Sarah Michiels on Physical Therapy for Tinnitus

well my research topic in tinnitus is somatosensory or somatic tinnitus so my main research is about how to treat patients with cervical complaint you also have tinnitus and patients with signatures who also have temporal mandibular or jaw problems. Somatosensory tinnitus is a type of tinnitus where input from the cervical spine or the jaw is either causing the tinnitus, but that is actually a minority of the patients but in most of the patients, and this input from the cervical spine or the jaw is actually changing an existing tinnitus with a different cause.

Sarah Michiels on Physical Therapy for Tinnitus
Sarah Michiels on Physical Therapy for Tinnitus

 We are not exactly sure how many people have the somatic component. It depends a little bit on how you define somatosensory tinnitus quite a lot of people can actually change their tinnitus by certain movements of the jaw or the neck especially if you ask them to like move their jaw against resisters. So there are a lot of patients who can do this but they aren’t necessarily real somatosensory tinnitus patients so if we look at a large sample of patients.

And we really want to see who is real somatosensory, whose patients are real smell of sensory tinnitus it’s mostly about 20 to 25%. So the whole group, the jaw and the neck related senators together. Physiotherapy can be used for treating the cervical spine in these patients and also for treating the temporal mandibular 12 sort of jaw.

In patients with cervical spinal related somatosensory tinnitus. We have investigated if like the standards treatment for cervical spine problems can also decrease the tinnitus and we found that in 43 percent of the people we treated in our institution in Antwerp, the tinnitus significantly decreased. After treatment with cervical spine, the mostly used cervical spine treatment nowadays.

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We’re doing now a study on temporal mandibular joint treatment, but that is still ongoing so if weak root it’s a hundred and twenty patients, actually and you are still following them up so I don’t really have the data yet but it looks very promising. I have the impression from first data that we have even better results with the jaw treatment then with the cervical spine treatment.

And from systematic review, we know that the combination of splint therapy so occlusal splint therapy, which is mainly made by a dentist that, in combination with exercise treatment, has the best effects for tinnitus treatment. It’s really important that we have large RCTs, including the right patients, because with increasing evolution and us knowing more about who is most likely to benefit from the treatment.

We can refine the inclusion criteria and if we have a large sample then we can actually prove that this treatment works and for whom it works. So that is one important thing I think another part that is important is to know why this works. Because that’s something that’s really fascinating me. Me, as a physical therapist, I also see a lot of patients with cervical spine problems who don’t have tinnitus. And that is really fascinating to me.

 I would like to know what is different between these patients one has neck complaints and develops tinnitus or an existing tinnitus gets worse, and the other one has the same neck problems, the same dysfunctions in the cervical spine, but they don’t develop tinnitus so that’s really interesting for me. And I think we need to look more into detail to that background as well.

Physiotherapists mainly like some knowledge are about what they really have to, howdy have to communicate with the patients, what they can tell, what they can’t tell. And one important thing for me is and I always tell it when I give courses to physiotherapists, that they can’t ask the patient every session like, how is your tinnitus today?

How was it after the last session? I think it’s really important when you’re treating patients with tinnitus that you don’t go and focus too much on the tinnitus. Well, the treatment regiment is a bit different for the cervical spine treatment and for the jaw treatment. Cervical spine treatment depends a bit on the differences in dysfunctions.

In patients so for instance, if you have a problem with mobility. You can’t move your neck as far as you would like it to move then we will try to do some mobilizations, those are manual techniques that the therapists will do. And we combine it with exercises to make sure that all muscles are strong enough and that the patient is moving.

In a correct way has a right posture so that cervical spine problems are aren’t returning too quickly. Because it’s no use treating someone for six weeks, and then after six weeks they go back to their old habits, and in the next three weeks, they develop new of course finds problems so that’s no use.

So we want to help them in the long term with their cervical spine problems. For the jaw problems it’s kind of a different approach. So we always apply a self massage technique where the mystic Ettore muscles first year and over here are addressed. So to loosen the muscles. And we give to patients and exercises to stretch these mustika tree muscles. Sometimes, we also apply manual techniques to increase mouth opening when patients have problems with that, but in patients with tinnitus, it is mainly a muscular problem that’s going on there.

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