Somatosensory Pulsatile Tinnitus Syndrome: A 10-year Progress Report

Almost a decade ago a previously unreported tinnitus syndrome, the Somatosensory Pulsatile Tinnitus [SSPT] Syndrome was described. In this paper our experience with this syndrome will be updated. As initially described, the tinnitus of this syndrome is (a) pulsatile [cardiac-synchronous] and (b) the pulsations can be totally suppressed by a strong somatosensory stimulus from the cranial or cervical region, typically a strong muscle contraction of the neck or jaw. The tinnitus can be perceived unilaterally or bilaterally. It is usually high pitched. From over 10 years of experience it is concluded that imaging never reveals a finding to account for SSPT. Audiograms are not related to the tinnitus. Forme frustes are the most common presentation of this syndrome; typically, a non-specific tinnitus is associated with intermittent, even if very brief, cardiac-synchronous pulsatile tinnitus. In some SSPT is heard (i) only when in bed, (ii) in others it disappears when in bed, and (iii) in still others the presence or absence of SSPT upon awakening determines whether or not SSPT will be heard that day. Two types of treatments have sometimes abolished SSPT on a long-term basis: (1) electrical stimulation of the pinna and (2) dry needling of trigger points. Since (a) the tonus of cervical musculature is dramatically different in bed than otherwise and (b) the successful treatment modalities appear to involve the somatosensory system, these observations provide further support for the somatosensory nature of SSPT.