Can Osteopathy (manual therapy) fix my tinnitus?

Tinnitus can be a complex presentation and we would recommend screening for otologic (ear) disorders and neurological diseases with your General Practitioner and Audiologist. Once these conditions have been excluded we can have a look at how manual therapy / Osteopathy can reduce or resolve your tinnitus. 

Summary:

This article will discuss-

• Osteopathy and tinnitus

• A manual therapy approach to tinnitus

• Tinnitus and TMJ function 

• Tinnitus and neck posture / function 

• Tinnitus and neural strain / compression 

• Management of tinnitus is a team effort

Osteopathy and Tinnitus

Tinnitus is commonly known as ringing in the ears, however some patients experience it as a buzzing or a swooshing sound. It can be quite debilitating and is associated with sleep problems, depression, anxiety and limitations in social and professional settings. 

Tinnitus can occur for a large number of reasons. As a general rule, if one's tinnitus can be modified by head, neck or jaw position or by direct pressure on surrounding structures then there is musculoskeletal involvement. And when there is musculoskeletal involvement, Osteopathy can be of assistance. 

Sometimes people are unsure if their tinnitus has a musculoskeletal component as isolating these factors can be quite difficult. This is when it’s helpful to have an Osteopathic assessment. 

An Osteopath will be looking for musculoskeletal causes, contributing factors and maintaining factors surrounding your tinnitus.

Following your assessment an Osteopath will create a treatment plan or, if required, write a detailed referral letter to another healthcare professional. We recognise the scope of our practice and understand the benefits of working collaboratively as a healthcare team.

A manual therapy approach to tinnitus

In the following paragraphs we will explore how Osteopaths as manual therapists can alleviate or reduce tinnitus.

Please note the information below is designed for the general public, if you’d like to take a look at some of the supporting evidence please visit our resources page for a collection of academic articles. 

Tinnitus and TMJ function 

The TMJ (jaw joint) has a very close anatomical and neurological link to the ear. Between the ear and TMJ there is direct attachment via a tiny ligament, a shared neural supply and some ear symptoms (eg/ stuffiness and fullness) can be caused by trigger point referrals from nearby muscles.

Osteopaths can identify these links through testing and assessment. Manual therapy in this area could include:

• Identifying and managing parafunctional habits (i.e.  jaw clenching and cheek biting).

• Providing soft tissue techniques on particular musculature surrounding the TMJ.

• Articulating the TMJ and the surrounding cranium bones. 

• Prescription of rehabilitation exercises to promote optimised TMJ alignment. 

• Addressing any dysfunctional habits (i.e. clenching) that impede TMJ function.    

Tinnitus and neck posture / function 

Head and neck movements are coordinated with the jaw during mouth opening and closing. We know that neck posture has a strong link to jaw posture and thus can impact the ear. 

In addition, certain manual therapy techniques of the neck have a calming effect on the nervous system. A significant number of patients experiencing tinnitus have a heightened nervous system and thus would benefit from these calming techniques. 

Osteopathic treatment of the neck may include:

• Whole body postural assessment and exercise prescription to correct dysfunctional alignments. 

• Articulation of the vertebrae (neck bones) to increase freedom of movement.

• Addressing certain hypertonic (tight) neck muscles that are not conducive to functional posture.

• Increasing parasympathetic input to have a calming effect on a heightened nervous system. 

Tinnitus and neural strain / compression

We understand that tinnitus involves the nervous system- sometimes the peripheral nervous system, sometimes the central nervous system and sometimes both. 

(Quick anatomy note: The central nervous system is the brain and spinal cord. The peripheral nervous system is everything else). 

Peripheral nerves can be directly compressed and/or overly stretched, when these nerves are constantly strained we can find them activating at a lower threshold than normal.

The central nervous system can also adopt this lower threshold activation pattern when placed under persistent strain. 

This ‘neural sensitization’ phenomenon occurs when the central and/or peripheral nervous system becomes overly sensitive to stimuli and will generate signals even when not required. 

Osteopathy treatment to address neural compressions, strains and sensitisations may include:

• Screening for central and peripheral nervous system involvement.

• Increasing the mobility of certain peripheral nerves (i.e. facial nerves) and the surrounding muscles to reduce friction or compression. This allows the nerves to slide and transmit neural signals unrestricted. 

Management of tinnitus is a team effort

Tinnitus can be very frustrating and the management usually requires a multi disciplinary approach. In addition to being medically cleared by your GP, Osteopathy assessment and treatment can be of benefit to help you work through the musculoskeletal manifestations of tinnitus.