It Seems That The Combination Of Tinnitus And Postural Instability Begins As A Cervical Pain Syndrome
In January 2021, publishing in The International Tinnitus Journal, Henk M Koning, MD, Ph.D., also noted that:
In patients with tinnitus as the main complaint, 64% of the patients have also cervical pain, and in patients with cervical pain as the main complaint, 44% of the patients have tinnitus. Both groups of patients have in common a high prevalence of postural instability and dizziness, degeneration of the intervertebral disc between the fifth and seventh cervical vertebrae, and a large anterior spur in front of the fifth cervical vertebrae. Patients with cervical pain as the main complaint have more degeneration of the intervertebral disc between the third and fourth cervical vertebrae, a larger anterior spur in front of the third cervical vertebrae, and more loss of cervical lordosis.
Postural instability is an important discriminant factor in patients with cervical pain and in patients with tinnitus as the main complaint. In patients with cervical pain postural instability was associated with the occurrence of tinnitus. In patients with tinnitus, there is evidence for two profiles of somatic tinnitus, discriminated by the occurrence of postural instability and low-frequency hearing loss. It seems that the combination of tinnitus and postural instability begins as a cervical pain syndrome and that the tinnitus aggravates in time. . .
Understanding The Cervical Spine And Hearing Loss
The neck consists of seven vertebrae, and the most common area for spinal injuries is the lumbar area. Studies have shown that abnormalities to the cervical spine, especially in the upper cervical spine, can affect the arteries and nerves connected to the ears, disturbing their functions in certain ways. For example, 60% of patients with cervical rheumatoid arthritis suffer from hearing problems.
Common causes of cervical injury include:
- Sudden trauma from accidents, sports injuries or falls
- Compression fractures from osteoporosis
- Inflammation of the spinal cord
Commonly, the earliest symptom of cervical spine injuries is movement limitation. Recent studies have shown that the gradual degradation of the intervertebral disk and articular cartilage causes problems with the spinal nerves. Over time, these problems will worsen and they can lead to hearing loss and tinnitus.
Sensorineural hearing loss can be caused by inflamed blood vessels and nerves, ligament injuries, and damaged middle ear bones caused by untreated cervical spine damage.
Clocking Tinnitus And Anti
In February 2019, researchers wrote in the Clinical Neurology and Neurosurgery of tinnitus being a symptom or manifestation of migraine headaches. The treatment option they offered was an anti-migraine treatment to alleviate the audible ringing. Here is a brief review of the research.
- The researchers agree that tinnitus is no longer thought of as only an otologic disorder. Current evidence supports it as a phantom sensory phenomenon of vestibulocochlear damage with the cortical reorganization. .
- It is a common problem worldwide, but the treatment response is always unsatisfactory.
Ten patients in this study were examined who described a ticking sound of a pendulum or quartz clock .
- Clocking tinnitus was experienced on one side in three patients
- Both sides in one patient
- and at the midline in another six patients.
- It usually subsided within 15min.
Neither patient experienced vertigo, hemifacial spasm, focal neurological deficit, or otic disorder in association with tinnitus. Pre-existing migraine was present in seven patients.
- During the tinnitus attack, a few migraine symptoms concurrently occurred in six patients.
So what is happening here: The researchers believed that a migraine caused the ticking sounds of tinnitus.
The interconnection between tinnitus and other symptoms and manifestations again shows that these problems are not problems in isolation but problems that can be traced, in many patients, to problems of cervical instability.
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The Connection Between Ear And Neck Pain
Do you ever have neck pain? Ringing in ears?
It turns out that neck pain, ear pressure, and inflammation are often be closely related. The ear is innervated by the vestibulocochlear nerve, also known as the 8th cranial nerve.
Any inflammation of these nerves, its many branches, or the tissues surrounding them can lead to ear pathology.
Here are some signs of ear problems that could be related to a neck injury.
What Are The Treatment Options
If you are experiencing hearing loss, you should see an ENT specialist, or otolaryngologist, who can make a specific diagnosis for you, and talk to you about treatment options, including surgical procedures. A critical part of the evaluation will be a hearing test performed by an audiologist to determine the severity of your loss as well as determine if the hearing loss is conductive, sensorineural, or a mix of both.
Based on the results of your hearing test and what your ENT specialists examination shows, as well as results from other potential tests such as imaging your ears with a CT or MRI, the specialist will make various recommendations for treatment options.
The treatment options can include:
- Observation with repeat hearing testing at a subsequent follow up visit
- Evaluation and fitting of a hearing aid and other assistive listening devices
- Preferential seating in class for school children
- Surgery to address the cause of hearing loss
- Surgery to implant a hearing device
These conditions may not, but likely will, need surgery:
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Evaluation And Treatment Of Hearing Loss
Arthritis doesnt change how an audiologist will evaluate your hearing, but you do need a complete assessment not just a pass/fail screening test. Your exam is likely to include listening to tones at different pitches, using vibrations to send tones directly to the bones of your inner ear, and seeing how well you can understand spoken words at different volumes and in different environments.
Extended high-frequency audiometry, a sensitive test that detects some types of hearing loss before they interfere with understanding speech, may help detect arthritis-related hearing loss earlier than other standard tests, according to Dr. Emamifar.
Treatments for hearing loss depend on the location and type of problem and may include removal of ear wax, surgery, the use of hearing aids, or a cochlear implant. For people with arthritis and hearing loss, your rheumatologist may consider starting or intensifying the use of disease-modifying antirheumatic drugs, supplementing these with steroids , and eliminating drugs such as hydroxychloroquine and chloroquine, which may damage hearing. Sudden hearing loss is treated with steroids.
Why Osteoporosis Cause Hearing Loss
The three bones in the middle ear transmit sounds from the outer ear into the inner ear. When these bones are damaged by osteoporosis, it may cause a hearing loss. The study found that an imbalance in bone formation and bone resorption caused by osteoporosis may lead to a hearing loss. The study found that osteoporosis was significantly associated with hearing loss despite nationality, age and gender.
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The Full Experience Of Living With Tinnitus From A Patients Perspective Has Been Under
This is from a new May/June 2019 study in the journal Ear and Hearing. Here we find Canadian researchers from the University of Montreal and the University of Ottawa suggesting that Tinnitus is a challenge that needs to be addressed on an individual basis. They point to these observations:
- The impact of tinnitus on sleep, concentration abilities, social activities, and mood may vary greatly from one individual to another, with some being severely affected and others only experiencing a slight handicap. WHY?
- The researchers suggest that the full experience of living with tinnitus from a patients perspective has been under-investigated. The answers may lie in something hidden.
Before we continue on with the research, here is a video from Dr. Ross Hauser that describes the patient conditions and what we look for in treatment possibilities.
Improving Tinnitus With The Treatment Of The Cervical Spine And Jaw
A case study published in the Journal of the American Academy of Audiology wrote: Musculature and joint pathologies of the head and neck are frequently associated with tinnitus and have been hypothesized to play a contributing role in its etiology.
To demonstrate the role of muscles and cervical spine pathology, the doctors of this case study offered the case of a 42-yr-old male experiencing intermittent bilateral tinnitus, headaches, blurred vision, and neck tightness. His occupation required long-term positioning into neck protraction. The examination found limitations in cervical extension, bilateral rotation, and side bending. Asymmetry was also noted with temporomandibular joint movements. Upon initial evaluation, the patient demonstrated functional, physical, and emotional deficits per neck, headache, and dizziness self-report scales and a score on the Tinnitus Handicap Inventory of 62 . Resisted muscle contractions of the cervical spine in flexion, extension, and rotation increased his tinnitus.
- Treatment focused on normalizing cervical spine mobility through repetitive movements, joint mobilization, and soft tissue massage.
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How Is Hearing Loss In One Ear Treated
Treatment options for your hearing loss will depend on the cause of your condition. In some cases, hearing loss will be irreversible. Your doctor may recommend a hearing aid to help improve your hearing if there is no other treatment for your hearing loss.
Other treatment options may include:
- surgery to repair the ear or remove a tumor
- antibiotics to treat infection
Drugs To Avoid If You Can
While there are a number of drugs that can cause tinnitus, some of the more common are analgesics like aspirin and NSAIDs .
- A 2014 article in the journal Hearing Research indicates acetaminophen or paracetamol to be a possible cause. There are antibiotics like gentamycin, erythromycin and vancomycin, which have been known to be causal.
- A 2010 study in the American Journal of Medicine gives us a clue to the type of analgesic and potential for damaging the ear with acetaminophen being the worse, NSAIDs like ibuprofen second and then aspirin. Many of these are from abuse of the drugs or high dosages, however, your doctor may be able to avoid aggravation by choosing alternative medications.
- A 2009 study in Cases Journal found a genetic susceptibility to aspartame toxicity suggesting cessation of its use may prove helpful for some. It has also been recommended that one should give up caffeinated beverages like coffee, tea, soda and foods like chocolate to see if symptoms are relieved.
- An interesting 2019 study in the International Archives of Occupational and Environmental Health found that although solvent exposure was not associated directly with tinitus, solvents with benzene, ethylbenzene, and toluene concentrations were significantly associated with high frequency hearing loss, which has been linked to tinnitus.
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A Good Massage Can Help
Massages and physiotherapy in general have a relaxing function on the muscles aimed at reducing the compression of some cervical nerves and sweeping away accumulated stress and tension. In these cases it is advisable to rely on professionals in the sector, avoiding being tempted by do-it-yourself, as a wrong exercise could accentuate the symptoms.
Treating Cervical Spine Issues
Problems with hearing due to cervical spine issues can usually be treated by a chiropractor who will locate the spinal misalignments that affect the central nervous system. Its important to understand the root cause of your issue before making any decisions about treatment.
The first step to treating your hearing loss or tinnitus is to book a hearing test with Health and Hearing in Brisbane. Our experienced specialists will determine the cause of your hearing problems and then make recommendations for the best treatment plan. You can book a free consultation by calling 3366 9355 or contacting us online.
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Treatment Options For Auditory Neuropathy
There is no cure for auditory neuropathy. The variable nature of this hearing disorder means that some treatments work in some cases and not others. Unfortunately, there are no tests to predict whether a particular treatment will work or not the patient and their hearing specialist may have to experiment to find out. Treatment options for auditory neuropathy include:
- cochlear implant a surgically implanted device that stimulates the nerves of the inner ear. These implants have been shown to help many people with this condition improve their ability to understand speech
- frequency modulation systems a portable receiver and headset that amplifies sounds without the need for wiring
- hearing aids to amplify all sounds. Generally, adults with auditory neuropathy dont find hearing aids particularly helpful.
How Can Neck Trauma Affect Your Hearing Health
The cervical spine makes up the first 7 vertebrae, which enclose and protect the soft nerve tissue that comprises the inner spinal cord, like a bony shield. Known as the neck, this portion of the spine begins right above the shoulder blades and terminates right at the skull, where it connects and supports. Many different systems compose this part of the spine, including muscles, bones, ligaments, and joints. Each of these structural systems also have nerves running through them, providing muscular control and the ability to perceive sensations to the skull and arms. So how can injury or trauma to the cervical spine cause hearing problems such as sudden hearing loss, tinnitus, or vertigo?
Neck problems can be associated with hearing problems in three different ways:
Many studies have shown that these vascular and neural problems that lead to sudden hearing loss could all be the results of misalignment in the vertebrae of the cervical spine.
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Arthritis And Hearing Loss
People with arthritis may experience hearing loss due to the disease or to the drugs used to treat it.
Several studies, including a 2018 study in Clinical Rheumatology, found higher rates of sensorineural hearing loss a type of hearing loss usually caused by poor function of the hair cells in the cochlea in patients with rheumatoid arthritis . Some evidence also links hearing loss with psoriatic arthritis , juvenile idiopathic arthritis , systemic lupus erythematosus and Sjogrens syndrome.
For most people with arthritis the likely culprits behind hearing problems are pain medications.
High doses of aspirin and other salicylates may cause reversible hearing loss or ringing in the ears . A 2010 study published in the American Journal of Medicine and a 2012 study in the American Journal of Epidemiologyconfirmed the risks of aspirin and NSAIDs on hearing and the risks of other NSAIDs and acetaminophen on hearing as well.
The 2010 study, which examined data from nearly 27,000 men, found that regular aspirin use increased the chances of hearing loss by 50%, and regular NSAID use made hearing loss 61% more likely in men younger than 50. Among regular users of acetaminophen, the likelihood of hearing loss was doubled.
In both studies regular use was defined as at least twice a week and the link between analgesic use and hearing loss was generally greater among those younger than 50.
How Medications Hurt Hearing
What You Can Do
Research On Cervical Instability And Prolotherapy A Mechanical Approach To Tinnitus
In the research above, a case is laid out for the treatment of cervical spine instability in patients with tinnitus. As pointed out, not every case of tinnitus can be attributed to tinnitus but it may be likely that more cases than are reported of tinnitus induced cervical spine instability exist. Certainly, at our center, we see many people with this connection because this is what we treat.
Above you read about cervical manipulation, physical therapy, and exercise programs for the treatment of tinnitus. In this section, I will explain our Prolotherapy program.
Medical research validating the use of Comprehensive Prolotherapy, from simple dextrose injections to stem cell prolotherapy injections is not new. There are decades years of research supporting the use of Prolotherapy for problems of the neck and head.
Caring Medical has published dozens of papers on Prolotherapy injections as a treatment in difficult-to-treat musculoskeletal disorders. Prolotherapy is an injection technique utilizing simple sugar or dextrose. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problem of tinnitus. It should be pointed out that we suggest in our research that Additional randomized clinical trials and more research into its use will be needed to verify its potential to reverse ligament laxity and correct the attendant cervical instability. Our research documents our experience with our patients.
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Sinus Pressure And Barometric Trauma
Nasal congestion from a severe cold, flu, or sinus infection can create abnormal pressure in the middle ear, impacting normal hearing and causing tinnitus symptoms.
Acute barotrauma, caused by extreme or rapid changes in air or water pressure, can also damage the middle and inner ear. Potential sources of barotrauma include:
- Diving / Snorkeling / Scuba
- Concussive explosive blasts
What Causes Inner Ear Problems
Many chronic health problems can be caused by inner ear problems. It is also true that neck problems can cause inner ear problems. Vertigo, hydrops, tinnitus, hearing loss, and Menieres disease can all be coming from the neck. These health problems are related to nerves that either exit the brain-stem or have their nuclei in the brain-stem.
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