What If It’s Not Your Ear? One Patient’s Journey Through Neck-Focused Care for Tinnitus

BackgroundA 60-year-old male presented to the Headache and Neck Clinic with a primary concern of intermittent pulsatile tinnitus on the right side, and mild non-specific vertigo. The tinnitus had a mechanical character, worsening during jaw movement. There was no recent trauma, but the patient had a long-term history of recreational judo activity.

Prior medical evaluation had ruled out acute otologic or neurological conditions. Given the patient's symptom pattern and long-standing mechanical stress history, a cervical spine evaluation was conducted from a chiropractic perspective.

Imaging & Clinical ObservationsA CBCT (Cone-Beam Computed Tomography) scan revealed:

High-riding right jugular bulb

• A high-riding right jugular bulb; is a blood vessel in the ear area that sits higher than usual. It’s usually harmless, but in some people, it can cause a pulsing sound in the ear (pulsatile tinnitus) or dizziness because it's close to parts of the ear involved in hearing and balance.

  

  Elevated Schmidt-Fischer Angle

• Elevated Schmidt-Fischer angle (130.5°, above the reference range), indicating hypoplastic occipital condyle (HOC)

  
  

  

  Odontoid Lateral Mass Interval Asymmetry

  
  

• Displacement of the atlas (C1) from the cranial base, with asymmetry in the odontoid-lateral mass interval

  
  

These findings suggested a potential mechanical disturbance at the atlanto-occipital joint (AOJ). From a biomechanical standpoint, this region is in close anatomical proximity to neurovascular structures including the internal jugular vein (IJV).

Chiropractic Care ProvidedThe patient received four visits of upper cervical care using low-force methods aimed at improving head-neck alignment. No spinal manipulative therapy involving thrusts, cracking, or cavitation was applied.

Outcome (As Reported by the Patient)After four visits, the patient reported:

• A reduction in the perceived intensity and frequency of his right-sided tinnitus

• Fewer episodes of dizziness

• Subjective improvement in overall head and neck comfort

These observations were documented and monitored without the use of any pharmaceutical agents, surgical procedures, or claims of cure.

DiscussionWhile individual responses may vary, emerging literature has explored the relationship between craniocervical junction alignment and venous drainage of the brain. Some studies suggest that altered positioning of the atlas and occiput may influence cerebrospinal fluid or venous outflow dynamics in certain individuals (Alperin et al., 2015; Zamboni et al., 2012).

This case illustrates a clinical correlation observed under care—not a guaranteed treatment outcome. Further research is required to confirm causality and establish appropriate interdisciplinary referral pathways.

DisclaimerThis case is presented for informational and educational purposes only. It is not intended to imply that chiropractic care can diagnose, treat, prevent, or cure tinnitus, vertigo, or vascular conditions. Any person experiencing these symptoms should seek advice from their general practitioner or relevant medical specialist. Chiropractic care should always be delivered in accordance with the practitioner’s scope of practice and in collaboration with other health professionals where appropriate.

References

Alperin, N., Lee, S. H., Mazda, M., Hushek, S. G., & Sivaramakrishnan, A. (2015). MRI study of cerebral spinal fluid and blood flow in the jugular veins of MS patients: Effect of upright posture. Fluids and Barriers of the CNS, 12(1), 1–9. https://doi.org/10.1186/s12987-015-0010-5

Damadian, R. V., & Chu, D. (2011). The possible role of cranio-cervical trauma and abnormal CSF hydrodynamics in the genesis of multiple sclerosis. Physiological Chemistry and Physics and Medical NMR, 41, 1–17.

Hirsch, J. A., Behrens, C. C., & Johnson, B. (2022). Venous outflow obstruction and pulsatile tinnitus: A literature review. Journal of Neurointerventional Surgery, 14(3), 239–244. https://doi.org/10.1136/neurintsurg-2021-017803

Zamboni, P., Menegatti, E., & Salvi, F. (2012). The role of the extracranial venous outflow in central nervous system disorders. BMC Medicine, 10(1), 70. https://doi.org/10.1186/1741-7015-10-70