of 30 control subjects (75%) showed normal hearing, 5 subjects had mild hearing impairment in the high frequency range, 2 had moderate sensorineural hearing impairment in the high frequencies and 3 subjects had a slight sensorineural hearing impairment across all frequencies.
The minimum duration of tinnitus was 2 months and the maximum 480 months (40 years) (average 68.2 months). Although after the treatment there has not been significant variations in pitch and loudness match for tinnitus, subjective general tinnitus intensity and annoyance improvement was reported by 10 participants treated with osteopathic manipulation and 12 subjects treated with InterX®. During initial clinical evaluation painful trigger points or muscle contraction in suboccipital region, neck, upper back, shoulders or TMJ were found in 33 (82,5%) of the tinnitus participants and in 18 (45%) of the controls. Variations in tinnitus intensity were reported by 36 subjects (90%), while a variation of tinnitus frequency was reported by 15 participants (37.5%).
Among controls, only one subject declared regular use of benzodiazepines for sleep problem, and another one reported an incidental use in situations of particular distress in working environment.
In all examined tests (open eyes, closed eyes, clenched teeth, open mouth, head extended backwards), the average pre-treatment oscillation envelope areas were significantly greater in tinnitus subjects (P 0.05), compared with controls (Figure 2).
The post-treatment average oscillation envelope areas diminished in individual subjects but did not overall vary significantly in both treatment groups: InterX® or osteopathic.
The pre-treatment THI scores ranged between 14 and 98 points (average 51.4) The average pre-treatment THI scores did not differ between the two treatment groups. In our population, tinnitus subjects presented a much higher prevalence of musculoskeletal strain and contraction compared with non-tinnitus individuals. Since the early 1980s, transcutaneous electrical nerve stimulation (TENS), have been reported for pain relief in humans33-39 as well as in experimental animals40,41 and tinnitus has many similarities with central neuropathic pain42-44. InterX® could be a more appropriate device for TENS stimulation in tinnitus subjects since it dynamically adapt the stimulation to the electrical potential of the skin automatically measured by the InterX® while delivering the stimulation.
In our sample, somatic modulation of tinnitus was quite common (82,5%) and therefore the physical treatments could be an option to consider in most subjects. In a study by Aydemir and colleagues21, after TENS treatment the subjective improvement of tinnitus measured by VAS scale was only marginally significant (p = 0.059). Also, tinnitus can be triggered or modulated by various afferences of the sensitive or somatic system such as skin stimulation46, gaze47,48 or speech49. Although in our study the efficacy in reducing tinnitus annoyance was less significant after osteopathic treatment compared to the InterX® group, a benefit was evident in some individuals.
In some cases cervical problems, such as cervical degeneration or cervical instability, can present with symptoms mimicking Meniere's disease: dizziness, fluctuating hearing loss, and tinnitus18,19,31. The use of osteopathy could be especially useful in somatic tinnitus especially when postural asymmetry is present, but also in individuals with tinnitus that mimics chronic pain since osteopathic treatment can interfere with the mechanisms of modulation of pain50. Osteopathic manipulative medicine is an approach to patient care that incorporates diagnostic and therapeutic strategies to address body unity issues, enhance homeostatic mechanisms, and maximize structure-function interrelationships50.
These preliminary results confirm that somatic modulation of tinnitus is a very common finding as demonstrated by other authors. Differences in postural control were found between tinnitus sufferers and controls, but further studies are needed to better understand the possible patophysiological mechanisms underlying these differences and to use the posturography analysis to identify or monitor changes in somatic tinnitus. Medical history, your current and past these abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia because of the multifactorial nature. Herbs really DO lessen or completely eliminate many peri-menopausal symptoms like night sweats, hot flashes, sleeplessness, hair loss, loss of libido, crazy periods, the whole deal.

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Craniosacral Therapy is a gentle, relaxing treatment which, through light touch can facilitate the body’s natural powers of self-healing. The therapist’s hands are used to listen to the intrinsic movements of the bones of the head, the membranes and the cerebrospinal fluid which surrounds and protects the brain and spinal cord. Initially, a full case history is taken, noting any specific ailments or concerns which may be bothering the client.
Up to one hour and fifteen minutes should be allowed for the first session, and one hour for subsequent treatments. Craniosacral Therapy can improve quality of life in general, as well as helping with specific problems. Craniosacral Therapy is intended to complement, not replace, the relationship you have with your medical practitioner. In the present study the prevalence of somatic components to tinnitus were evaluated and the efficacy of two different physical treatments were compared: InterX® transcutaneous dynamic electrical stimulation and manual osteopathic therapy. They were evaluated pre and post therapy with audiogram up to 16 kHz, tinnitus pitch and loudness match, MML, THI questionnaire, posturography, structured interview with special attention on postural and movement influence on tinnitus, physical evaluation and osteopathic evaluation.
Posturographic test, showed an average oscillating areas significantly greater in tinnitus participants (p 0.05), compared with control subjects. The mechanisms generating this symptom are uncertain and the onset of tinnitus can be associated with non otologic causes.
Also, it has been described that many tinnitus sufferers may present symptoms of temporomandibular joint (TMJ) or dental problems12,13, cervical spine disorders3,14, head, neck and shoulder pain2,6. Also, anomalous cross-modal interactions along the audiovestibular, visual and somatosensorial pathways could be responsible for the aberrant signals5. These connections can either increase or reduce the activity of areas of the dorsal cochlear nucleus and such activity can be affected by hearing loss17. It is the electrotherapy most commonly used in physiotherapy for pain, muscle contractions, and inflammation in several neural and osteoarticular conditions as well as those affecting tendons and ligaments for it reduces pain25,26. In fact, there is considerable evidence that the symptoms and signs of some forms of tinnitus and central neuropathic pain are caused by functional changes in specific parts of the central nervous system and that these changes are caused by expression of neural plasticity27.
The device produces biphasic impulse current indicated for symptomatic relief and management of chronic pain, post traumatic strain and pain, muscle relaxation and muscle re-education.
The success of spinal manipulative therapy, particularly of the atlanto-occipital joint, can be up to 82% of patients with dizziness (46% total relief, 36% high improvement). Cervical problems in the generation of tinnitus should be taken into account, especially in the elderly with a later onset of symptoms. Patients and controls were initially evaluated and the patients were then randomly selected for treatment (1 treatment per week for 2 months): 20 were treated with osteopathic manipulations and 20 with InteriX®. Also, individuals with recent history of neoplastic disease or chronic cardiovascular problems (including hypertension) were not recruited for this study. Time of awareness of tinnitus, subjective discomfort generated by tinnitus and degree by which tinnitus interfere with patients' daily life, were also evaluated by mean of a visual analogue scale (VAS 1-10). The t-test for paired experiments was used for evaluating the significance of therapic effects within groups of tinnitus patients. This may account for the subjective improvement in tinnitus annoyance and discomfort obtained after physical treatment. In fact, for traditional TENS there is no definite agreement with regards on the benefit on tinnitus and this could be influenced by the parameters used for the stimulation or the difference mechanisms generating tinnitus in different subjects. However, after electrical stimulation, there was statistically significant improvement regarding tinnitus severity scores, tinnitus handicap inventory scores, NHP fatigue, social isolation, and emotional problems scores.
Therefore, specific exercise or physical treatments can be effective at least in some cases. Too little is known on the applications of such treatments in tinnitus, but given the prevalence of somatic modulation on tinnitus it would be important to further explore these possibilities. Physical treatments allow improving not only muscle contraction and pain of upper back and neck somatic muscles, but they can be used to significantly reduce tinnitus annoyance. Week after week, I visit with women who share stories of soaking the bedsheets from wicked night sweats, suffering weeks or months of exhausting insomnia, tracking periods that run the gamut from every 2 or 3 months to every 2 or 3 weeks, with flooding and sometimes debilitating pain, migraines and too many other miseries to name here. Furthermore, posturographic measurements were analysed to verify the postural control in tinnitus subjects. 40 controls with no tinnitus, underwent audiological tests, postural and osteopathic evaluation for comparison. On the average in the treated groups, the enveloped areas were not significantly affected by either of the treatments. Several studies have shown that tinnitus can arise directly from a disorder of the head and upper neck through activation of the somatosensory system, which can trigger or modulate tinnitus in 64-80% of the participants2-9. The main difference with the traditional TENS techniques is that InterX® is designed to sense the difference in skin potential and to dynamically adapt its stimulation to this modifying parameter through a process of interactive feedback.
Painful areas or trigger points of the neck, upper back or around the ear muscles are treated by the therapist during the entire session with interX in tinnitus subjects. Still (1828-1917), focusing on the diagnosis, treatment, prevention, and rehabilitation of musculoskeletal disorders and the effects of these conditions on a patient's general health. Furthermore subjects with severe or profound hearing loss across all frequencies were not included.
The homogeneity of variances was checked with Bartlett's test before comparing patient-group averages by means of LSD test or t-test with separate variance estimate32.
Improvement of somatic pain, muscle contraction or headache was reported by 36 subjects (90%). Tinnitus loudness changed also with chin protrusion in 30% of the subjects (12) while only 7.5 % (3) subjects reported changes in tinnitus frequency.

This was more evident after transcutaneous electrical stimulation with the dynamic system InterX® compared with manual osteopathic manipulations. This is in agreement with other studies that showed electrical stimulation of the median nerve at the wrist could cause tinnitus to increase in some individuals and decrease in others27, therefore the protocol of stimulation sequence could greatly influence the results and a dynamic adaptation of the stimulation could be more effective in treating tinnitus.
Also, manipulative treatments can be used in responsive tinnitus subjects such as those with painful trigger points11. Many of the manipulative treatments used for musculoskeletal disorders such as chiropractic manipulations, osteopathy, and massages may be considered in tinnitus treatment not only in patients with somatic tinnitus, but also in subjects presenting other associated symptoms (insomnia, irritability etc.) since these therapies may elicit reflex which have effects on non-musculoskeletal symptoms. The choice of treatment may influence the rate of success and it is therefore important to evaluate different methodologies to possibly point out the most effective in different tinnitus individuals, for example dynamic transcutaneous stimulation may be more effective than the classical TENS static applications. Multi-sensory interactions in tinnitus: visual evoked potentials and somatosensory stimulation.
Otological and vestibular symptoms in patients with low grade (Quebec grades one and two) whiplash injury. Multisensory integration in the dorsal cochlear nucleus: unit responses to acoustic and trigeminal ganglion stimulation. Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss. Treatment of tinnitus with transcutaneous electrical nerve stimulation improves patients' quality of life.
Somatic modulation of tinnitus: test reliability and results after repetitive muscle contraction training. Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects.
Transcutaneous electrical nerve stimulation and transcutaneous spinal electroanalgesia: a preliminary efficacy and mechanisms-based investigation. Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation-Induced antihyperalgesia. Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. The effects of non-painful transcutaneous electrical nerve stimulation on cutaneous pain threshold and muscular reflexes in normal men and in subjects with chronic pain. Changes of cutaneous sensory thresholds induced by non-painful transcutaneous electrical nerve stimulation in normal subjects and in subjects with chronic pain. Effects of acupuncture and transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects. Effects of transcutaneous electrical nerve stimulation and aspirin on late somatosensory evoked potentials in normal subjects.
Transcutaneous electrical nerve stimulation produces variable changes in somatosensory evoked potentials, sensory perception and pain threshold: clinical implications for pain relief. The current status of electrical stimulation of the nervous system for the relief of chronic pain.
Effect of transcutaneous electrical nerve stimulation (TENS) on central nervous system amplification of somatosensory input.
Electrophysiological evidence for the antinociceptive effect of transcutaneous electrical stimulation on mechanically evoked responsiveness of dorsal horn neurons in neuropathic rats. Differential modulation of nociceptive neural responses in medial and lateral pain pathways by peripheral electrical stimulation: a multichannel recording study. The analogy between tinnitus and pain: a suggestion for a physiological basis of chronic tinnitus. Transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for the treatment of somatic tinnitus. Gaze-evoked tinnitus following acoustic neuroma resection: a de-afferentation plasticity phenomenon? Taking a problem like night sweats to a professional herbalist might be the LAST thing you consider. Never disregard medical advice or delay in seeking it because of anything you have read on this website.
Tinnitus improved subjectively in most patients: loudness decreased, % time of awareness, % time of annoyance and quality of life was overall perceived as improved.
This could reduce the overstimulation occurring in some cases, reducing the risk for worsening of tinnitus. According to osteopathic textbooks, therapy for tinnitus aims at the identification of structural problems to correct; the relaxation of muscles especially in the neck, upper back and TMJ and the improvement of lymphatic local circulation. Participants were asked to not associate other therapies for tinnitus (such as sound therapies or medications) while participating in the study. In fact, Herraiz and colleagues22 report improvement of tinnitus in 46% of their sample of 26 individuals with tinnitus receiving 2 hours treatment daily (alternated stimuli, 150 pps, pd 10 micorsec, 0-60 mA amplitude, mean amplitude 27 mA) for 10 days. We have all had sleepless nights, but for millions of post-menopausal women it happens 61 percent of the time, affecting their quality of life and their relationships. Up to now, no studies have been published on the efficacy of osteopathic treatment on tinnitus. 5% of the subjects (2) had changes in tinnitus intensity with pressure on neck trigger points.
If tinnitus was intermittent and not associated with other symptoms, results were more consistent underlying the importance of identifying tinnitus sufferers having some clinical clues to somatic influence on tinnitus such as painful trigger points and modulation of tinnitus with head and neck or jaw movements that could benefit from the physical treatment.
Empty nest syndrome, caring for aging parents, relationship changes, career adjustments and mid-life stress, bundled together with hormones in flux is a recipe for sleepless nights. In 12.5% of the subjects (5) tinnitus intensity and in 5% (2 subjects) tinnitus frequency varied with head rotations. In 5% of the subjects (2) tinnitus intensity and in 2.5% (1 subject) tinnitus frequency varied with rotations of the shoulders.

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