Do you sometimes hear a ringing in your ears after a night out or a loud concert? If so, you're not alone. This phenomenon is called tinnitus, and it affects a significant number of people worldwide. In fact, about 10% of the population experiences chronic tinnitus (present for more than 3 months) (1). However, despite the high prevalence of tinnitus, we still have a lot to learn about its causes and effective treatments.

Chronic tinnitus often accompanies chronic pain conditions like jaw pain (2–4), headache (5–8), and neck pain (3,8). Interestingly, chronic tinnitus and chronic pain share several similarities, such as heightened sensitivity to sensory stimuli (9), changes in specific brain areas (10), and associations with psychological factors like stress, anxiety, and depression (11–14). Lifestyle factors such as physical activity levels and disturbed sleep have also been found to be associated with chronic pain and tinnitus (15–17).

This has led researchers to propose a hypothesis: central sensitization, a phenomenon already observed in various chronic pain conditions, might also play a role in chronic tinnitus. A first study on this topic has provided some initial evidence supporting this idea (18). Patients with chronic tinnitus have reported more symptoms indicative of central sensitization (using the Central Sensitization Inventory), compared to healthy individuals. They also showed increased sensitivity to local mechanical stimuli. Similar results were found for a control group with only chronic neck pain.

Notably, these features were more pronounced in patients who suffered from both chronic tinnitus and chronic neck pain. These individuals not only reported more symptoms indicative of central sensitization, they also exhibited widespread hypersensitivity to mechanical stimuli when compared to patients with only tinnitus or healthy controls. These findings were not present in a control group with only chronic neck pain. Patients with both chronic tinnitus and chronic neck pain, and a control group with only chronic neck pain reported a higher psychological burden and poorer sleep quality compared to healthy controls.

While there is still much more to discover about the association between tinnitus and central sensitization, these findings open up exciting possibilities for future research and clinical interventions. By screening for chronic (neck) pain and signs and symptoms of central sensitization in patients with chronic tinnitus, we may identify an important pathway for improving treatment outcomes.

Kayleigh De Meulemeester

Postdoctoral researcher within the Spine, Head and Pain Research Unit Ghent, Ghent University, Belgium

2023 Pain in Motion

References and further reading:

1. Jarach CM, Lugo A, Scala M, van den Brandt PA, Cederroth CR, Odone A, et al. Global Prevalence and Incidence of Tinnitus: A Systematic Review andMeta-analysis. JAMA Neurol. 2022 Sep;79(9):888–900.

2. Ausland JH-L, Engdahl B, Oftedal B, Steingrímsdóttir ÓA, Nielsen CS, Hopstock LA, et al. Tinnitus and associations with chronic pain: The population-based Tromsø Study(2015-2016). PLoS One. 2021;16(3):e0247880.

3. Bousema EJ, Koops EA, van Dijk P, Dijkstra PU. Association Between Subjective Tinnitus and Cervical Spine or TemporomandibularDisorders: A Systematic Review. Trends Hear. 2018;22:2331216518800640.

4. Omidvar S, Jafari Z. Association Between Tinnitus and Temporomandibular Disorders: A Systematic Reviewand Meta-Analysis. Ann Otol Rhinol Laryngol. 2019 Jul;128(7):662–75.

5. Langguth B, Hund V, Landgrebe M, Schecklmann M. Tinnitus Patients with Comorbid Headaches: The Influence of Headache Type and Laterality on Tinnitus Characteristics. Front Neurol. 2017;8:440.

6. Langguth B, Hund V, Busch V, Jurgens TP, Lainez J-M, Landgrebe M, et al. Tinnitus and Headache. Biomed Res Int. 2015;2015:797416.

7. Lainez MJ PA. Tinnitus with headaches. In: Moller ALB, De Riddeer D K, T, editors. Textbook of Tinnitus. New York: Springer; 2011. p. 487–90.

8. Deklerck AN, Debacker JM, Keppler H, Dhooge IJM. Identifying non-otologic risk factors for tinnitus: A systematic review. Clin OtolaryngolOff J ENT-UK ; Off JNetherlands Soc Oto-Rhino-Laryngology Cerv-fac Surg. 2020 Sep;45(5):775–87.

9. Moller AR. Similarities between chronic pain and tinnitus. Am J Otol. 1997 Sep;18(5):577–85.

10. Rauschecker JP, May ES, Maudoux A, Ploner M. Frontostriatal Gating of Tinnitus and Chronic Pain. Trends Cogn Sci. 2015 Oct;19(10):567–78.

11. Kleinstäuber M, Weise C. Psychosocial Variables That Predict Chronic and Disabling Tinnitus: A SystematicReview. Curr Top Behav Neurosci. 2021;51:361–80.

12. Salazar JW, Meisel K, Smith ER, Quiggle A, McCoy DB, Amans MR. Depression in Patients with Tinnitus: A Systematic Review. Otolaryngol neck SurgOff J Am AcadOtolaryngol Neck Surg. 2019 Jul;161(1):28–35.

13. Hruschak V, Cochran G. Psychosocial predictors in the transition from acute to chronic pain: a systematicreview. Psychol Health Med. 2018 Dec;23(10):1151–67.

14. Boecking B, von Sass J, Sieveking A, Schaefer C, Brueggemann P, Rose M, et al. Tinnitus-related distress and pain perceptions in patients with chronic tinnitus -Do psychological factors constitute a link? PLoS One. 2020;15(6):e0234807.

15. Gu H, Kong W, Yin H, Zheng Y. Prevalence of sleep impairment in patients with tinnitus: a systematic review andsingle-arm meta-analysis. Eur Arch oto-rhino-laryngologyOff J EurFed Oto-Rhino-Laryngological SocAffil with Ger Soc Oto-Rhino-Laryngology - Head Neck Surg. 2022 May;279(5):2211–21.

16. Manderlier A, de Fooz M, Patris S, Berquin A. Modifiable lifestyle-related prognostic factors for the onset of chronic spinalpain: A systematic review of longitudinal studies. Ann Phys Rehabil Med. 2022 Apr;65(6):101660.

17. Carpenter-Thompson JR, McAuley E, Husain FT. Physical Activity, Tinnitus Severity, and Improved Quality of Life. Ear Hear. 2015;36(5):574–81.

18. De Meulemeester K, Meeus M, De Pauw R, Cagnie B, Keppler H, LenoirD. Suffering from chronic tinnitus, chronic neck pain, or both: Does it impact the presence of signs and symptoms of central sensitization? PLoS One. 2023 Aug 24;18(8):e0290116. doi: 10.1371/journal.pone.0290116. PMID: 37616265; PMCID: PMC10449148.