The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity.

The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST.

A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus.

In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night's sleep (P=.01) and light intensity exercise (P=.01).

Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise.