What is Somatic Tinnitus?

Somatic tinnitus occurs when the tinnitus sound changes due to movement, tension, or inflammation in the body, most often in the neck and jaw. Understanding the nervous system's role in somatic tinnitus is essential for developing effective treatments. The key to lasting relief is a multimodal approach that targets both the body and the brain.

But how can changes in the body affect how we hear tinnitus? This is a puzzle that has prevented many doctors from fully understanding the problem and therefore offering their patients effective treatment options.

The answer lies in network of neural connections between the hearing system and the trigeminal nerve. Importantly, somatic tinnitus and migraine both involve the trigeminal nerve and these two conditions are deeply connected. Understanding this overlap is essential for effective treatment.

In this article, I’ll explain what we know about somatic tinnitus and explore how its connection to migraine shapes the best approach to treatment.

• How do you diagnose it?
• How is the trigeminal nerve involved?
• How do you treat it?

What are the symptoms of somatic tinnitus?

Somatic tinnitus, sometimes called ‘somatosensory tinnitus', is most often seen in with jaw or neck pain, although it has been associated with shoulder, arm, or even eye movement.

A recent study found that the prevalence of body-influenced tinnitus is up to 69% [1]. It's most common in those with temporomandibular joint disorders (TMDs), cervical spine (neck) dysfunction, or those with a history of head and neck surgery.

Likewise, tinnitus patients are much more likely to have somatic conditions of the head and neck region. A recent study found that tinnitus patients are 6.7x more likely to have TMDs and 2.6x more likely to have neck issues than patients without tinnitus [2].

What are the clinical features of somatosensory tinnitus?

Here are some common characteristics seen in this form of tinnitus:

Characteristic	Description
Tinnitus Sounds	Can manifest as ringing, buzzing, humming, pulsating, or clicking noises.
Modulation by the Body	The tinnitus sound changes with head or neck movements, jaw clenching, changes in posture, or muscle tension.
Musculoskeletal Issues	Often presents with TMJ pain, neck stiffness, or muscle tension in the head, neck, and shoulder regions.
Fluctuating Nature	Tinnitus tends to fluctuate and is coincident with neck or jaw pain.
Comorbidities	Frequently associated with migraine, anxiety, depression, and sleep disturbances.
Quality of Life	May lead to impaired social and occupational functioning.
Relief With Movement	Some find relief with neck or jaw exercises, physical therapy, or relaxation techniques.

How do you diagnose somatic tinnitus?

Diagnosing this form of tinnitus involves:

• Medical History: Assessing for somatic symptoms.
• Physical Exam: Evaluating the head, neck, and jaw for signs of dysfunction.
• Audiological Exam: Checking for hearing loss.
• Imaging Studies: Using scans to identify structural or vascular issues.
• Specialized Assessments: Employing tests to evaluate TMJ/neck function.

This is follow by checking somatic maneuvers, specific movements or actions aimed at assessing their impact on tinnitus. Here are some somatic maneuvers we commonly use:

Somatic Maneuver	Description
Teeth Clenching	Clench teeth together firmly while checking for tinnitus changes during and after the clenching motion.
Mouth Opening	Open mouth as wide as possible, noting any change in tinnitus symptoms.
Jaw Protrusion	Move the jaw forward to see if it modulates tinnitus (with or without applied pressure).
Lateral Jaw Movement	Move the jaw side-to-side to see if it modulates tinnitus (with or without applied pressure).
Resistance to Force	Keeping the head in a neutral position, check for changes in tinnitus when pressure is applied in different directions against resistance.
Neck Movements	Various neck movements (forward, backward, lateral bending, and rotation) are performed to see if it modulates tinnitus
Torsional Force Exertion	Neck is turned to one side and slight torsional force is applied to the cheekbone on the same side while checking for tinnitus changes

Are somatic tinnitus and unilateral tinnitus related?

If someone has unilateral (one-sided) neck or jaw issues, their somatic-related tinnitus tends to be more prominent on the affected side.

Can somatic tinnitus affect pulsatile tinnitus?

Pulsatile tinnitus is related to blood flow and the sound aligns with the rhythm of your heartbeat. In some cases, changes in muscle tension or jaw position can affect nearby blood vessels. When this happens, the somatic factors can modify or even worsen the loudness of pulsatile tinnitus.

The Trigeminal Nerve and Somatic Tinnitus

Somatic tinnitus is often related to an underlying migraine-like process. The key to understanding this connection is the trigeminal nerve and its connections to the hearing system.

What is the trigeminal nerve?

The trigeminal nerve, also known as the fifth cranial nerve, provides sensory information to the TMJ and face region. It also transmits sensory information from the lining of the brain, making it the primary nerve responsible for classic migraine headaches.

Studies have shown that the trigeminal nerve multiple connections the auditory system and these are highly preserved across all mammals. These connections likely exist because the movement of the jaw and neck helps the brain process sounds and understand where they are coming from.

When the neck or jaw moves—or when these areas become irritated—trigeminal nerve activity can change the nerve activity in the hearing system. This leads to noticeable changes in tinnitus perception. With simple neck or jaw movements, these changes are temporary and quickly reversed. However, when they are related to trigeminal nerve irritation, the amplification of tinnitus can persist for much longer.

Here are some ways that trigeminal nerve irritation can led to prolonged tinnitus loudness.

Clinical Context	Trigeminal Nerve Connection
Temporomandibular Joint Disorders	TMJ disorders can lead to trigeminal nerve irritation, which then leads to increased tinnitus loudness.
Dental Problems	Dental issues such as bruxism (teeth grinding), malocclusion (misalignment of teeth), or dental trauma can affect the trigeminal nerve and lead to worsening tinnitus.
Muscular Tension	Muscular tension in the head, neck, and shoulder region can worsen tinnitus via trigeminal irritation.
Neuropathic Pain Syndromes	Conditions such as trigeminal neuralgia can impact sensory processing and contribute to tinnitus intensity.
Neck-Jaw Integration	The trigeminal nerve connects with neck nerves in the brainstem. Irritation in neck nerves can be transmitted through trigeminal connections and ultimately affect tinnitus.

Can neck problems cause tinnitus?

The neck and trigeminal system are closely linked through connections in the brainstem, specifically in a relay center called the trigeminocervical complex (TCC). These connections help explain why neck pain and tinnitus often occur together.

The TCC processes sensory information from two key nerve groups:

• The trigeminal nerve, which controls sensation in the face and jaw.
• The upper cervical nerves, which provide sensation to the neck and back of the head.

When the neck nerves are irritated or move abnormally, they send signals through the TCC, which can then influence the hearing system. This is how cervical issues can amplify tinnitus sounds.

The Role of CGRP in Tinnitus

Calcitonin gene-related peptide (CGRP) is a molecule released by nerves in response to inflammation. CGRP levels can affect how intense symptoms feel. It plays a major role in chronic pain conditions, including TMJ disorders, neck pain, and migraines.

CGRP also increases sensitivity to sound, which may explain why people with TMJ issues, neck pain, or migraines often experience tinnitus that varies in loudness.

The Role of the Trigeminal Ganglion

The trigeminal ganglion is the meeting point for the three main branches of the trigeminal nerve, where their cell bodies are located. When CGRP-driven inflammation affects one branch, it can easily spread to the others due to their close connection. This explains the strong link between jaw pain, facial pain, and migraine.

Anatomy studies show that there are direct connections between the trigeminal ganglion and the hearing system. Inflammation in any of the branches of the trigeminal nerve will affect the trigeminal ganglion, and this can then lead to tinnitus amplification.

The Role of Atypical Migraine

Migraine is not just a headache! Instead, migraine is best understood as a sensory processing disorder. It occurs when there is an imbalance between excitation and inhibition in the nervous system, making the nerves overly sensitive and easily triggered. This leads to sensory hypersensitivity, affecting not just pain perception but also other senses.

In a classic migraine, this sensory hypersensitivity affects the first branch of the trigeminal nerve, which supplies the lining of the brain, leading to the intense headaches we typically associate with migraines.

In an atypical migraine, this hypersensitivity affects other branches of the trigeminal nerve, leading to symptoms like facial pain, ear fullness, jaw discomfort, and neck stiffness—without necessarily causing a headache.

What This Means for Treatment

Since atypical migraine and somatic tinnitus affect the same exact nerves, treatments for one condition can often help the other. Research has shown that many people with somatic tinnitus respond extremely well to migraine treatments.

At NeuroMed, we focus on treating the migraine-related reaction in the brain, which has led to significant improvements for most tinnitus patients with somatic features. Understanding these shared pathways opens up new, more effective treatment approaches.

Is somatic tinnitus really atypical migraine in disguise?

When structural issues in the TMJ or cervical spine are present, chronic inflammation from the underlying condition is the primary cause of trigeminal nerve irritation.

However, in other cases, somatic tinnitus may not be caused by structural issues but instead stem from atypical migraine.

Intrinsic Structural vs. Neurological Somatic Tinnitus

Even when TMJ or cervical spine dysfunction is present, the way tinnitus is amplified still follows the same trigeminal nerve pathways. The key distinction is:

• When there is a clear structural abnormality, tinnitus is primarily driven by localized inflammation affecting the trigeminal system.
• When no clear structural abnormality is present, the underlying issue may be a migraine-like process, where trigeminal nerve hypersensitivity causes sensory distortion, including tinnitus.

The following table highlights key distinctions and overlaps between structural somatic tinnitus and migraine-related somatic tinnitus:

Clinical Fact	Structural Somatic Tinnitus	Migraine-Related Somatic Tinnitus
Primary Driver	Structural issues (TMJ, cervical spine problems)	Trigeminal hypersensitivity, myofascial issues
Key Mechanism	Chronic inflammation affecting the trigeminal system	Central sensitization and neurogenic inflammation
Fluctuating Symptoms	Tends to be more stable but worsens with jaw/neck movement	Symptoms fluctuate based on triggers (stress, sensory input, diet)
Response to Treatment	Musculoskeletal interventions plus multimodal therapy	Migraine-based treatments (neuromodulation, inflammation control)
Neurological Basis	Localized nerve irritation and inflammation	Centralized nervous system excitability and sensory amplification

Rather than viewing somatic tinnitus as a single condition, it is more accurate to recognize two distinct but related forms:

1. Structural somatic tinnitus, where TMJ dysfunction, cervical spine issues, or musculoskeletal inflammation are the primary causes.
2. Migraine-related somatic tinnitus, where trigeminal nerve hypersensitivity and central sensitization drive symptoms in the absence of an obvious structural problem.

And because both forms share trigeminal nerve hypersensitivity they will both respond well to multimodal therapy.

Can somatic tinnitus go away with treatment?

Treatment for somatosensory tinnitus involves addressing underlying the underlying jaw or neck issues concurrent with treating the brain issues driving the migraine process. This comprehensive approach integrates various strategies tailored to the individual patient's needs.

Mono-therapy yields poor results – you can't just treat the neck or jaw. For the best results, you also need to treat the migraine-like sensory hypersensitivity affecting the trigeminal system.

The Role of Physical Medicine

Physical medicine techniques are commonly used to reduce tinnitus symptoms by addressing underlying musculoskeletal dysfunction. A variety of interventions can help alleviate tension, improve mobility, and restore proper function in these areas, including:

• Acupuncture – Stimulate specific points to reduce pain, tension, and stress in the jaw and neck.
• Jaw exercises – Enhance mobility and alignment of the temporomandibular joint.
• Manual therapy – Reduce muscle tension and improve joint function through hands-on techniques.
• Postural correction – Minimize strain on the neck and jaw by improving head and shoulder alignment.
• Muscle tension reduction techniques – Help release tight muscles contributing to tinnitus symptoms.
• Trigger point release – Target muscle knots that may be linked to referred pain and tension.
• Myofascial release – Improve flexibility and relieve restrictions in the connective tissue.
• Stretching exercises – Loosen tight muscles in the jaw, neck, and shoulders to promote relaxation.
• Biofeedback – Train patients to control muscle activity and reduce tension-related symptoms.
• Relaxation techniques – Lower stress levels, which can influence muscle tightness and tinnitus.
• Chiropractic adjustments – Improve spinal alignment, potentially relieving nerve irritation.

But the key is that these interventions must be used in with a multimodal approach. For instance, one study found that somatic tinnitus patients respond to combined CBT and sound therapy as a stand alone treatment [3]. Logically, the addition of physical medicine to this would only amplify results.

We've found that the combination of medical management of atypical migraine and physical therapy for the jaw and neck is the most effective approach for this kind of tinnitus.

Does neck surgery help somatic tinnitus?

Cervical tinnitus is when the tinnitus can be directly related to structural issues in the neck. In these cases, surgical intervention may be considered. Surgical procedures such as cervical spine fusion, decompression surgery, or disc replacement are examples of the kinds of surgeries used in these cases.

Surgical intervention, however, is reserved for cases where conservative treatments have failed to provide relief, where there is confirmation of significant cervical disease, and the benefits outweigh the risks. Unfortunately, I've know of several patients who underwent unnecessary neck surgery in a failed attempt to address somatosensory tinnitus symptoms.

What is the Susan Shore Device?

The Susan Shore Device (SSD) is a form of bimodal stimulation for tinnitus, meaning that it combines sound therapy with a secondary form of sensory stimulus. In the case of the SSD, the secondary form of stimulation is through electrical signals to the jaw or neck region. Many are hoping that the device will prove particularly useful for people with somatic tinnitus, given the secondary region of stimulation. This device is not currently FDA approved or available for commercial use.

The Role of Migraine Treatment

Migraine treatments are essential when treating somatosensory tinnitus. The body and brain must be treated simultaneously. Medications commonly used in migraine management are very helpful in this regard. Further, lifestyle modifications, including stress management, regular exercise, adequate sleep, and dietary changes, are essential complements to medication therapy.

Botox injections, approved for the treatment of chronic migraine, may also be helpful in this regard, as they reduce muscle tension and pain in the head and neck region.

What is the best treatment for somatic tinnitus?

We have found excellent results by treating the body and the brain simultaneously with a multimodal approach. Elements of our tinnitus management protocol include:

• Pharmaceutical Therapy
• Nutraceutical Therapy
• Cognitive Behavioral Therapy
• Sound Therapy
• Mindfulness Meditation
• Dietary Therapy
• Sleep Optimization
• Physical Exercise

For patients where the neck and jaw nerves are be contributing to tinnitus, we encourage the concurrent use of physical medicine, such as physical therapy, manual therapy, massage, and jaw and neck exercises.

Conclusion: Somatic Tinnitus Treatment Should be Multimodal

Tinnitus related to jaw and neck issues are a unique challenge. Understanding the interplay between sensory systems, musculoskeletal function, and neurological pathways is crucial for effectively treating tinnitus

For the reasons outlined above, I believe that somatosensory tinnitus is an atypical migraine variant. Even when the underlying issue is structural, the mechanisms relating to tinnitus amplification follow an atypical migraine pattern. This means that effective treatment must address the body and the brain simultaneously. This “functional medicine approach” has been delivering excellent results for my patients.

If you are suffering from tinnitus related to neck or jaw problems, I invite you to call the team at NeuroMed to learn how our program can be customized to your specific needs.

Somatosensory Tinnitus References

[1] Ralli M, Greco A, Turchetta R, Altissimi G, de Vincentiis M, Cianfrone G. Somatosensory tinnitus: Current evidence and future perspectives. J Int Med Res. 2017 Jun;45(3):933-947.

[2] Bousema EJ, Koops EA, van Dijk P, Dijkstra PU. Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review. Trends Hear. 2018 Jan-Dec;22:2331216518800640.

[3] Ostermann K, Lurquin P, Horoi M, Cotton P, Hervé V, Thill MP. Somatic tinnitus prevalence and treatment with tinnitus retraining therapy. B-ENT. 2016;12(1):59-65.