Timothy C. Hain, MD. • Page last modified: April 28, 2019
A rare source of tinnitus is damage to the neck. The concept here is not that the neck injury creates sound, but rather that neck input can modulate brainstem structures that are involved in sound generation. We believe it to exist based on cases that we have encountered through the years in our clinical practice. We think that cervical tinnitus is rare. However, there are some authors that state that it occurs "very often" (Montazem, 2000). A systemic review in 2018 that included 24 papers on the subject stated that "There is weak evidence for an association between subjective tinnitus and CSD." (Bousema et al, 2018).
Diagnosis of cervical tinnitus is by history. It is a subjective tinnitus, that the examiner cannot hear. One must rely on the patient to document a sound that changes according to neck movement.
The diagnosis of cervicogenic somatic tinnitus (CST) is made when the predominant feature is the temporal coincidence of appearance or increase of both neck pain and tinnitus. (Michiels et al, 2015). We would also consider tinnitus as probably cervical, if it appeared after an injury that was clearly confined to the neck, or if it was produced only after manipulation of the neck (such as massage).
Features needed to diagnose cervical tinnitus include:
Cervical tinnitus, like cervical vertigo, is probably mainly due to alterations in brainstem structures involved with hearing, as a result of changes in cervical input. In other words, it is probably a variant of somatic tinnitus (Levine, 1999). In general, it is thought that cervical input can modulate hearing related neural structures in the brainstem (Shore et al, 2007).
In general, cervical conditions are treated by treating the neck -- relief of spasm and pain. Cherian et al (2013) reported response in a single patient to physical therapy. As this is a single case report, little can be concluded. However, we think the general idea is good - -one should treat cervical tinnitus by treating the neck.
Levine (2007) suggested that cervical treatment was most successful in individuals with asymmetrical tinnitus (on matching), but normal hearing threshholds.
McCormick et al (2015) reported successful treatment with cervical epidural steroids in a single patient. We have encountered patients who respond to cervical epidural steroids injections(CESI) at other levels too (C4-C5).
Koning et al (2015) reported successful treatment of tinnitus in general from a radio frequency block of the superior cervical sympathetic ganglion. We think this is probably a placebo response as there is no reasonable rationale for this treatment to affect the inner ear.
Vanneste et al (2010) reported successful treatment in 18% of 240 patients with tinnitus modulated by somatosensory events, using C2 TENS. This of course includes a very large number of patients with ordinary tinnitus as most people's tinnitus increases with, lets say, clenching the job. This response is similar to placebo.