Constant High Pitch Sound Driving You Mad

Signs and Symptoms: Progressing tinnitus bilateral side but manifest unilaterally (Left is louder).

Type of Trauma: Patient does not recall any specific moment of trauma.

Adjustments: Gentle manual and instrumental adjustment based on the 3D x-ray image findings. Absolutely NO cracking or twisting involved.

Outcome: Tinnitus reduced to the level where it does not bothers him anymore.

A male in his early 30s visited Headache and Neck Clinic for his progressing tinnitus (ringing in his ears) on both sides. However, the tinnitus would alternate, with only one ear ringing at a time rather than both simultaneously. In addition to the tinnitus, he also complained of:

• Neck pain

• Mid-back pain

• Stiffness throughout his body

• Night sweats

• Photosensitivity (sensitivity to light)

• Headache (associated with the tinnitus)

• Anxiety

• 
  

He noticed that his tinnitus seemed to lessen when moving, such as walking or standing up from a seated position, but worsened when he was seated or lying down on his back.

The patient had already visited an ENT specialist and had an MRI brain scan. The report revealed no particular disease near the ear. Despite the lack of findings from the ENT specialist, his symptoms persisted, leading him to seek alternative treatment options.

After a thorough evaluation, I referred the patient for a Cone Beam CT (CBCT) scan to gain a deeper understanding of the possible mechanical causes of his symptoms. The results revealed several issues in the upper cervical spine that could be contributing to his condition.

Disclaimer

*Since the case is very complicated, this post focuses on the tinnitus ONLY. This interpretation is purely from my personal idea gained from the knowledge of anatomy/physiology and reported cases and studies. This post is not claiming that all tinnitus can be treated or helped by the following methodology.

CBCT revealed that the space between the C1 atlas transverse processes (C1-TVP) was positioned unusually. The right C1-TVP was significantly anteriorly deviated, positioned anterior to the styloid process, while the left C1-TVP was aligned with the styloid process. Maintaining a certain amount of space between the C1-TVP and the styloid process is important as several vital structures pass between them, one of which is the Internal Jugular Vein (IJV).

The patient's anterior displacement (mild misalignment) of the C1 was severe enough to compress both of the internal jugular veins, particularly more so on the left side.

A similar case was reported in the Journal of Anesthesia, Pain & Intensive Care (Pakistan). In this study, the hospital measured the distance from the mastoid to the C1-TVP to assess how much it had moved forward. They found an 8.5mm shift, which was noted to significantly impact pressure on the brain.

The following is the same measurement from the CBCT of this case's.

The left C1-TVP shows 12.5mm.

The objective of the treatment was to decrease the anterior displacement of the C1 and, in other words, increase the gap between the C1-TVP and the styloid process (on both sides).

A very specific direction and amount of force was applied to help create space between them. After 7 visits over a period of 2 months, the patient reported a significant reduction in his tinnitus. In addition, his headache, neck pain, and anxiety symptoms also improved noticeably.

This was a very complicated case and one of the most successful outcomes within the tinnitus cases treated. Such a result was made possible through advanced imaging studies, such as CBCT and MRI. It highlights the importance of investigating the craniocervical junction when neurological symptoms persist. Without proper investigation, it is impossible to know what underlying factors may be contributing and which structures are involved.