Patients with head or neck injury may have particularly loud and disturbing tinnitus (Folmer and Griest, 2003). Tinnitus due to neck injury is the most common type of "somatic tinnitus". Somatic tinnitus means that the tinnitus is coming from something other than the inner ear. Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. This is thought to be due to somatic modulation of tinnitus. We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.
However, the multidisciplinary approach based on CBT is not a “cure for tinnitus”, as implied in some papers, but rather a system for managing its symptoms and effects on people’s lives. The differences in outcomes between the treatment and usual care groups were quite small, with the multidisciplinary approach giving a small improvement in quality of life compared with usual care, and moderate improvements in tinnitus severity and impairment. Also, less than 70% of participants completed the trial to 12 months, and this could have affected the reliability of the study’s overall results. Furthermore, as the patients in the study were only followed for 12 months, it is uncertain whether this approach can help in the longer term.
Tinnitus can be extremely disturbing to people who have it. In many cases it is not a serious health problem, but rather a nuisance that may go away. However, some people with tinnitus may require medical or surgical treatment. Sixteen million Americans seek medical treatment each year for tinnitus, and about one-quarter of those experience it so severely it interferes with their daily activities.
Schecklmann et al (2014) suggested that tinnitus is associated with alterations in motor cortex excitability, by pooling several studies, and reported that there are differences in intracortical inhibition, intra-cortical facilitation, and cortical silent period. We doubt that this means that motor cortex excitability causes tinnitus, but rather we suspect that these findings reflect features of brain organization that may predispose certain persons to develop tinnitus over someone else.

Another thing that tinnitus and sleep problems share? A tendency among people to brush them off, and try to “tough it out,” rather than addressing their conditions. It’s not worth it, to your health or your quality of life. If you’re having trouble sleeping and you have symptoms that sound like tinnitus, talk with your doctor about both, so you can sleep better—and feel better— soon.

Treatment of the underlying primary disorder may help to improve or cure rhythmic tinnitus. For example, the treatment of blood vessel disorders (e.g. dural arteriovenous shunts) can include certain medications or surgery. A surgical procedure known as sinus wall reconstruction can successfully treat pulsatile tinnitus due to sigmoid sinus diverticulum and dehiscence. In fact, most individuals have experienced complete resolution of their tinnitus following this surgery. Surgery may also be necessary for rare cases of pulsatile tinnitus caused by a tumor.


Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; both short- and long-term exposure to loud sound can cause permanent damage.
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