Somatic Pulsatile Tinnitus??

[Lindagb]

Hi there!

I'm Linda. I've had pulsatile tinnitus for 2 years now. I noticed it the first time while straining my neck to look at my back pant pocket. I heard a vibratory like sound in my right ear while I was looking hard to the left. I didn't think much of it other than not liking the sensation so I stopped. Since then anytime I'd strain my neck to that position I would hear it. After about a year of it, I began paying more attention to it. That's when I realized it was pulsatile in quality and it "whooshing " in time with my pulse. Mine it what I consider low pitched and I only hear it when my head is turned left and slightly bent at the neck. It's normally a fast whoosh however, if I open my mouth, move my jaw sidewise or swallow I can hear it longer. My sternocleidomastoid must be jetting out in order to hear the PT. As long as my head is not turned left, the muscle is relaxed, the sound is not audible. I can also sometimes, while my head is turned, press hard on the left of my neck and hear the sound in my right ear.

In the mornings it's very very low pitched and so quiet that I can hardly hear it when I try. It is louder in the day but when I've been very actively working or exercising, after running up stairs etc, the sound is never heard no mater how hard I try to elicit it.

I have had an ultrasound on my neck, a ct of the temporal bones,an MRI of my head, MRA and an MRV of my head and neck with and without contrast. I have seen an ophthalmologist. I saw a neurotologist who ordered the ct and they did not hear a bruit behind my ear. The vascular neurologist who ordered the MEI did not hear any bruit either.

From all the testing all that was found was a dilated mastoid emissary vein on the side of the PT. The eye doctor stated I have small crowded optic discs but otherwise normal findings. I've asked about the possibility of needing a cerebral angiogram to rule out an AVF however the neuro neurologist who is dedicated to stroke prevention stated that the MRI was done on the best machine out there and the pics were very good. They did consult with their top neuro radiologist at UC and they were all in agreement. They stated I'd have more clues on the MRI that would point to an AVF as well as hear the sound all the time and they too would hear a bruit. Because of this they don't feel I have an AVF.
Aside from the sound, when I trigger it to experiment with pushing on different areas to try to stop it,I end up with pain in my temple that lasts for hours after.

I know a dilated mastoid emissary vein can cause PT but again the position in which it's heard doesn't make sense.

I just came across a report about somatic tinnitus also causing pulsatile tinnitus and it shouldn't like this could be the cause of mine.

I did have a bad neck adjustment shortly before this began as well. I use to think I could stop the sound by pressing on my jugular but now I'm not sure if I'm pressing on the vein or just the sternocleidomastoid itself. If I trigger it, I can also stop it by gently touching behind the lobe of my ear and anywhere along the muscle itself... Some spots harder than others.

I'm wondering how can I know if I'm pressing on the external jugular? And does this seem to be somatic related?

 

[Karen]

Hi, Linda, and welcome!

I'm afraid I don't know much about somatic pulsatile tinnitus, other than what I've read on this forum. Here is a link to information about somatic pulsatile tinnitus:
https://www.tinnitustalk.com/threads/somatosensory-pulsatile-tinnitus-syndrome.9534/

It sounds like you've certainly had the right tests and contacted specialists who are knowledgeable about this condition.

I was wondering if, since yours seems to have a connection to the neck region, you had considered any type of physical therapy. Not a chiropractor, but actual physical therapy.

You might try sending a private message to one of our members, Kaelon, who seems to have this same type of pulsatile tinnitus. He might be able to provide more information, or at least an opinion about your particular symptoms.

I've had pulsatile tinnitus for five years now myself, but mine is constant, and I don't believe it has anything to do with movement of the head or neck. I also have high-pitched regular tinnitus in the same ear, plus some hearing loss. Although I've had a lot of the same tests you've had, they never found anything, so I've just been trying to live with it for right now. Mine has definitely not gotten any worse, and may even be slightly better.

Have you read about Dr. Levine, who is doing research on this type of pulsatile tinnitus?

I wish you well on your search to find some answers!

Best wishes,
Karen

 

[Lindagb]

Thank you for your reply. Of all the testing I've had, I don't believe the MRI itself was of the neck so now I'm wondering.

The only thing I can think is it's compressed which movements. I have not tried physical therapy as I've never had problems with my neck and even now, it's just the PT. I know that doesn't mean there isn't something going on however.

I can say that the less I move my neck to that side, the less often I hear it once I finally do. Then the more often I trigger it the more often and easier it occurs thereafter. I've told my husband for a while now that it has to be muscle related and I need to stabilize my head for a while to allow something to heal. This is just guesswork on my part of course.

 

[Karen]

Linda,

It sounds to me like you have a better idea of the cause than the doctors do! Yes, I agree that it's too bad that, of all the tests you've had, you didn't have an MRI of the neck. I wonder what it would show?

There are other people on this forum who have neck and back issues, along with severe tinnitus (but not pulsatile). I really do believe it is a likely cause of your problem. Perhaps a physical therapist, or even a sports medicine clinic, could be of help to you. I certainly understand what you're going through, and know that you're anxious to find some answers. I was, too, until I had all those tests, and the next test for me (CT scan with contrast) would have involved more radiation. That's when I decided to stop going for more tests, unless my PT got worse. So far, it hasn't, so I am just living with it for now.

Take care, and please keep me posted on how you're doing!

Karen

 

[Lindagb]

The testing seems never ending. The neurotologist whom I saw wanted a CT with contrast on me as well but I refused which is why I ended up with a neuro vascular neurologist to get the MRI testing instead, they agreed that a CT isn't the best test for tinnitus because the bones block too much of the vessels. I'm not sure if that would apply to regular tinnitus or not. I think I could live with the regular tinnitus knowing that it's not dangerous per say but I also understand how nerve wracking it can be.
I keep telling myself that even though I didn't have an MRI on my neck that the ultrasound I did have would have picked up anything else up. She at least had me trigger the sound while she checked but the muscle blocked the view... however there were no abnormalities found there. I'm wondering if there could be a mass of some kind that presses on a vessel when I swallow and turn. Even then though I would think that if that were the case then light pressure on the muscle shouldn't stop the sound. This is how I came to the conclusion that perhaps it's somatic. Just stinks not knowing if I'm right or not.

I keep thinking I need a cerebral angiogram to rule out a fistula but I know that test carries some serious risks. Luckily my doctors don't feel it's that due to the lack of classic symptoms related to an AVF.
Tinnitus all together is nerve wracking.

So sorry that you are suffering as well. I have the regular tinnitus too but have never given that much though. I always figured it was my brain at work I never hear it though unless I listen for it then I hear three different tones. All steady, non the sound of blood flow or the like.

I read that Van Gogh possibly cut off his ear because of tinnitus then ended his life for the same reason. Who knows if it's true but it make sense.

 

[Karen]

Yes, I would think that the ultrasound would have picked up something if you had a mass in your neck. I've heard of a number of people who can stop their tinnitus by pressing on their neck, but I'm not one of them. I've tried so many times pressing on points around my ear, down my neck, etc., and there is no change. For me, the regular tinnitus was just about as bothersome as the pulsatile tinnitus (both were very severe in the beginning), but they have both improved recently. I must have habituated to the sound to a certain extent, as much as that's possible with PT.

A person I've communicated with on another site had a cerebral angiogram, and the doctor accidentally nicked an artery, so she had to go through months of taking anticoagulants to ensure that she wouldn't have any complications, such as a stroke. It is an invasive procedure, and definitely does have some risks.

I don't know about the somatic tinnitus, but I guess it is a possibility. Maybe someone else on this site who knows about somatic pulsatile tinnitus will wish to comment.

Take care,
Karen

 

[Kaelon]

After reading Dr. Levine's paper on Somatic Pulsatile Tinnitus Syndrome, I went to Massachusetts General Hospital for a follow-up on a diagnosis that I had received as the Massachusetts Eye and Ear Infirmary back in November of last year (as vaguely "neuromuscular inflammation," most likely caused by a "neck or jaw issue"). MGH confirmed that Somatic Pulsatile Tinnitus Syndrome was the likely diagnosis in my case, but they were clear to tell me that there aren't any definitive tests for it, and that instead, it's a process of elimination, history, and physical examinations along with cross-referencing tests to determine whether this diagnosis sticks. Here's what they told me:

Signs of the Syndrome Include:

• Ability to change volume or pitch of Tinnitus through physical movements of the neck or jaw.
  
  
• Positive response to anti-inflammatory and/or anti-spasmodic medications (partial or total resolution of the Tinnitus).
  
  
• Exhibiting muscle pain, aching, stiffness, and/or spasming sensations along the head, neck, upper back, or jaw regions.
  
  
• Waxing-and-waning phenomenon; without treatment or intervention, tinnitus inexplicably almost totally resolves one day, only to be louder than it ever has been before the next. While all tinnitus patients experience considerable variation in their tinnitus, Syndrome sufferers are nearly "cured" one day, and then "worse than ever" the next.

Favorable Tests:
(These support a diagnosis.)

• Cervical X-Ray to identify misalignment of the vertebrae (C1-C7 usually complicit).
• Panoramic X-Ray to identify wearing in the jaw; illustrative of grinding or clenching.

Exclusionary Tests:
(Given to rule out something far more serious.)

• Brain MRI: Exclude acoustic neuroma
• Brain MRA: Exclude vascular occlusion
• Head CT: Exclude other conflicts or disorders

So, that's the good news -- the syndrome is being more readily recognized to explain tinnitus that is principally somatic in nature; according to the ATA, about a third of all tinnitus cases have a somatic component and cannot be explained by hearing loss. However, it's important to note that the vast majority of all tinnitus cases are, of course, connected to hearing loss or damage. In all cases, tinnitus is a widespread dysfunction of the brain, rather than a single misfiring.

Here's the bad news -- there is no cure for this syndrome. It comes about due to life-long or long-term chronic problems (usually, poor posture, inadequate sleep, terrible diet and exercise lifestyle routine, etc.); as a consequence, the only treatments that show promise are long-term trans-muscular electrical stimulatnts with physical therapy, which over the course of several years, can reduce the volume (or the perception) of the tinnitus itself.

Finally, it's important to note that I was advised that neck MRIs (and MRI's in general) are terribly inefficient and likely won't show any malfunction that can definitively explain the syndrome. If you've read Levine, you'll note that the neurological etiology of the syndrome is a neuromuscular conflict that reaches the back of the head and interferes with the normal functioning of the dorsal cochlear nucleus, or DCN, and that because of the interconnection between all of the muscle and nerve groups of the head, neck, back, and jaw, it's almost impossible to pinpoint where the spasm begins versus where it simply continues.

I hope this helps.

 

[Lindagb]

Thank you both for the info. It is helpful. I did read the paper that you refer to which is what made me wonder if this is what I have. He mentioned in it that there were two patients at his clinic that were like mine where as they did not hear it until the triggered it which was the opposite of those who were specifically included in that particular study. The paragraph said for them it was a clear cut case of somatic pulsatile tinnitus.

I'm tempted to try an anti inflammatory but I'm thinking over the counter stuff would be too mild.
I myself don't notice spasms in my neck but I've had life long back problems resulting in spasms. I can tell there is tension in my neck and that muscle. In the past the chiropractors always mentioned my vertebrae in my neck being off. Given the number of years I worked as a hairstylist then rehabbing houses, non of that surprised me.. Not to mention the bad neck adjustment by my old chiro.

I certainly believe my movement is compressing a vessel leading to the PT and perhaps inflammation is to blame. Not to diagnose myself or anything... Perhaps I will run it by the neurologist and see what they think.

Again thank you for the help and all the info!

 

[Pilot]

I don't recall neck pain, spasms, aching, etc. or the waxing and waning being mentioned in the research that Dr. Levine did. They actually say that it is relatively constant. Have doctors at MGH done additional research to change this? If not then it seems like they are trying to gravitate the definition closer to somatic tinnitus.

I had in my mind three types of tinnitus (that we are talking about):

"somatic" which is caused by a physical injury in the head, neck, or jaw (could be something going on in the brain too). Treated by treating the injury. Tanit Ganz Sanchez in Brazil is a leading doctor if a person has unusual symptoms such as gaze evoked tinnitus (GET).

"pulsatile" (lower frequency) which has a vascular origin. Treated by finding the vascular defect. I think Dr. David Eisenman in Baltimore or Dr. Maksim Shapiro in New York are very good.

"somatic pulsatile tinnitus syndrome" (higher frequency) which has auditory characteristics of both, but does not have a vascular origin or physical injury. Instead caused by a change or failure in the Dorsal Cochlear Nucleus. Treated with P-STIM (somehow it reduces sensory inputs to the brain). Dr. Robert Levine is the most knowledgeable.

I think it's entirely possible for someone to have two out of three types at the same time.

 

[Lindagb]

I was under the impression that somatic tinnitus in the pulsatile form indicated somatic tinnitus but from a vascular sorts as well as somatosensory. Kind of a mixture of each if you will...
I know somatic tinnitus on it's own definitely represents regular tinnitus being modified by position change, clenching the jaw etc.

When I read about somatic pulsatile tinnitus they described people that were able to stop the pulsatile tinnitus all together at times. I also believe I read that it was vascular but unclear as to how it was transmitted as such.

I took the repost to mean that it was vascular tinnitus and the sounds of blood flow were being transmitted to the hearing nerve.. The reason the nerve did not block the sound (due to a failure) or due to something else causing the sound to now be audible despite a normal nucleus, was what was unknown.

 

[Pilot]

The two possible causes that Dr. Levine lists are a) cardiac synchronous somatosensory
activation of the central auditory pathway or (b) failure of the somatosensory-auditory central nervous system interactions to suppress cardiac somatosounds.

For a) my guess for what is happening is that somewhere there are sensory nerves that are near a capillary or other blood flow, which is normal, and they are "feeling" the pulsating blood flow. They send the signals back to the brain along the sensory nerves, but it is so small that no one would ever actually feel it. When the faint signal gets to the Dorsal Cochlear Nucleus, the nearby auditory nerves have mal-adaptively latched on and pick up the signal and send it to the auditory cortex so that a person now hears what their sensory nerves originally sent.

I don't understand b) as much, or the mechanism of the brain to suppress cardiac somatosounds.

The problem seems to lie solely in the brain though, most likely the DCN like they mention in their research.

In classic pulsatile tinnitus, a person can directly hear their blood flow as it goes near their cochlea, usually because the blood flow has become turbulent. All of the nerves and cochlea are functioning normally. A person with PT shouldn't be able to move their head, neck or jaw and stop it because you can't stop blood flow by moving around. In PT there is usually a physical abnormality in the vascular system (or a pregnant women in her second trimester). One test they can do to figure out if it is venous or arterial is to push on the jugular vein or carotid artery. If pushing on the jugular stops it then it's venous, if pushing on the carotid stops it then it's arterial.

Somatic means it can be changed by physical movement, which is common for all types of tinnitus. But it is rare to be able to suppress or eliminate tinnitus with movement. Usually physical movement makes it worse, if it makes it better then there is a much greater chance for the tinnitus to go away.

 

[Lindagb]

Hum.. this is all so much to try understanding. Mine clearly has a somatic component since I only hear it when my head is held in a certain position and not other times. If my head is turned I sometimes hear it when I start to yawn too.. I thought it stopped with pressure on the jugular but now I'm realizing that even if I'm not touching a vessel I can stop it just by lightly touching the muscle, behind my ear lobe etc. I had hoped my testing would have given a diagnosis but the fact that it didn't and my symptoms being so strange make me wonder if it could be something like this. It seems to be something compressing a vessel cause if I turn my head then pinch my neck with my left shoulder I hear a fast whooshing the right ear as if I've squirted the blood up and through to the other side. Its my assumption that its the same reason the head position is what causes the sound. Perhaps something not seen on testing is compressing a vessel, or causing a vessel to press the nerve in this position. Ugh

Mine started during pregnancy but never went away. It certainly sounds like blood flow to me... it's a whoosh sound that takes the form of woo woo, woo woo. The pitch varies as does the loudness. Most of the day it's the same tone of someone trying to make a shh sound... or close to that anyway. I never hear it if I plug my ear or plugged ears due to a cold. I can also hear my jaw on that side slide into position, it moves around as well if I press my cheek. It's all so strange, I just don't want to worry about a fistula.

 

[Pilot]

It is hard to understand, I'm sorry you are going through this. I think we are our own best doctors and that you will figure it out. I've been dealing with mine for 6 months and have spent a lot of time researching and trying to understand mine. I spent a lot of time researching somatic tinnitus, and a lot of time researching pulsatile. My symptoms have characteristics of both but didn't fit into either. When I read about somatic pulsatile tinnitus syndrome then everything made sense. I also had noise sensitivity and what's known as kindling and winding up effect which caused my ears to ring after being in a restaurant for an hour, or near a fan for several hours. That lasted 3 months and made it obvious that my problem was in my brain.

It sounds like you are talking about the sternocleidomastoid muscles (SCM). It is the muscle behind the ear lobe and is attached to the mastoid bone in that area. The right side would also be in play when turning your head left.

The SCM has been known to transmit sounds to the ear through the mastoid bone, I think it would normally happen if it is injured or has trigger points but who knows.

My left ear gets the loudest when I fully stretch my left (SCM), I stretch it looking up at the ceiling and trying to touch my right ear to my right shoulder. I can suppress sounds in my left ear by pushing on my lower right jaw, I think it is relieving something in my left TMJ. I have no TMJ discomfort though.

It's strange that you can't hear it if you plug your ears. If it was a fistula I would think it would be more constant.

Do you hear it in both ears?

 

[Lindagb]

Yes the sternocliedoidmastoid is the muscle I was talking about. I don't hear the sound if I stretch my neck up but I read that that causes tension on the vessels and can cause pulsatile tinnitus. Mine has to jet out of my neck therfore really straining for my sound to be audible to me which is the positions I described above. It's almost as if the muscle is so tight that it's squeezing a vessel or moving it closer to the ear but again, just guessing.

Your movement with your right ear to your right shoulder is exactly what I do to my left ear and left shoulder which causes a fast gush like sound in the right ear. It only lasts for a second though... Typically the PT I have even when in the position to allow me to hear it, only lasts seconds. Rarely will it last longer than 30 seconds while in that position but every time I straighten then go back to that position it does it again.

My PT is only in my right ear... well, I do on occasion get a different pulsatile sound in the left but that's only when I bend down quickly. It's a swish swish sound, higher pitched, quite and that I can hear with my ear plugged. I assumed that was intracranial pressure but IIH was ruled out so the assumption is that pregnancy and hormones from pregnancy are to blame for it. It's kind of strange though, if I press hard on what I know is my carotid when I hear that sound while bending, it will sometimes cause it to stop but makes my typical pt ear make its sound.

Have you seen anyone about TMJ? I saw a chiro about it since I hear sounds when I move it and I have a slight issue he said he did some kind of treatment for it but it hurt so bad doing it and for days after that I couldn't go for more.

My doctors don't believe I have a fistula since mine is subjective, not there unless I have my head just the right way, low pitched with a two beat sound and because I can't hear it if I plug my ears... all of which should be the opposite if it were a fistula. Plus they assured me that my images were very good. Even though they found a dilated vessel, there were no signs with that to make them think a fistula was to blame, I wish I could let that ease my mind especially since they did find a dilated emissary vein that's a known cause of it, but I know not everyone is textbook so anything is possible.

I too thought it made sense when I came across the somatic pulsatile tinnitus report. I nearly cried because it was so similar to my symptoms. All except for the high pitched part anyway. Reading about The two cases that paper describes regarding the patients that had intermittent PT but could elicit the pt with head movements made me want to jump for joy!

I am really starting to think my old chiro and the bad adjustment caused this in some way. I can not come to any more logical conclusion for mine other than thinking a vessel is being compressed. Why I can't hear it with my ear plugged is a mystery though.

 

[Pilot]

A dentist did a check for TMJ but didn't see any problems. I don't have any symptoms of it either.

Some doctors can listen around your ear with a stethoscope, maybe a doctor could listen near your ear while you do the maneuver that creates it.

Fun times.

 

[Lindagb]

My drs did attempt that, no luck.

 

[Karen]

I'll be interested to hear if any of you find a cause for your PT. It sounds like you've explored a lot of options already.

Mine is low-pitched, and sounds like a bass drum. No one else can hear mine, and I cannot change it at all by moving my jaw, or pressing on any spot around my ear or neck. It is continuous, and I hear it all the time. I also have loud tinnitus in the same ear (right).

I've been to several neurotologists in my area, and so far, no cause has been found.

Please keep us posted on your progress.

 

[Lindagb]

Have you been checked for a sigmoid sinus diverticulum Karen? A CT of the temporal bones will show that but it's pretty new and not many neurotologists have learned about them yet.

 

[Karen]

Hi, @Lindagb,

Yes, the very first neurotologist I went to ordered a CT scan of the temporal bone. Nothing was found, I'm afraid. I think that was what he was checking for, although I didn't know it at the time. I hadn't read up on this condition very much back then. Since then (6 years ago), I've certainly learned a lot about pulsatile tinnitus.

In my case, it started very suddenly, and probably had something to do with changes in blood pressure. I'm back to normal now, blood-pressure-wise, and am no longer on any blood pressure medication. However, I still have both tinnitus and pulsatile tinnitus. What a mysterious condition this is!

 

[Lous22]

Linda-

I chatted with you on this thread almost a year ago. And what are the odds... a Google search lead me right back here! I am so shocked when I read your posts because our symptoms are so similar. I too started hearing the pt in my other ear (the left). It's more of a light swishing sound and not the deep whooshing that I hear in my right. When I try to quiet the left ear by pushing the artery on that side it triggers the PT in my right ear so I can't tell if the noise in the left ear stops! The new sound in my left ear mainly happens after I stick my finger in it and itch it, although sometimes it happens randomly. I used to only hear the noise in my right ear when I turned my head, like you, but now I also hear it if lie in that side. I am beyond terrified that I have a fistula. I do have an enlarged artery or vein (can't remember) on that side of my head. One dr recommended an angiogram, another one didn't. So I just feel stuck. Part of me wants the test so I can know once and for all, but the other. Part of me is terrified. It's been almost two years, and I'm so tired of thinking I'll drop dead any second.

 

[lotte]

@Lindagb I have been following this thread for a while now and after my PT has acted up last night stumbled across it again. I am wondering how you are doing and if you ever got a LP?

My Pt is quite similar. When I bend my head left ear to left shoulder my right ear starts whooshing. I can make the whooshing louder by pressing on my right neck. It is like the strain on my right neck muscles compresses something that results in pt and pressing on the jugular causes even more turbulent blood flow. Anyway, I sometimes also get symptoms in my left ear but in different positions.
I have always felt that inflammation played a role, as in, my PT can be triggered more easily if my head feels inflamed. I almost can feel when my PT can be triggered. No headaches, had recently checked my eyes and all seems good there.

I also feel the pulse and it stops if I plug my ears.

Wondering if you got any answers?

 

[Lindagb]

I have not had any further testing done. It is still unchanged for the most part. When my heart rate is really high from exercise, it's not there. After the gym, it happens if I am talking and turn my head or swallowing as I turn my head etc... but it is still affected by turning to the left or straining my neck in some way. If I stand and hunch over to dig through a laundry basket or to turn on water in the tub or even to slurp up noodles when eating, it will set off the sound. I can do something with my neck where it allows me to hear the same sound one often hears when they yawn... when I do that somehow I'm messing with the tunes or drums in my ear and at times that seems to also allow me to hear the whooshing. I'm trying not to worry about it. Yours seems to be exactly like mine though.

 

[Ian Mc]

Linda, I also can't hear mine with my ear plugged with my finger...

 

[Lindagb]

No luck with mine. It's continued with very little change at least. I've lost 44 lbs and it still whooshed with head position. Some days there's no sound when I try to hear it. If I keep moving my neck in that way, it will come back. Some days it's easier and more frequent to deal with as well. This week for example, looking up over my shoulder triggered it. Standing up caused a different whoosh in my other ear. It's a similar type sound as in my problematic ear but it sounds different. I hear this when I occasionally tie my shoes. I'm leaning more toward the cause of mine being IIH because of this. It has to be a narrow vessel for me. Nothing else makes sense.

 

[Greg Sacramento]

@Lindagb Linda, you tagged me once in the past, sorry I didn't see your notification. I just read your posting history where you had radiological testing and ultrasound. You have also done considerable research with intelligent thought processing.

From all your provided information, everything including optic vision - sternocleidomastoids and carotid arteries probably can be excluded, except your vertebral arteries which are housed in the C spine. This would relate to all that you have discussed within your posting history. It very much appears that stenosis - not acute - has taken place from a neck alignment. This is quite common, even though chiro/therapy will not admit to it. Ultrasounds would not note vertebral artery trauma. A MRA or CAT would also have a difficult time in seeing sectional vertebral stenosis within the discs. The gold standard in vertebral artery imaging is digital subtraction angiography.

You don't seem to be symptomatic other than blood pressure. No abdominal aortic or heart problems. The carotid relates more to these problems, although when one vessels is affected, other arteries and veins can also, including heart and abdominal aortic. So it doesn't appear that you need cardiovascular risk factor modification. Symptomatic patients should at least be given an anti platelet agent.

The biggest restriction is forward head bending and bending down. We can talk more if you wish.

 

[Lindagb]

Hi Greg. Thanks for the reply. Reading it made sense and seemed to calm my anxiety a bit.
It's interesting that you mention the vertebral artery. Looking back, there was a mention of this on my reports. The notes for my MRA of the neck state, "mild irregularity of the horizontal portion of the left vertebral artery just below the level of the c2". It goes on to say this is normally a flow related artifact but that a slight direction can not be excluded.

Considering it's been 5 years though since this started, I'm unsure as to the significance of this however. I'd assume if this were the cause, it would have healed or caused more symptoms by now.
The fact that only certain movements that cause tension or strain on the sternoclidoid, causes the sound in my right ear, it does make sense that this is causing compression of some sort. I'm no longer convinced that when I apply pressure to the neck on the same side, that I am stopping flow through the jugular as it seems as long as I press anywhere along the muscle or manipulate the muscle with my hand, the sound halts.

Some days the sound in that position is a quick whoosh while other days, the sound easily lasts through 15 beats. It rarely ever lasts longer than that though even if my head position is maintained but always, always stops once my neck is back to a neutral position. Jaw movements if my head is turned and tipped down can trigger it, as can swallowing if I swallow at the same time as I turn my head left. Another strange one I noticed is if I'm leaning over a bowl of soup and slurp a noodle, that has triggered it too.

These triggers confuse me though.

My pt has kicked up over the last week or so. It's been more noticeable and easier to trigger. The other day while lying in bed with my head turned left, simply rubbing my cheek forward from my ear toward my nose cause the whoosh! That was new for sure. It stopped as soon as I let go of my cheek but did it again when the skin was pulled taught. The pt also seems to happen most frequently if I'm sitting down or slouching or balled up on my couch with my knees up to my chest,as opposed to sitting or standing up straight. My vision in my left eye has been bothering me as well. It's blurrier than normal despite my new eye glasses being 5 months old. I've also been feeling some dull headaches, and pressure behind my eyes (that is reminiscent of how they feel if I've been crying) the last few days which seems to be related to my pt triggers but perhaps that's a coincidence... This with the whooshing in the other ear on occasion, when I stand up and when I bend down have me wondering if they are related. (Is this the blood pressure issue you spoke of?).

I know there can be two different issues occurring here considering the sounds are different and have different triggers but I can help but wonder if one is causing the other.

I have been to a cardiologist due to palpitations the last few years. My echo and EKG were normal with the exception of one side of my heart being slightly larger than the other. The doctor wasn't concerned about my PT and the palpitations were within normal limits, my blood pressure readings are never more than 125/80 and I'm on no medications currently. My most recent appointment with my optometrist was just 5 months ago and he saw no signs of issues with my optic nerve... just very myopic. I haven't been back to an ophthalmologist since the initial appointment I had with them 4 years ago since it was all clear basically.

 

[Greg Sacramento]

@Lindagb Linda, I have posted many times about the sternocleidomastoids as reason and cause to many here - including neck bending. With your depth of knowledge I won't need to give SCM direct notation, pathway and branches per the carotid, eyes and over 60 other biological associations.

It's clear that you don't have heart or aortic associations and being female is another reason. I see the SCM as a receiver of trauma, but not cause of PT.

The SCM can relate to the jaw as well as the C1 - and is a player with your conditions. I would consider there is mechanical compression during head rotation due to muscular and tendinous insertions, but not noticeable osteophytes around the C1-C2 level. 50% of C spine rotation occurs around C1. Here is a quote from Araz Server et al (2018). Reduced blood flow in the ipsilateral vertebral artery when the head was both hyperextended and rotated. This is what causes pulsing, not muscles of the neck and this being symptomatic can be treated with meds.

SCMs rarely cause PT, but can cause somatic tinnitus along with facet joints, nerve fibers and other factors. You appear to have both, as with myself, so your SCMs have somatic involvement. I gave a complete list before, but it's needed to explain each cause in detail because there is additional flow charting to other intervening biology. It took me about a 100 posts to write all this out. Physical somatic tinnitus is not always difficult to figure out, but often pulsing tinnitus takes lots of though because it can associate to the abdominal, heart, neck arteries, thyroid, eyes, legs, shoulder, back and neck pain and about 120 other stuff. My neck has many age and life style degenerative conditions and diseases.

You do not have vertebral artery dissection (not acute). After rapid head turning you may have thrombosis and that may be contributing to your PT. In article: In particular, your chiropractic manipulation may has been implicated in a wide variety of vertebral artery abnormalities, including thrombosis. Physical therapy and movement exercises is not often a friend with PT.

Most of the time the carotid and subclavian involves PT when turning the neck with influence to the C1 and SCM. but for you not singular likely as an ultrasound did not pick up narrowing - reduced flow. Also your ECHO would not have been clean. As I mentioned above, the gold standard in vertebral artery imaging is digital subtraction angiography, however it's not commonly used because of risks.

My carotid is <50% blocked and both the carotid and vertebral arteries are causing my PT. I have heart and abdominal aortic problems. These problems can be caused from neck arteries and cranial nerves. My eye sight problem is being caused by both arteries by blood being pumped by my heart. So when my blood pressure rises due to a hyper event with neck twisting, my PT rises and my eye sight is affected - left retina detached. I had laser surgery and with meds, my eye sight is now about 50% resolved. Had many floaters and large spiders.

http://www.ajnr.org/content/ajnr/10/3/650.full.pdf

 

[lotte]

Hi @Lindagb
I am wondering how you were doing? My PT has recently changed a lot and it reminded me to check in here.
My PT used to be only triggered by neck movements but is now whooshing away (in both ears sometimes at the same time, sometimes alternating) as I lie in bed‍. I can feel it too, throbbing in my ear. Ive been thinking now that I will need to see a specialist for testing and wondering if you had any additional tests done since yours seems so similar to mine!
I hope you are well