A new therapeutic approach for somatosensory tinnitus

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Somatosensory tinnitus is suspected when perceptual characteristics (e.g., pitch and loudness) change immediately following head and neck maneuvers, forceful muscle contractions, or eye or jaw movements. Prevalence estimates range from 60 to 80% of tinnitus patients being able to modulate their tinnitus by manipulating somatic regions of the jaw, head, and neck (Ralli et al, 2017), suggesting somatosensory tinnitus to be common, yet the prevalence of this type of tinnitus in Veterans is unknown. The fact that somatic manipulations can directly influence the tinnitus perception for many patients (Shore, 2011) provides the scientific premise for the proposed research to adapt a non-traditional therapeutic approach (i.e., not usual care) for Veterans with this type of tinnitus, which involves physiotherapy. This research is the first step in achieving our long-term goal to develop a clinical framework that can diagnose, assess, and treat Veterans with somatosensory tinnitus. The proposed research is based on the Cleveland Clinic model which evaluates all tinnitus patients to determine if their tinnitus can be somatically modulated. When somatosensory tinnitus is detected, an individualized physiotherapy program is prescribed. This novel approach to somatosensory tinnitus treatment provides the structure for our pilot study. Results of this study will: i) provide data estimating and describing the prevalence of somatosensory tinnitus in Veterans with tinnitus and ii) generate feasibility data for using an adapted version of Cleveland Clinic's individualized physiotherapy approach to treat Veterans with somatosensory tinnitus. The focus of Year 1 will be adapting the neurological screening exam and physiotherapy procedures used at Cleveland Clinic's Tinnitus Management Clinic for use in Veterans. A phone screening will be conducted to identify Veterans suspected of having somatosensory tinnitus. Based on the phone screening results, 10 Veterans suspected of having somatosensory tinnitus and 10 Veterans whose tinnitus is not suspected to be influenced by somatic maneuvers, will be invited to attend an in-person visit to determine how accurate the phone screening was in identifying Veterans with somatosensory tinnitus (Aim 1). Additionally, another sample of 10 Veterans who can somatically modulate their tinnitus (confirmed by in-person Visit 1) will be invited to participate in the physical therapy portion of this study and attend 3 individualized physiotherapy treatment sessions (Aim 2). Questionnaires will be administered to evaluate the effects and impact of somatosensory tinnitus on quality of life. Outcomes of the proposed work will have clinical impact for patients and health care providers. This research is taking the necessary steps to provide an evidence-based approach to direct clinical decision-making for Veterans with tinnitus. Knowledge learned will be disseminated to healthcare providers in multiple disciplines (e.g., audiology, physical therapy, primary care, etc.) to dispel the belief that “nothing can be done” and raise awareness regarding how best to assess and treat Veterans with tinnitus.