How Nerves Act in Tinnitus

In tinnitus, several neural pathways can become overactivated or dysregulated.

As a Cranosacral Therapist working with people who have ringing in their ears often enough, I have found it helpful to understand some of the possible contributors for tinnitus.  Took it upon myself to research it a bit and ask questions to help educate.

In my practice I have been able to help people habituate, and sometimes lower the sound level.  Other CST’s have told me that they have helped it to become a non-issue.  My focus right now is to keep supporting the brain to calm and heal itself.  Once the body shows me, I leave it in the wisdom of the body to do its magic.

The main ones include:

1. Auditory Nerve (Cochlear Nerve)

• While not always the origin of tinnitus, changes in input from the auditory nerve—due to hearing loss or cochlear damage—can lead to neuroplastic changes in central auditory pathways, contributing to the perception of phantom sounds.

• The cochlear nerve originates from the spiral ganglion, a collection of nerve cell bodies located within the cochlea, the inner ear organ responsible for hearing. These cell bodies, specifically the bipolar cells, have fibers that extend to the organ of Corti, where they receive auditory signals, and central fibers that form the cochlear nerve. 

2. Dorsal Cochlear Nucleus (DCN)

• This is one of the first relay stations in the brainstem for auditory signals.

• In many tinnitus cases, neurons in the DCN become hyperactive or hypersynchronous, especially following hearing loss or noise trauma.

3. Central Auditory Pathways

• Overactivation is seen in higher auditory centers, including:

  • Inferior colliculus

  • Medial geniculate body (thalamus)

  • Primary auditory cortex

• These areas show increased spontaneous firing rates and altered tonotopic 

  (Tonotopic organization refers to the systematic mapping of sound frequencies to specific locations in the auditory system, from the cochlea to the brain. In essence, different frequencies of sound are processed in distinct areas of the brain, with higher frequencies being processed in one area and lower frequencies in another. )

  maps in tinnitus patients.

4. Non-Auditory Areas (Involved in Emotion and Attention)

• Amygdala, anterior cingulate cortex, and hippocampus may be overactive due to emotional and stress-related responses to tinnitus.

• Parietal and frontal cortices can also be involved, reflecting attention and distress components.

5. Somatosensory Nerve Inputs

• In some forms of tinnitus (like somatic tinnitus), input from trigeminal or cervical spinal nerves can influence auditory centers (especially the DCN), potentially causing or modulating tinnitus.

So, it’s a complex interplay between damaged auditory input and compensatory hyperactivity in both auditory and non-auditory neural circuits.

Is it possible to determine which kind of tinnitus a person has?  We can ask:

Patient History & Symptom Profiling

• Subjective vs. Objective Tinnitus: Is it only heard by the patient (most common), or can others hear it too?

• Somatic Modulation: If neck/jaw movement affects the sound, somatosensory pathways might be involved.

• Laterality: Unilateral tinnitus can point to asymmetrical auditory input or vestibular disorders.

• Pitch & Loudness Matching: Helps characterize the tinnitus and may hint at the region of auditory map reorganization.

Functional Brain Imaging

These methods show which brain areas are overactive or misfiring:

• fMRI (Functional Magnetic Resonance Imaging):

  • Detects abnormal activity in auditory cortex, limbic system (emotional response), or attention networks.

• PET Scans:

  • Measures metabolic activity. Can show increased activity in areas like the primary auditory cortex or dorsal cochlear nucleus.

• SPECT:

  • Occasionally used to observe blood flow differences in tinnitus patients.

Electrophysiological Testing

These look at nerve and brain response to sounds:

• Auditory Brainstem Response (ABR):

  • Assesses integrity of auditory pathways up to the brainstem.

  • May show delayed waveforms or amplitude changes in tinnitus.

• EEG/MEG (Electro/Magnetoencephalography):

  • Measures brain wave patterns.

  • Often shows increased gamma activity or decreased alpha in auditory cortex and non-auditory networks.

Audiological and Somatosensory Tests

• Pure Tone Audiometry: Detects hidden or high-frequency hearing loss that may not be noticeable.

• Tinnitus Retraining Tests: May include sound therapy and masking response.

• Musculoskeletal assessments: For somatic tinnitus, jaw or neck dysfunctions may be linked.

Multimodal Integration

Because tinnitus often involves multiple systems (auditory, limbic, somatosensory), specialists piece together data from:

• Hearing tests

• Imaging

• Emotional/cognitive assessments

• Modulation tests

The Journey

Audiological and Somatosensory Evaluation

• Pure Tone Audiometry: Identifies hearing loss often linked to tinnitus.
• Tinnitus Masking and Retraining Therapy Tests: Gauge how external sound affects perception.
• Jaw and Neck Exam: Checks for musculoskeletal sources of somatic tinnitus.

5. Integrating Multimodal Data

Most tinnitus types involve more than just hearing damage. Specialists integrate results from hearing, neurological, and psychological testing to identify which systems are contributing—whether auditory, limbic, or somatosensory.

6. Exploring Treatment Options Worldwide

While there is no universal cure for tinnitus, various approaches have shown effectiveness in managing symptoms. Global research and clinical trials support the following:

• Western Medicine: Includes cognitive behavioral therapy (CBT), tinnitus retraining therapy (TRT), and hearing aids with sound therapy. Some medications may help in managing anxiety or depression linked to tinnitus.
• Craniosacral Therapy: Some anecdotal and small-scale studies report relief, particularly in cases with somatic involvement, though robust clinical evidence is limited.
• Acupuncture and Traditional Chinese Medicine (TCM): Clinical trials (especially in China and Germany) show mixed but occasionally promising results in reducing perceived loudness and distress.
• Homeopathy: Evidence is largely anecdotal, and most scientific reviews find no strong efficacy, but some individuals report improvement.
• Herbal Remedies: Supplements like Ginkgo biloba have been widely studied, with inconclusive results; some subgroups report benefit.
• Mindfulness and Meditation: Supported by growing evidence, these techniques help reduce the emotional impact of tinnitus by retraining attention and decreasing stress-related reactivity.

7. Scientific Studies Supporting Tinnitus Relief

• A 2018 meta-analysis in JAMA Otolaryngology found CBT to be the most consistently effective method in reducing tinnitus distress.
• A 2020 study in Brain Research confirmed increased gamma activity in auditory cortex in tinnitus patients—supporting neuroplastic treatments.
• Studies from Germany’s Tinnitus Research Initiative suggest combining sound therapy with psychological intervention has significant benefits.

Understanding which neural circuits are malfunctioning is the first step. The second is matching that insight with one or more evidence-informed treatment strategies. For practitioners of manual therapy, the ability to create calming, parasympathetic shifts may support the brain in reprocessing tinnitus more neutrally—even when the sound does not fully disappear. While tinnitus remains a complex and highly individualized condition, hope continues to grow across both clinical and holistic communities worldwide.

Hope this was helpful to people suffering with tinnitus.  There are ways to manage easier.  

Sharon Hartnett CST-d

703 509-1792

www.craniosacraltherapistcolumbus.com