Tinnitus is the perception of sound—ringing, buzzing, hissing, or pulsing—without an external source. While commonly associated with hearing loss, it’s increasingly understood as a neurological and somatosensory issue, particularly in patients who can modulate their symptoms through neck or jaw movement. This makes the upper cervical spine a key area of interest for those experiencing chronic tinnitus.
Tinnitus and the Upper Cervical Spine
Research shows that the upper neck may influence tinnitus symptoms through both neural and vascular mechanisms. Let's break down both:
1. Neural Connections
Tinnitus can be triggered or modulated by altered sensory input from the neck, jaw, and upper spine. This form is often referred to as somatosensory or somatic tinnitus, and it's seen in up to two-thirds of tinnitus sufferers.
Key points:
- Modulation by movement: Most tinnitus patients can change the intensity or pitch of their tinnitus by moving their jaw, neck, or face—indicating somatosensory input is involved.
→ (Levine, 1999; Pinchoff et al., 1998) - Neck and TMJ trauma: Onset of tinnitus is often triggered by neck injuries (like whiplash) or temporomandibular joint (TMJ) disorders, both of which alter afferent signaling into the central auditory system.
→ (Dehmel et al., 2008a; Rubinstein et al., 1990) - Cervical nerve involvement: Input from C2 spinal nerves and trigeminal afferents (from jaw and face) can alter activity in the cochlear nucleus, an early processing center in the brain's auditory pathway.
→ (Shore et al., 2007; Dehmel et al., 2008a) - Maladaptive plasticity: After trauma or chronic irritation, the brain may increase firing and synchrony in the auditory system—even without sound input—causing the phantom noise of tinnitus.
→ (Shore et al., 2005b) - Multisensory integration: The auditory system shares dense anatomical connections with somatosensory pathways, allowing for auditory-sensory illusions (like the “parchment skin illusion”) and explaining why somatic maneuvers can affect tinnitus.
→ (Jousmäki & Hari, 1998; Shore, 2005b)
2. Vascular Connections
In cases of pulsatile tinnitus—where the sound pulses in rhythm with the heartbeat—the issue may be vascular rather than neural. The vertebral arteries, which pass through the upper cervical spine, are crucial here.
Key considerations:
- Vertebral artery compression: Misalignment of the upper cervical spine may reduce or alter blood flow to the brainstem and cochlea, potentially contributing to pulsatile tinnitus or amplifying symptoms.
→ (Speculative but consistent with vertebrobasilar insufficiency findings) - Hemodynamic changes: Altered neck posture or tension can affect vascular tone and intracranial pressure, sometimes exacerbating tinnitus symptoms.
→ (Cifuentes et al., 2016)
Upper Cervical Care Approach
Our goal is to restore proper neurological and vascular function through precise correction of structural imbalances in the upper neck.
Here's how we do it:
- Advanced Imaging (CBCT)
We use 3D Cone Beam CT to evaluate the atlas (C1), axis (C2), and surrounding neurovascular structures for misalignment or asymmetry. - Precision Correction
If misalignment is found, we perform a gentle, image-guided correction to improve alignment, relieve neural irritation, and restore vascular flow. - Postural and Functional Integration
Tinnitus often correlates with poor head and neck posture, so we provide recommendations to improve muscle balance and long-term stability.
Summary
Tinnitus may not always be an "ear problem"—in many cases, it's a neck and nerve problem. If you’ve had neck trauma, TMJ issues, or find that your tinnitus changes with movement, upper cervical care could be a missing piece in your recovery.
