Tinnitus is an internal noise usually experienced as a continuous ringing in the ears, coming from within the person and not from an external source. It may be experienced in one or both ears. It can make different sounds like ringing, hissing, buzzing, clicking, whooshing or a high-pitched whine and the sound level may vary in intensity from time to time.
Although it is conventionally regarded as a sensory disorder, tinnitus seems to have eluded medical treatment thus far. Initially, patients consult an ENT specialist, audiologist and/or a neurologist. In most cases, no known cause is identified. Patients are often told by their doctors that not much can be done, to shift their focus, unscramble the picture and mask the sound. They are advised to get used to it and to learn to live with it.
Craniosacral therapy, however, treats tinnitus as not merely a localised hearing/ear problem but as a nervous system syndrome with a whole-body reaction, and this is why it has emerged as a successful line of treatment for tinnitus. Tinnitus is about our nervous system and brain, as our brain continually scans our inner and outer world for threats. When any threats are detected, our ancient biological stress response automatically fires up.
Ears play a big role in our biological stress response, making our sensory perceptions more acute so that we can pick up cues of imminent danger. The hearing apparatus of the inner ear provides sensory input to the amygdala in the brain. The amygdala is critical to survival – it processes the things you see and hear, uses the input to learn what is dangerous, and then activates the whole body to survive the threat by fight or flight. It's function is involuntary; we cannot consciously control it. The amygdala responds to every perceived threat by triggering a cascade of physiological changes within the body, to equip it better to deal with the threat.
Ancient man needed this evolutionary response and the increase in adrenaline and cortisol to fight foes or to run fast to escape danger. Modern man continues to have the same physiological response when faced with any perceived threat, whether physical or emotional. Emotions such as anger, fear, anxiety and rage can trigger the amygdala. The amygdala responds to any perception of threat – which can include situations of social anxiety, a loud sudden noise, a stressful day at work, a verbal altercation, etc – in the same way and it cannot differentiate between actual threat to life and the stresses of daily life, such as the above. The physiological changes that it triggers include a faster heart rate and breathing rate, increased blood flow to the muscles, a flood of hormones like adrenaline through the body, as well as hypervigilance within the nervous system. Hypervigilance makes our senses, including the auditory sense, more acute, to enable us to quickly detect the source of the danger.
When we move into a state of red alert, the way we hear radically changes. In red-alert mode, we listen keenly for any sign of danger and as a result, background noises are amplified in our perception. Hearing can become so sensitive, that you hear the noises inside as well as outside your body. Nervous impulses along the auditory nerve can sound like a buzz or a hiss. Movements inside the head such as changes in pressure can sound like crackles or pops. The cerebral cortex becomes highly activated and therefore, the part of the brain that remembers sound, recognises it and can conjure up any imagined sound, becomes over-stimulated. This means that our sound imagination can take over and we can hear noises that aren’t real.
Each patient’s tinnitus is different. Some patients have hearing loss, some have neck and shoulder issues, some have issues with the TMJ or temporal bones - but the common denominator appears to be a hypervigilant nervous system. Tinnitus patients live in their heads, spending most of their time engrossed in thought, planning, analysing, imagining, worrying, solving problems. There is always something for them to strive toward, and rarely time to sit in quiet satisfaction. They tend to fill their days with frantic activity. Often, they spend most of their time in deep thought, with little awareness of the body or bodily sensations. To the trained therapist, the body can feel like it is standing at attention or continually bracing itself. It is difficult for such patients to let go at a deeper level. Many tinnitus patients do not have much body awareness, as they are too locked up in their thoughts to connect with their bodies.
Some common features of tinnitus are as follows:
Tinnitus impacts the neural regulation of the middle ear muscle. When we are in fight or flight mode, stressed and perceiving threat, the body is biologically primed to focus on detecting low level sound frequencies and background noise, so it can detect the presence of the predator and be ready to respond to the threat. Many tinnitus patients find it hard to go into places that have high levels of low frequency background noise – such as restaurants, shopping malls or bars - as the low frequency sounds trigger the nervous system and make them feel uncomfortable and anxious.
The auditory vestibular nerve transmits sound and a sense of equilibrium or balance through the hair cells of the inner ear to the brain. The nerve originates in our brainstem and exits the inner skull via the internal acoustic meatus in the temporal bone. Some tinnitus patients have a misalignment of the temporal bones that could have an adverse effect on the functioning of this nerve.
Tinnitus patients often have issues such as stiffness, hypermobility or clicking at the Temporal Mandibular Joint (TMJ). The TMJ is the joint where the jaw or mandible attaches to the skull. We use the TMJ when we chew, yawn, speak and communicate and when we move the jaw in any direction. TMJ issues appear to be a part of the Tinnitus syndrome and may even be a contributory factor. Jaw-clenching is a primitive reflex based on instinctive survival patterns – we clench the jaw in response to stress, anger and fear. TMJ issues caused by jaw-clenching are widely acknowledged as a symptom of stress. Jaw-clenching is a common muscular bracing pattern that is linked to hyper-arousal of the nervous system and anxiety. People who experience cranial nerve dysfunction often tend to clench the jaw or grind their teeth.
A person with tinnitus typically holds tension at the base of the head and along the length of the spine. Tinnitus patients often have a very tight neck and shoulders. The large muscles in the neck and shoulders that contribute to neck and shoulder pain, are the Sternocleidomastoid muscle and the Trapezius muscles. These muscles allow us to look up, down, sideways and turn our head. Survival depends on being able to turn the head effortlessly to get the maximum amount of sensory input, and these muscles are mainly responsible for these movements. The muscles are innervated by the spinal accessory nerve, a cranial nerve that emerges from the brainstem. A dysfunction here can lead to an over-strained sore neck and shoulders. The muscles of the head, neck and shoulders tend to tighten and brace, in response to any real or perceived threat, as directed by the amygdala. This muscular holding pattern can lead to persistent myofascial pain and/ or stiffness, which may affect the auditory-vestibular structures that lie within.
Some tinnitus patients say that they have none of the above symptoms. Some have inner thought processes or stress that lies below their conscious awareness.
Some people may develop tinnitus after a one-off trauma or injury like a physical trauma or blow to the head or body.
Certain foods (salty or sweet) or stimulants (caffeine, tobacco, alcohol) may exacerbate tinnitus for some patients.
Craniosacral Therapy is unique in that it addresses all of the above issues and more - working structurally around the auditory tube, on structures such as the temporal bones, cranial nerves, TMJ - jaw, neck & shoulders, releasing the fascia and bony compressions or misalignments, working with the brain and its meninges.
Craniosacral therapy is known to settle and calm the nervous system, improving vagal tone, reducing hypervigilance and helping the nervous system regulate its fight and flight response. It reduces anxiety and stress within the system.
Alleviating tinnitus involves receiving craniosacral treatments at regular intervals over a period of time, rather than in one quick fix. It is a gradual process, as it is about regulating and rewiring the brain and improving the self-regulation of the entire central nervous system.
A multi-disciplinary approach works best. Patients who see the greatest results are the ones who don't expect to be “fixed” by the therapist, but who are willing to put in the work as well, by adopting beneficial practices like meditation, exercise and activities that help them to connect with their bodies.
For some, the ringing in the ears becomes less intrusive and they don’t focus on it anymore; some find that the noise has gradually reduced and they are able to forget about it, while some patients can make a full recovery, with the help of craniosacral therapy.