Chronic Cervicogenic Tinnitus Rapidly Resolved by Intermittent Use of Cervical Collar

Abstract

Introduction: Cervicogenic tinnitus is not a generally accepted pathogenetic subtype, which might be subsumed under the concept of somatosensory tinnitus. After the personal experience of therapy-resistant tinnitus in context with a cervical pain syndrome (CPS) and successful add-on treatment with cervical collar (CC), the idea was pursued in several individual treatments in patients.

Patients and methods: Reporting one particular case with chronic tinnitus, considered untreatable, that rapidly improved with exclusive treatment by CC use. Thereafter, tinnitus was experimentally replicated by head inclination, the respective neck-head angles, and cerebral blood flow was measured.

Results: Chronic subjective tinnitus of a 20 years duration completely disappeared within 4 weeks with an intermittent short time application of CC. Thereafter, tinnitus was deliberately again induced by head inclination, set on with anterior tilt of 14°, reaching maximum strength by 23°. Tinnitus stopped with return to neutral head position. Blood flow in the vertebral arteries on both sides was unchanged during head inclination with prevalent tinnitus; however, blood flow was physiologically reduced with head rotation though not accompanied by tinnitus.

Discussion: In a single case of chronic tinnitus, we found that treatment with CC rapidly led to full remission. Blood flow reduction in vertebral arteries was unrelated to tinnitus. However, tinnitus could be resumed by constrained head postures. Experimental tinnitus replication (by inclination) points to an underscored role of upper posterior cervical muscle groups, matching with animal experiments, also in concert with other triggers including psychological factors.

Keywords: cervical collar; cervicogenic headache; cervicogenic tinnitus; tinnitus mechanisms; tinnitus treatment.

Figure 1

The figure represents the full length of disease history of this single case, from the beginning 20 years ago with a cervical pain syndrome associated with tinnitus. When the cervical pain syndrome was intensely treated with established treatments (mainly physiotherapy of various types; for details, see the respective signs within figure) the CPS only gradually improved over time, even worsened after a chiropractic measure. After successful treatment of the cervical pain syndrome, the tinnitus, nevertheless, was chronic, persistent over about 20 years. The tentative recommendation to consider this type of tinnitus as a minor symptom of an incompletely treated cervical syndrome was based on own personal experiences and observations (Karl Bechter, see Introduction), and led to recommend exclusively the intermittent CC use in an outpatient setting (with no other treatment). CC was used repeatedly during day time, initially more frequent, after 2 weeks less frequent, and after 4 weeks the usage nearly ended because of rapid, complete relief from tinnitus. Abbreviations: T, tinnitus; HS, periarthritis humero scapilaris simplex left; Oth, orthopedic therapy; Pth, physiotherapy; OsTh, osteopathic therapy; CC, cervical collar.

Figure 2

Representation of tinnitus-related head postures and corresponding (posterior) craniocervical angles. Position A: tinnitus neutral position, Position B: tinnitus trigger point, and Position C: tinnitus maximum strength.