Course Description:

Tinnitus is the perception of sound in the absence of an external acoustic stimulus. Patients commonly describe a perceived sound as ringing, buzzing, hissing, chirping, whistling, or humming. Tinnitus may be continuous or episodic and is typically exacerbated by stress, noise exposure, and fatigue. The cause can be otologic, neurologic, metabolic, pharmacologic, vascular, musculoskeletal, or psychological. Many of the causes of tinnitus are not treated with physical therapy, however tinnitus associated with biomechanical causes such as cervical spine or temporomandibular joint (TMJ) dysfunction, trigger points, ergonomics, and posture ("somatically related tinnitus") may be relieved with physical therapy intervention. The pathogenesis of tinnitus is not fully understood; however, imaging studies have demonstrated that tinnitus may occur as a result of hyperactivity within central auditory areas of the brain. Noise-induced tinnitus may be related to the function of hair cells in the cochlea, and somatically related tinnitus may be due to somatosensory nerve impulses from the head and neck making multisynaptic connections in the brainstem and cochlea. Treatment may include transcutaneous electrical nerve stimulation (TENS); therapeutic exercises that include stretching, postural training, and progressive muscle relaxation; manual therapy; and biofeedback aimed at stress reduction. Education about methods to relieve symptoms, including masking and selective attention, may be helpful.