title: Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis.
abstract: OBJECTIVE
  Of all nonauditory sensory systems, only the somatosensory system seems to be related to tinnitus (eg, temporomandibular joint syndrome and whiplash). The purpose of this study is to describe the distinguishing characteristics of tinnitus associated with somatic events and to use these characteristics to develop a neurological model of somatic tinnitus.
  
  
  METHODS
  Case series.
  
  
  RESULTS
  Some patients with tinnitus, but no other hearing complaints, share several clinical features including (1) an associated somatic disorder of the head or upper neck, (2) localization of the tinnitus to the ear ipsilateral to the somatic disorder, (3) no vestibular complaints, and (4) no abnormalities on neurological examination. Pure tone and speech audiometry of the 2 ears is always symmetric and usually within normal limits. Based on these clinical features, it is proposed that somatic (craniocervical) tinnitus, like otic tinnitus, is caused by disinhibition of the ipsilateral dorsal cochlear nucleus. Nerve fibers whose cell bodies lie in the ipsilateral medullary somatosensory nuclei mediate this effect. These neurons receive inputs from nearby spinal trigeminal tract, fasciculus cuneatus, and facial, vagal, and glossopharyngeal nerve fibers innervating the middle and external ear.
  
  
  CONCLUSIONS
  Somatic (craniocervical) modulation of the dorsal cochlear nucleus may account for many previously poorly understood aspects of tinnitus and suggests novel tinnitus treatments.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston 02114-3096, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Levine
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000294:innervation*; D017626:Cochlear Nucleus / Q000502:physiology*; D004431:Ear, External / Q000294:innervation; D004432:Ear, Middle / Q000294:innervation; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000502:physiology*; D008875:Middle Aged; D009412:Nerve Fibers / Q000502:physiology*; D009434:Neural Pathways / Q000502:physiology*; D012886:Skull / Q000294:innervation*; D014012:Tinnitus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014276:Trigeminal Nerve / Q000503:physiopathology; D014432:Tympanic Membrane / Q000294:innervation