Tinnitus Syndrome- A New Treatment Model - The brain is not at rest

Tinnitus is an internal noise or a hyperactivity in the central auditory system normally experienced as a ringing noise in the ears, coming from within the person. In some cases it is temporary and goes away over time. Unfortunately for others the ringing noise can be constant and impact their daily life. Tinnitus can be experienced in one or both ears. It can make different sounds and can vary in intensity. Tinnitus can be brought on by many different causes including dental trauma, loud music, TMJ (jaw problems), a physical trauma, long-term work stress, trauma or anxiety. Tinnitus is much more widespread than generally known with around 25% of Americans and around 20% of Australians suffering from it.
 
Tinnitus is considered a neurological/audiological condition but has eluded medical treatment and scientific understanding so far. Initially, sufferers consult an Ear Nose and Throat (ENT) specialist, audiologist and/or a neurologist. In the majority of cases (around 80%) no known cause is found. If nothing specific is found, then sometimes medication is prescribed like Valium or Amitriptyline but thankfully more and more mindfulness meditation. Sufferers are often told by their doctors that not much can be done, to shift their focus, unscramble the picture and mask the sound. At best the brain will adapt and learn to live with it. 

However if we view Tinnitus as not just being about a "hearing/ear" problem but a nervous system problem with a whole body reaction, we might be a step closer in bringing relief to Tinnitus sufferers. I believe there is a largely untapped potential in understanding the variables, common threads and biological nervous system responses in Tinnitus sufferers and approaching it in a new light. This calls for a treatment model that not only incorporates the physical body and the Craniosacral system of the physical body but also the mental and emotional body and this is exactly the strength of Craniosacral Therapy.  
 
Craniosacral Therapy views Tinnitus oa as a signal where the adrenal flight and fight response seems to be manifested through the auditory system as noise in the ears, leaving a certain hyper vigilance, which keeps the brain active. This leaves your system so sensitive that you actually hear your own internal noises like ie: nerve impulses, structural movement and/or fluid movement, as well as the external noises. In my personal Craniosacral practice, Tinnitus clients, describe their ringing as: cicadas, kettle boiling, a high pitched dog whistle, the pinging of a microwave, humming of a fridge or as a high frequency. Often, but not always clients symptoms appeared in or around a major event in their life, or related to an echo of past difficult experiences. In these circumstances I usually find, that whatever the trigger was for the tinnitus to occur, it usually is the last overwhelm of previous layering challenges to the clients long suffering system, that breaks the "donkeys" back, like in the kids game Buckaroo. The last suitcase may have triggered Buckaroo's back to buckle but many other suitcases were loaded on top first.

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 the stress response automatically fires up. As you go through life the brain acquires expectations based on your experience and in particular negative one’s. When situations occur that are even remotely similar, the brain automatically applies its expectations to them, if it expects pain or loss or even just the treat of these, it pulses fear signals, creating hyper vigilance, keeping the brain active (Buddha's Brain-2009). Most of the time these seems to happen subconsciously as people are not aware of how their bodies respond in their day to day life, to stress or threats and how this can manifest as ringing in the brain. 

A new scientific study at the University of Illinois (July 2017) seems to validate this. Using MRI, this new study found that tinnitus is in the hearer's brain. They found that chronic tinnitus is associated with changes in certain networks in the brain. A tinnitus patients brain seems to be not truly at rest even when they are resting, as the brain stays more alert. This could also explain why sufferers also feel tired more often.

I personally view Tinnitus more as a Syndrome than a condition as the whole central nervous system is on high alert and tinnitus is just one of the many side effects of this whole body reaction with everybody's Tinnitus being different. Some clients may have a slight hearing loss but not all clients with hearing loss have tinnitus, some clients have neck and shoulder problems and then again some have TMJ issues and/or temporal bone(s)/muscular dysfunction but the common denominator seems to be (unconscious) anxious and/or unprocessed stressful times and patterns lodged in the body. Some people may be aware off of this, some totally unaware but in all cases it has not been dealt with on a bodily level. I find looking at our evolutionary biological stress pathways and the structures involved around Tinnitus very insightful. Let me break it down: (Please view My blogs on our biological Stress Pathways,  TMJ and our 3 Brains for more in-depth background information). 

• Ears play a big role in our biological stress response, making our sensory perceptions more acute so we can pick up any danger in the fight and flight, hyper vigilant arousal. If it stays too switched on, you may start to hear your own internal noises, the noises of your nervous system. Our auditory pathways are hard wired to the limbic system which is where the emotional centre in your brain lies and in particular to the Amygdala - which is the brain's alarm system and storehouse of emotion-linked memory. The hearing apparatus of the inner ear and autonomic nervous system provide sensory input to the Amygdala, which acts like a smoke sensor every time a real or perceived threat presents itself to us, making us hyper vigilant.
• 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 frequency and back ground noise, so it can be ready and hyper vigilant to detect the predator. Tinnitus and overwhelmed people find it hard to go into low frequency places like restaurants, shopping malls or bars as the low frequency sounds make them feel uncomfortable and anxious. They often get diagnosed with Hyperacusis . But what this really means is that you are hypersensitive to sounds as your nervous system is tuned on to detect a predator. 
• The auditory vestibular nerve, known as the eighth cranial nerve, transmits sound and equilibrium through the hair cells of the inner ear to the brain. It originates in our brainstem - which is where our fight and flight lies. The nerve exits the inner skull via the internal acoustic meatus in the temporal bone.

• People with Tinnitus often have very tight neck and shoulders. We use all of our sense organs in our head, as a basic universal motor pattern, for gathering information as we scan our environment for input. The muscles of the head and neck are intimately involved in this sensory information and brace themselves in response to any real or perceived threat and/or fight/flight survival in a muscular holding pattern and can lead to persistent Myofascial pain. 
• The two large muscles in the neck and shoulders that contribute to Neck and Shoulder pain, are the Sternocleidomastoid (SCM) and Trapezius also known as the emotional muscle. These two muscles allow us to look up, down, sideways and turn our head. Survival depends on being able to turn the head effortlessly and these muscles are mainly responsible for it. Both muscles are innervated by Cranial Nerve XI - This spinal accessory nerve, emerges from the brainstem, where our fight and flight lies. (All other 650 + muscles in our body are innervated by the spinal nerves) and a dysfunction here can lead to sore neck and shoulder muscles.
• People with Tinnitus also often have TMJ problems. Can TMJ be a structural cause of Tinnitus? I think it is part of the overall syndrome and is a contributing factor. Jaw clenching is a primitive reflex based on instinctual survival patterns and also a muscular bracing pattern linked to arousal. Common problems of Cranial Nerve Dysfunction are tightly clenched teeth and grinding. TMJ problems are a well-known symptom of stress  We mainly clench at night, a time where we process our experiences of the day. 
• Some Tinnitus people have none of the above symptoms or very mildly but have conflicting inner thought processes and negative stuck thought processes acting as a pressure cooker but mainly lying below conscious awareness that causes them unduly stress, anxiety and/or inverted anger: "You cant let go of what you don't know and don't acknowledge. 
• Some people may develop Tinnitus after a one-off trauma like a physical trauma to the head or body. I have had a client with Tinnitus after a one coward punch to the head where the temporal bones were clearly implicated but also the central nervous system, or a client whom after an operation, where many things went wrong and the body went in shutdown during the operation, woke up with Tinnitus. Again here it is dealing with the trauma, fight and flight lodged in the body as it is about resting the brain tissues and working with cranial bones and muscular restrictions.

The strength of Craniosacral Therapy is that it addresses all of the above: working structurally around the auditory tube structures i.e. temporal bones, cranial nerves, intra-oral work, TMJ - jaw, neck & shoulders, releasing any tissue and bone restrictions, resting the brain & the meninges (brain tissue). Craniosacral is known to resettle the Nervous System, so stored tensions can be released,  decreasing “the fight and flight” hyper vigilant sympathetic nervous system and increase the "rest and digest" parasympathetic system, lowering the tone of the Vagus Cranial Nerve. Craniosacral therapy sees symptoms as a signal of the body and unpacking any issues and unconscious thought processes that may have contributed to the onset off their Tinnitus can be very helpful, Having more awareness means you can make a choice. The body tends to hold tension and emotional conflict deep inside until it feels safe and is ready to process it. 

UK based Julian Cowan Hill is an ex-Tinnitus sufferer. He found his cure in Craniosacral Therapy and has since become a CS practitioner himself. He has written a book about Tinnitus “From tyrant to friend" which I recommend. It is a handy practical little book, packed with information and a Wellbeing Matrix with levels and exercises to go through. He also has You Tube videos that people find helpful. Simon Baker (an ex DJ with hearing damage) is also an ex Tinnitus sufferer and has also become a CST practitioner himself and is a Professional Tinnitus advisor with the British Tinnitus Association. A link to one of his articles: https://djmag.com/content/hearing-damage-djs-guide-preventing-tinnitus
 
Tinnitus treatments are about regular treatments rather than a one quick fix. It is a gradual process, as it is about regulating and rewiring the nervous system and brain, learning to switch off the whole central nervous system. Grooves and patterns are often hardwired and they take time to change and integrate, to build a new road. My advice would be that if you do suffer from Tinnitus, try Cranio earlier at the onset of your symptoms. Cranio is one of the best therapies around for settling the nervous system, treating TMJ, resting the brain and cranial nerves and clearing any unprocessed shock, becoming less hyperactive and if applicable uncovering any unconscious emotional conflict. My clients that develop the best results are the ones that don't expect to be just fixed but are prepared to put in the work as well by adopting a multi-disciplinary approach and new life style regimen through diet, meditation, exercise and unpacking any issues. For some clients, the ringing in the ear becomes less intrusive and they don’t focus on it anymore, some clients find the noise has backed off and even forget about it and some clients make a full recovery. As Julian Cowan Hill says: "The state of your nervous system is very changeable and reversible, as the nervous system is a fluid, constantly altering state of balance, when the right conditions come along, it changes". He should know, he cured his.
 
References: 

• Tinnitus: From Tyrant to friend - how to let go of the ringing in your ears - Julian Cowan Hill - 2010. I want to thank Julian for being a pioneer in bringing relieve and hope to Tinnitus sufferers and being an inspiration to the Craniosacral Community and beyond.
• Tinnitus: Ringing in the Brain | Josef Rauschecker | TEDx (online - youtube)
• Living with Tinnitus - sbs life - online www.sbs.com.au -  the sound that comes from nowhere.
• www.Neurosciencenews.com/tinnitus-attention-7378 (online) University of Illinois - "ringing in ears keeps brain more at attention and less at rest".
• Buddha’s brain: the practical neuroscience of happiness, love and wisdom. Hanson, Rick 2009.

Keep up to date with news, research and my upcoming book with oa Tinnitus case studies.