We can ease pain of tinnitus

I have been working as a musculoskeletal (MSK) physio for Wirral Community NHS Trust since 1996. I developed an interest in vestibular rehabilitation about 10 years ago, and have built a good working relationship with local ENT consultants. Through this collaboration I also began to receive referrals for otalgia, when it was considered of MSK origin. 

Whilst treating ear pain, some patients commented that palpation of certain myofascial trigger points altered their tinnitus; a couple of patients even claiming resolution of their tinnitus on completion of their course of physio.  I had not investigated their tinnitus on assessment, nor had I made any claims that might prompt these responses.

For those distressed by their tinnitus, there is a high correlation with depression, insomnia, and reduced cognitive performance at work. There are few options for these patients, most being informed that they have to live with it. It seemed to me that, if there is a mechanical basis for their symptoms, then perhaps physiotherapy might help reduce symptoms in some patients.

With my employer’s support I embarked on a Masters Module to examine whether there was  a scientific rationale to my experience, and whether there had been any clinical trials investigating the efficacy of physiotherapy as a treatment.  My study included a case study and a literature review.

Research confirmed that tinnitus can be modulated with muscle contraction in up to 68% of cases. A strong correlation between tinnitus and both cervical spine and temporomandibular dysfunction has been reported. Complex neurophysical interactions between the somatomotor, somatosensory, and the auditory nervous pathway offer a rationale for this. 

Whilst research is in its infancy, a few trials have shown promise, with symptoms reducing in correlation with reduction in pain and with improvement maintained at follow up. 

The patient in my case study presented with objective shortening of the right sternocleidomastoid, scalenes and upper traps, along with ipsilateral neck pain and ‘roaring’ tinnitus. His response to manual therapy and home care program mirrored those in clinical trials. He felt empowered to control his tinnitus by using stretches, relaxation and trigger point techniques on himself. 

I presented my findings as a poster at the British Tinnitus Association Conference last September. Physiotherapy has already been integrated into tinnitus management in some clinics in Germany, Sweden and Brazil. My goal is to achieve a similar status here.  If you’re interested, I’d love to hear from you:  tanya.huskisson@nhs.net 

• Tanya Huskisson works for Wirral Community NHS Trust