Tinnitus School – An Integrated Management of Somatic Tinnitus

Epidemiological data suggest that tinnitus is something more and something different from an auditory symptom. In fact, subjective tinnitus is reported to be present in 10-15% ( Axelson et. al 1995) persons in general population but it represents a medical problem, that interferes with general and emotional health state, only about 2%. Furthermore, factors associated with tinnitus such as hearing loss, hypertension, hormonal disorders, anxiety, depression are more frequent than tinnitus itself. (Sindhusake et al. 2004) Stress is known to be a significant factor influencing the clinical course of tinnitus. Auditory system is in fact particularly sensitive to the effects of different stress factors (chemical, oxidative, emotional, ...). Horner in 2003 described different stages of auditory pathways reacting to stress: alarm, resistance and exhaustion. Individual characteristics of stress reaction may explain different aspects of tinnitus in various patients with different responses to treatment, despite similar audiological and aetiological factors. A model based on individual reactions to stress factors (Stress Reaction Tinnitus SRT -Model) could explain tinnitus as an alarm signal. In 2007 Alpini et al. described a therapeutic proposal based on SRT Model, through an integrated approach to the management of patients suffering from chronic tinnitus. The educational aspect was emphasized and therefore the approach was named Tinnitus School, that is a three-phases program (counselling, training, home training) mainly based on fitted physiotherapeutic protocol. The usefulness of physical exercises in Tinnitus patients for reducing the emotional arousal that is underlined by different Authors, e.g ranging from Dehler et al. (2000) to Biesenger et al. (2010), but, in our experience, fitted physical activity could be the specific treatment of Somatic Tinnitus. Somatic tinnitus regards a sub-group of tinnitus suffers. It is defined as tinnitus which is associated to a somatic disorder involving the head and the neck. Dehmel et al. (2008) introduced the Somatic Tinnitus Syndrome (STS). They presented the anatomical basis for the auditory-somatosensory interactions and showed how auditory neurons respond to somatosensory stimulation. Particularly, muscle--skeletal system could be a chronic stress source. In this way muscle-skeletal disorders can pathologically integrate with auditory disturbances increasing tinnitus. In this way, Stress Reaction Tinnitus (SRT) model could be