Have you ever wondered if your tinnitus is normal or common? 

Variations in tinnitus can be related to its cause, moving a part of the body such as the jaw or neck, whether it is audible to other people, and other factors.

Tinnitus can vary widely, even for the same person.

Oto provides the complete guide on tinnitus types, how to know which one you experience, and how to manage it.

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Types of Tinnitus

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Somatic Tinnitus

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Somatic tinnitus refers to tinnitus that is caused, exacerbated, or changed by body movement. Commonly, somatic tinnitus is reported due to voluntary movement of the jaw, face, head, neck, or shoulders.

For example, some people report that moving their jaw such as when yawning, makes their tinnitus louder or more noticeable. This may be related to a disorder of the joint that connects the lower jaw (the mandible) to the temporal bone of the skull, the temporomandibular joint (TMJ).

Learn more about TMJ and tinnitus.

Somatic tinnitus can also be triggered by spasms or contractions in the neck, ear, or jaw muscles. These may be involuntary and thus troubling when they cause an uptick in tinnitus intrusion.

Somatic tinnitus may be either objective or subjective:

• Objective means that the tinnitus is caused by a specific reason and that it is audible or observable by other people
• Subjective means that the cause may be unknown and it is not audible or observable by other people

Treatment for somatic tinnitus includes identifying and treating the cause (if possible) or avoiding certain body movements or postures to avoid causing an uptick in tinnitus.

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Somatic Tinnitus Treatment Plan

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The first step is to identify what movement or posture makes the tinnitus worse. This can be evaluated by a medical doctor or physical therapist.

Then, the specific muscle or reflex can be identified to determine if there is a way to remediate it making tinnitus worse.

Sometimes treatment is easy, such as avoiding certain positions, or simply knowing that chewing can make tinnitus more noticeable but that it returns to baseline.

Treatment can also entail working with a physical therapist to treat:

• The TMJ - the therapist may teach you exercises and strategies to relieve tension, clenching, or other abnormal jaw movements
• The cervical spine - this is the part of the spine that supports the neck. Treatment may focus on the bones, discs between the bones, muscles, or ligaments in this region
• Grinding or clenching teeth - the physical therapist may recommend that you consult with a dentist to obtain an "occlusal splint" (also referred to as a nightguard), which is a device that is worn over the teeth to prevent grinding or clenching

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Learn more about physical therapy for tinnitus in this video.

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Objective Tinnitus

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Objective tinnitus refers to tinnitus that can be heard or observed by another person and has an objective cause. Often it is observed by a healthcare provider when they place a stethoscope on or near the external auditory canal or near other common sources of objective tinnitus, such as the neck.

This is a less common form of tinnitus that can arise from various causes:

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• Often can be due to vascular (referring to the circulatory system including veins and arteries) abnormalities of the jugular vein or bulb, arteriovenous abnormalities, vascular stenosis (narrowing) or tumours, or intracranial hypertension
• If tinnitus is accompanied by headache, one possible cause is benign intracranial hypertension (excessive fluid build-up in the brain and spinal cord)
• Patulous Eustachian Tube - a condition where the tube that connects the middle ear to the nasal cavity does not close fully/properly, which leaves the tube open and can cause popping or clicking tinnitus as well as other ear symptoms such as ear fullness, pressure, fluid build-up in the middle ear, and hearing loss
• Contractions of muscles of the palate (the region at the top of the mouth) and/or middle ear can cause "clicking" tinnitus

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Because there is typically an identifiable cause to the tinnitus, objective tinnitus tends to be more commonly curable than subjective tinnitus.

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Treating Objective Tinnitus

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Treatment for objective tinnitus entails first identifying the cause of the tinnitus. Treatment may involve behavioural management, medication, and/or surgery depending on the cause.

A medical doctor can identify if a vascular pathology may be to blame for the objective tinnitus and will order further imaging or tests to identify if this is the case. Typically surgical correction of the abnormality will improve the tinnitus.

If the tinnitus is related to benign intracranial hypertension, treatment can entail losing weight, taking a medication such as a diuretic (water pill) to decrease fluid retention or other prescription medication, or in severe cases, surgery to help your body more effectively drain cerebrospinal fluid (CSF) or the fluid that surrounds the brain and spinal cord.

In the event that a Patulous Eustachian tube, this may be addressed by increasing hydration, limiting unnecessary use of decongestants, treating allergies or sinusitis (inflammation of the sinuses), or surgery to remove a growth that is obstructing the Eustachian tube.

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Finally, muscular contractions can be voluntary (the person purposefully elicits the contraction) or involuntary (the contraction is elicited due to an underlying cause and cannot be controlled by the person). Some causes of involuntary muscular contractions include multiple sclerosis, epilepsy, and Parkinson's Disease.

Read more on objective tinnitus.

Check out this video from the Journal of the American Medical Association (JAMA) to hear the sound of objective tinnitus from the middle ear myoclonus.

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Subjective Tinnitus

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Subjective tinnitus is the most common form of tinnitus and it simply means that only the person with tinnitus can hear it. Because there is no concrete or objective cause to the tinnitus, it is referred to as "subjective."

That doesn't mean that the tinnitus isn't there, or that it isn't bothersome or severe. Usually, there is no curative treatment for subjective tinnitus but there are many treatments that help to reduce tinnitus intrusion.

There are many ways to reduce subjective tinnitus intrusion, including:

• ‍Cognitive-behavioural therapy (CBT) is the standard treatment for subjective tinnitus. It is known to be both safe and effective
• Relaxation, meditation, and managing stress
• Getting good sleep
• Listening to pleasant and relaxing sounds
• Engaging in relaxing hobbies and activities

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Sensory Tinnitus

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Sensory tinnitus is technically a subtype of subjective tinnitus, although the technical cause is that the sensory organs for hearing (the cochlea or inner ear) have suffered damage and tinnitus has resulted. Sensory tinnitus occurs as the result of hearing loss.

Reducing the intrusion of sensory tinnitus is possible. Usually, hearing aids or amplification is helpful in improving access to a fuller range of sound.

For people with hearing loss and tinnitus, hearing aids for tinnitus can be a powerful tool in providing the person with access to ideally a normal or improved range of sound which helps to aid the sensory loss. There is no way to restore or recover normal auditory function once a sensory loss has occurred, with the exception of sudden sensorineural hearing loss.

Similar to subjective tinnitus, there are an array of other tools available to reduce the intrusion of sensory tinnitus such as CBT, improving sleep, and listening to pleasant and relaxing sounds.

The Oto app offers an array of support for sensory tinnitus and 86% of Oto users experience relief.

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Hear from an Oto app user who got relief:

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"I have been using the Oto app since February 2021 and, quite frankly, it has been a lifesaver!

My tinnitus started about three years ago, and I explored many techniques and therapies, with varying but temporary results, until my hearing consultant told me about an app that was launching called Oto. I downloaded it immediately and have been working with it ever since.

Oto has become my hugely supportive and essential tinnitus buddy, with tips and techniques to help me start the day in a positive way as possible, that I can go back to whenever I have a bad or panicky moment. There are so many helpful sessions in the programmes, some are favourites, particularly the CBT sessions, but the choice is made depending on how my tinnitus is that day and during the night.

I’m working through the clever sounds and masks, that can be personalised to your own tinnitus, to find the best one for me, and also use the physical therapy exercises and sleep sessions.

Having tinnitus can be a very lonely experience but listening to Oto and hearing Lili, who is the soothing voice of the app, makes you realise that you are not alone. That someone knows exactly how you are feeling and what you are experiencing is a huge comfort, and I am now managing my tinnitus so much better by using these techniques.

With thanks to all the clever and helpful people behind Oto, my best tinnitus buddy!"

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‍Neck Exercises for Tinnitus

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Neck exercises and stretches can improve range of motion, relaxation, blood flow, and reduce tinnitus intrusion. Always consult with a medical doctor or physical therapist if you experience pain, discomfort, injury, or have had surgery or prior therapy to the neck, shoulders, head, or jaw.

Check out this video on how to properly stretch to sternocleidomastoid (SCM) muscle that runs from the shoulder to the jaw: Stretching this one muscle can help your tinnitus.

The Oto app provides physical therapy exercises that you can try.

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Join Oto

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The Oto app is a comprehensive tinnitus solution that offers relief for all types of tinnitus:

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• Physical therapy stretches for the jaw, neck, shoulders, and back to promote physical relaxation
• Pleasant and relaxing sounds
• Guided exercises for meditation