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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.


Male in his early 30 visited Headache and Neck Clinic for his progressing tinnitus (Ringing in his ears) on both sides. However only one side was ringing at a time not simultaneously on both sides. Other than the tinnitus, he also complains; neck pain, mid back pain, entire body feels stiff, night sweats, light bothers eyes (photosensitivity), headache (associated with the tinnitus) and anxiety.


His tinnitus was lessened while was moving like walking or standing up from the seated position and worsened when he was in a seated position or lying down on his back.


He already had visited a ENT specialist and had a MRI brain scan. The report said no particular disease was found near the ear.


I referred him to have his CBCT (3D x-ray) and it showed number of issues.


Disclaimer

*Since the case is very complicated this post focuses on the tinnitus ONLY. This interpretation is purely from Dr Jarod's 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 the space between the C1 atlas Transverse processes (C1-TVP) were positioned in a atypical manner. They were significantly anteriorly deviated, the right C1-TVP was positioned anteriorly to the styloid process and left C1-TVP was in aligned with the styloid process. There has to be a certain space maintained between the space of the C1-TVP and the styloid process because certain structures pass between them and one of them is called "Internal Jugular Vein (IJV)".


The patient's C1 anteriorly displacement (Anterior subluxation) was so severe enough that it was compressing on both of the IJVs and particularly more on the left.

Similar reported case is from a journal of Anesthesia, Pain & Intensive Care (Pakistan). The hospital measured the distance from the mastoid (part of the head as a reference) to the C1-TVP to find out how much it has moved forward. They found 8.5mm and states that was significantly affecting the pressure of 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 measurement 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 introduced to make some gap between them and after 7 visits over 2 months, patient's tinnitus decreased to the level where he could find the significant difference. At the same time, his headache, neck pain decreased and also the anxiety.


This was a very complicated case and was one of the most successful outcome within the cases of the tinnitus. Such result was able to be made due to the advanced imaging studies such as CT and MRI. Therefore it is critical to investigate the craniocervical junction if there is any neurological symptom that persists because you never can guess what is hiding under the skin and what structures are being involved.

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