Tinnitus affects between 10-20% of the population (1) and ranges from being mildly irritating and occasionally distracting to a constantly distressing and debilitating condition. This post discusses the role of stress in how we ‘hear’ Tinnitus and how approaches like Craniosacral Therapy may be able to help.

What is Tinnitus?

Tinnitus is the perception of sound without an external source and is sometimes referred to as ‘phantom sound‘. One of the earliest documented mentions of the condition, continuing the spooky terminology, dates back to the ancient Egyptians who called Tinnitus “Bewitched Ear”(2). The word Tinnitus comes from the latin for ‘Ringing’ (Tinnare) although the sound can also be experienced as buzzing, hissing, humming, clicking, crackling, throbbing or whooshing. For people living with long-term Tinnitus, the symptoms can last anywhere between a few minutes to a few days or in some cases ‘constantly’.

What causes Tinnitus?

There are two types of tinnitus, ‘objective tinnitus’ (a rare form that can be ‘heard’ on medical examination) and ‘subjective tinnitus’ (that only you can hear). Subjective Tinnitus is the most common type and (as with many subjective phenomena in the body) there can be a range of causes including:

Ear bone changes (Otosclerosis)
Earwax blockages
Blood vessel dysfunctions (eg Atherosclerosis or high blood pressure)
TMJ dysfunctions (Jaw)
Head injuries (damage of nerves in the ear or brain areas associated with hearing)
Overstimulation through noise exposure (eg drilling, loud music at a concert or headphones)
Medication (some antibiotics, some antidepressants, nicotine and caffeine)

The wide range of causes is perhaps why Tinnitus has historically been so difficult to treat and why often a cause isn’t easily identified. Interestingly, many of those listed above can also be part of the stress response eg a tight jaw, high blood pressure and likelihood of taking medication.

Stress and Tinnitus

Tinnitus is usually thought of as being caused by exposure to external noise. However, Tinnitus can also be considered a Stress Related Condition. As stress accumulates, our body responds by adjusting digestion, muscular tension and heart rate, for example. This heightened activity can lead to a generalised overstimulation creating a kind of internal noise which is then perceived by our nervous system as threatening, even in the absence of a threat in the external environment. In this way, Tinnitus can be seen as a warning signal that we have reached our tolerable limit for stress. Here’s an example of actor, Josh Gad describing how forgetting his lines on stage caused an episode of Tinnitus. (Watch from the beginning until 1min14sec)

Josh Gad on the Late, Late Show with James Corden talks about his ‘actor’s nightmare’ and the onset of tinnitus

Stress comes from a complex range of sources including professional and societal demands, environmental allergens, over-consuming stimulants like caffeine, heightened emotional responses, physical fatigue, traumatic experiences and sleep deprivation. For Josh, the trigger was immediately obvious. The biological effects of stress are often complex with multiple causes so a single trigger for the onset of Tinnitus can be harder to find, particularly when stress is long term and builds up gradually.

How does a stressed nervous system generate Tinnitus?

Brain Networks Involved in Tinnitus modified from Phantom percepts: tinnitus and pain as persisting aversive memory networks. De Ridder et al., 2011

The more stress we experience, the harder our nervous system has to work. This means neurons communicate faster and secrete excitatory chemicals to meet the demand of the stressors. Our sensory and decision-making activity increases and we seek memories to find a solution from past experience. Our emotional response will be expressed physically and as it intensifies, we may tense up and change our posture. Throughout our nervous system, stress causes a cascade of chemical and electrical communication which filters through every level of our being to create an internal warning that “something’s up!”.

Nervous systems are complex with context dependent tendencies. In some people, the brain’s tendency will be to generate pain as a protective internal warning. In other people the brain’s tendency will be to generate Tinnitus. If the nervous system is overloaded with stress, different parts of the brain find it harder to communicate with each other coherently. Nerves in the brain’s hearing centres (auditory cortex shown in green in image above) generate the sound of Tinnitus when they become overexcited and desynchronised from the activity in parts of the brain involved in attention, memory and emotion for example (shown in blue, grey and red in the image above).(3)

In high stress, the brain’s emotional centres send messages down through the body to change our physiology. The Autonomic Nervous System (which regulates our heart, lungs and digestive organs) regulates the increased activity, for example filtering more oxygen and glucose to our blood. Although the brain generated part of this response, it still receives information back from the body and interprets this information as an additional indicator of stress. The internal ‘alarm bells’ again respond accordingly and the Tinnitus gets even louder. This is sometimes called a Conditioned Reflex Loop (4) whereby the fear and concern (conscious and subconscious) towards experiencing Tinnitus reinforces the pattern of over excitation and desynchronisation, the loop becomes a vicious circle.

The stress caused by (and that possibly causes) Tinnitus can often lead to feelings of fatigue, irritation and distraction, particularly during intense or long lasting periods of the condition. It’s easy to see why Tinnitus can be so distressing and tiring when the Autonomic Nervous System is generating the message that the internal environment is under threat.

Craniosacral Therapy and Tinnitus

In my Craniosacral Therapy practice, I help people to feel more comfortable in their own skin with a combination of touch and body awareness. As this happens, people often describe feeling more grounded and aware of feeling their physical presence, less distracted and less irritated. Other signs that their Autonomic Nervous System is settling include relaxation of the breath, facial expression, voice and muscle tone. Sometimes this coincides with a reduction in their Tinnitus symptoms for a brief period, sometimes longer. Even if the Tinnitus doesn’t change significantly, there is often at least some respite from some of the other symptoms of the condition.

Various new approaches to treating Tinnitus try to harness the power of the Parasympathetic nervous system through Vagus Nerve Stimulation (see image below). For people who do not have access or interest in such devices, Craniosacral Therapy may be one of a range of options to consider in stimulating the Vagus Nerve to reduce stress.

I offer a gentle and reassuring way of holding the body and meet each person with compassion and respect which encourages feelings of safety. On a biological level this stimulates the Parasympathetic branch of the Autonomic Nervous System which helps to reduce the sense of threat and stress. Given the complex nature of Tinnitus, nervous systems and people in general, a wide ranging approach to treatment has many benefits. It’s well worth considering sleep habits, nutrition, medication, movement and exercise to take the load off the nervous system.

Making Friends with Tinnitus

One way of breaking the ‘Conditioned Reflex Loop’ (where symptoms are exacerbated by the stress of the condition itself), is to gradually reduce the anxiety around the experience of Tinnitus. For example, as people feel more settled and their symptoms reduce, episodes of Tinnitus can eventually become a friend in the form of biological feedback. Instead of Tinnitus adding fuel to the fire of stress, it can prompt us to address our sleep patterns, caffeine intake, exposure to sunlight, social interactions and exercise so that we can take the necessary steps to bring about more balance and synchronisation to our nervous system.

NB – Seek medical advice

Tinnitus can have a range of causes. It is important to have a medical opinion as some disease states have Tinnitus in their profile. The support I offer to clients is ‘complementary to‘ not ‘instead of‘ medical care. Anyone who has Tinnitus needs to speak with their primary care contact in the first instance and particularly if they have any concerns about their health.

Steve Bonnelucq-Lane is a Craniosacral and Trauma Therapist. Based in the UK, Steve practices in East Sussex and West Sussex from clinics in Brighton, Haywards Heath and Lewes. Steve also teaches Craniosacral Therapy internationally and offers supervision and post graduate workshops to qualified practitioners.

References:

(1) Tinnitus Characteristics & Therapy - Dziuganowska 2016
(2) Eber’s Papyrus circa 1500BC
(3) Neuroimaging and Neuromodulation: Complementary Approaches for Identifying the Neuronal Correlates of Tinnitus - Langguth et al 2012
(4) Neurophysiological Model for Tinnitus - Pavel Jastreboff 1990

Tinnitus and Craniosacral Therapy