Tinnitus has proven one of the most difficult conditions to treat, and after many decades of investigation, still does not have a generally accepted medical treatment. This article explores what is known, and looks at new scientific explorations which can add useful and different approaches to treating tinnitus and related ear problems.

We have learned that tinnitus takes place in the brain, but that the ear, and indeed multiple neuro-sensory pathways, play a role in its continuance. Tinnitus can be triggered by a wide range of auditory system injuries. Recent investigations of sensory-based therapies have opened the possibility of remapping the auditory system to bring relief from tinnitus.

One of the most promising is Dr Tomatis’ method of re-integrating the auditory system by rehabilitating the middle ear muscles through active sound stimulation with Sound Therapy. Though it was invented several decades ago, and has built a strong following of therapists in the sensory integration field, the Sound Therapy method has not yet received the full medical recognition it deserves as a viable tinnitus treatment.

Introduction

The most common cause of tinnitus is noise damage (Axelsson, and Prasher, 2000). This is an indication of how responsive the ear is to noise, and the fact that noise or sound is the most direct and obvious way to produce changes in the ear and the auditory system.

Continuous exposure to noise above 85dB is known to cause permanent hearing damage (Fausti 1995.) This type of damage is likely to affect the cilia (the hair like receptor cells in the inner ear) and has a flow-on effect on the nerve pathways and cortical centres they supply. Tinnitus can also result from head injury, infections, tumours, viruses and stress. In effect, any damage or injury to the anatomy and physiology of the auditory pathways can result in tinnitus. However, the tinnitus noise itself, or the factor generating the experience of noise, occurs within the brain, as evidenced by incidents where the auditory nerve is severed but the noise continues. (House and Brackmann, 1981) Therefore, it is the brain’s interpretation of sound that has to be altered to relieve tinnitus. (Rauschecker, 2010)

Significance of the ear in our nervous system

The ear has several functions: hearing, pressure sensation, balance, sense of movement and spatial orientation. Its deep and varied integration into our various sensory systems is cause to think more broadly about its purpose. It appears to play a more significant role in our overall functioning than previously thought. In order to better understand how these treatments might work, we need to appreciate that the ear is part of the nervous system. This means that many different aspects of our perception and function are related to the health of the ears. In fact, the ear is linked to ten of the twelve cranial nerves (Figure 1) indicating its impact, through sensory integration, with many aspects of our nervous system (Weeks, 1989).

Auditory-neural integration is a two way street, since there are both sensory and motor nerves feeding into the auditory system (Sidlauskas, 2003; Delano and Elgoyhen, 2016). Researchers now recognise that, just as brain plasticity produces problems like tinnitus, it can also be the key to their recovery (Rauschecker 2015).

It is suggested that enhancing ear performance affects the way we process sensory information and can have an impact on tinnitus (Richards, 2003). The ear and brain form a feedback system which can be gradually re-educated through sound. Sensory nerves stimulate and re-map the brain, resulting in improved auditory processing and sound perception. The brain, in turn, sends signals back to the ear to improve its function. These motor signals (originating in a part of the brain stem called the Superior Olivary Nucleus) are part of a continuous feedback loop. Thus the middle ear muscles play an active role in enhancing ear function.

Richards (2003) says:

“The efferent nerves run close to, but not within, the same tracts, as the afferent nerves. The Superior Olivary Complex is the region of the brainstem where efferent neurons arise and have their point of origin, but are not within the afferent nuclei. It is this system that is responsible for the auditory reflex activities of the stapedius and the tensor tympanic muscles.”  (Figure 2)

One type of tinnitus is the kind that accompanies Meniere’s Vertigo. Dr Tomatis’s writing on Meniere’s syndrome gives a well-informed insight into the possible mechanism of these muscles in effective, overall performance of the ear. Though the role of the middle ear muscles has previously been minimized in hearing research, new evidence now suggests they may play a more active role than previously thought, on both sound sensitivity (Porges, 2014) and vertigo (Tomatis, 1991) (Figure 3).

The integrated approach to healing, represented by the field of integrative medicine, fosters an understanding that each part of a functional system plays a key role in the performance of the whole system (Bland 2015).

Dr. Tomatis writes on Meniere’s:

“To what then is Meniere's vertigo due? I believe I have the authority to declare, as a result of the frequent recoveries we have achieved, that we are dealing with an anomaly in the tension of the stirrup muscle. This muscle, which regulates the pressures of the fluid in the labyrinth, can, like every other muscle, and especially the facial muscles, be suddenly moved by independent, involuntary movements called “twitches.” Each of us has seen or felt one of his own muscles suddenly begin to dance about without his having made any voluntary movement to cause this. Such a twitch often happens on the face, and when one questions those suffering from Meniere's vertigo, one often discovers its coexistence with a facial twitch. In fact, the distribution of the nerves in the facial muscles is similar to that which governs the stirrup muscle. Consequently, under the impetus of the stirrup plate, which drives itself into the labyrinth like a piston, the endolymphatic liquid is going to be stirred up into a storm, so bringing in its wake a cataclysmic depression.

"In order to stop such a tempest, everything is put in place to relax this muscle, which is altogether too active. Hence vertigo arises, under the agitated movement of the endolymphatic liquid, and so do buzzings (perceived as bodily noises, following the non-regulation of inhibitory phenomena) and hearing loss, as a result of the reduced tonus of the stirrup muscle."

"Once vertigo sets in, the musculature no longer is able to easily ensure its normal functioning, and internal irritation triggers off discharge which in turn brings about hypertension. Through the use of the Electronic Ear and its electronic gating mechanisms, the hypertension of the stirrup muscle may be reduced, thereby allowing it to resume its proper balancing role. This is followed by diminution of the buzzing noises in the majority of cases and finally the restoration of hearing to some degree.” (Tomatis, 1991)

Some Sound Therapy listeners have experienced both improved hearing and reduced tinnitus, even when caused by noise induced trauma (Joudry 2009). This is because an integrative approach, based on stimulating the whole system of the body to heal itself, results in improved health of an entire functional system, and therefore often results in improvement to numerous symptoms, or illnesses, of that system (Bland 2015). While this is by no means a guaranteed result, it has been shown that improvement is possible, so the diagnosis that all tinnitus sufferers must simply learn to live with their condition no longer seems appropriate.