Tinnitus Newbie Desperate for Answers, Trying to Determine the Cause — From Cervical Injuries?

[IntotheBlue03]

Hello All,

Hope everyone is finding some sense of peace this evening and for the Holidays. I am new to tinnitus and had my onset on 12/14/2021 of moderate to severe tinnitus and needless to say, my holidays have been a nightmare between dealing with this crisis and trying to run from doctors appointment to doctors appointment right before the holidays.

I'm in the stage of heavily researching and learning everything I can and was curious if there are any other advanced tests (audio-wise or other) that you folks can recommend based on my case? I have the following:

• Bilateral Tonal Tinnitus (between 14 kHz-15 kHz roughly)
• No Hearing Loss based on 2 "normal" audiograms (not testing in High Frequency)
• Normal ENT exam
• Scheduling for a Brain MRI TBD

I don't know if it's even possible to continue a "process of elimination" to determine the cause of tinnitus but so far I am hoping the MRI will be able to rule out ear/nerve damage or inflammation as a cause.

In addition, I have cervical injuries based on MRIs and a Digital Motion X-ray I took the DAY of tinnitus onset (hoping it was due to cervical irritation from extreme movements for the X-ray). So I am leaning towards somatic tinnitus and hoping PRP/Prolotherapy can help (I've had 4 years of prolotherapy that took me from near disabled with severe chronic pain from cervical and thoracic injuries to minimal pain now). However, my upper cervical (C0-C2) was never treated due to lack of imaging availability with a digital motion X-ray.

Long story short if there are other tests that exist and someone could advise, I'd greatly appreciate it. I also am being tested technically for autoimmune conditions but that's honestly a stab in the dark with my ENT based on ear fullness and random bouts of ear pain I'm also experiencing. Is the OAE/ABR I keep reading about of any relevance?

Thank you all for your time as I'm sure you're familiar with the despair of some newbies like myself.

 

[IntotheBlue03]

Good evening @Greg Sacramento.

Was curious if you could lend your insight to my inquiry above. I am very impressed with your expertise and insight into somatic related tinnitus. I am curious about what further testing I should look into. Thanks kindly.

 

[tofurky]

I would be interested in hearing about what you might learn regarding PRP or Prolotherapy as a potential treatment option for tinnitus. Thanks!

 

[IntotheBlue03]

@tofurky, will absolutely keep you posted. I just had my lower cervical treated today and will have upper cervical treated in a month. It's a bit more risky but where a lot of my damage is.

 

[just1morething]

Hello All,

Hope everyone is finding some sense of peace this evening and for the Holidays. I am new to tinnitus and had my onset on 12/14/2021 of moderate to severe tinnitus and needless to say, my holidays have been a nightmare between dealing with this crisis and trying to run from doctors appointment to doctors appointment right before the holidays.

I'm in the stage of heavily researching and learning everything I can and was curious if there are any other advanced tests (audio-wise or other) that you folks can recommend based on my case? I have the following:

• Bilateral Tonal Tinnitus (between 14 kHz-15 kHz roughly)
• No Hearing Loss based on 2 "normal" audiograms (not testing in High Frequency)
• Normal ENT exam
• Scheduling for a Brain MRI TBD

I don't know if it's even possible to continue a "process of elimination" to determine the cause of tinnitus but so far I am hoping the MRI will be able to rule out ear/nerve damage or inflammation as a cause.

In addition, I have cervical injuries based on MRIs and a Digital Motion X-ray I took the DAY of tinnitus onset (hoping it was due to cervical irritation from extreme movements for the X-ray). So I am leaning towards somatic tinnitus and hoping PRP/Prolotherapy can help (I've had 4 years of prolotherapy that took me from near disabled with severe chronic pain from cervical and thoracic injuries to minimal pain now). However, my upper cervical (C0-C2) was never treated due to lack of imaging availability with a digital motion X-ray.

Long story short if there are other tests that exist and someone could advise, I'd greatly appreciate it. I also am being tested technically for autoimmune conditions but that's honestly a stab in the dark with my ENT based on ear fullness and random bouts of ear pain I'm also experiencing. Is the OAE/ABR I keep reading about of any relevance?

Thank you all for your time as I'm sure you're familiar with the despair of some newbies like myself.

I hope you can find relief, head noise is so annoying. I have a good day maybe once every 2 weeks. I have bone on bone in my left TMJ and some neck issues. Did you have your digital motion X-ray at Caring Medical? I've read that C2 issues can cross into your hearing causing tinnitus.

 

[IntotheBlue03]

Hi @just1morething, yes I'm struggling except for 3 tracks I've found on YouTube (one created by a member here for high frequency neuromodulation).

I'm sorry to hear about your neck and TMJ issues. I'm currently trying to schedule a TMJ MRI and having a hell of a time doing that lol.

I'm very familiar with Caring Medical but no I had my DMX in my area, I had been searching for awhile and a chiropractor offering it happened to pop up. I'm really hoping my cervical injuries are the cause as prolotherapy has helped me immensely in the past. This is honestly very PTSD for me because I went through severe chronic pain for a decade and had recovered with prolotherapy as of 2020. Tinnitus is another layer of hell I didn't know existed.

 

[just1morething]

Hi @IntotheBlue03, Sorry you have so many body issues at your young age. I'm about a generation older than you. I was trying to scan my TMJ MRI done at The Piper Clinic in Florida in April 2021 and post it here. That could be the cause of my noise or inner ear damage from a 2008 airplane barotrauma. I have an annoying hiss today in my left ear today. I had a neck fusion C5-C7 in 2016. Unfortunately I had complications with a hematoma.

I had to be flown by helicopter to my surgeon as I could barely breathe and my local hospital didn't want to deal with it. I don't think it fused properly and may have to be redone. I also have back and feet issues but my tinnitus bothers me the most by far. My toes were stinging last night bad though and I took Lyrica. I think it's coming from my lower back.

 

[IntotheBlue03]

Hi All,

Tagging a few folks I've seen across different threads and in regard to this antidepressant. I'm over 3 weeks in with bilateral high frequency (15 kHz like an old CRT tv) tinnitus and today I just hit my breaking point. I have a prescription filled for low dose 10 mg Nortriptyline and am looking to start it tonight just for the sleep relief (the tinnitus is severe and has completely upended my entire life, luckily I have been off from work during this time but I have been averaging an hour or 2 of fractured sleep a night since onset).

I was already a very high anxiety person prior to the onset of tinnitus so this has greatly exacerbated things, I'm curious if anyone can chime in on their experience particularly if you have "head tinnitus" and anxiety as opposed to depression.

I've gone down the rabbit hole on threads, studies and forums as I'm worried about making my tinnitus worse or other unintended side effects (I have panic attacks on Marijuana and have never been one for any drugs recreationally or medicinally aside from CBD) but am hoping since this is a low dose it can serve as a sleep aid and a bit of anxiety reliever to cope with these early stages while I attempt treatments in the form of prolotherapy/PRP for what I believe is upper cervical instability induced tinnitus and maybe even TRT which I have an appointment set for tomorrow.

In addition, if anyone can advise as to how long the drug takes to show effect if any I'd appreciate it. Different threads seem to refer to 3-4 weeks.

I appreciate you all.

@Stacken77, @DebInAustralia, @glynis, @Michael Leigh, @Lukee, @kingsfan.

 

[ZFire]

Hi All,

Tagging a few folks I've seen across different threads and in regard to this antidepressant. I'm over 3 weeks in with bilateral high frequency (15 kHz like an old CRT tv) tinnitus and today I just hit my breaking point. I have a prescription filled for low dose 10 mg Nortriptyline and am looking to start it tonight just for the sleep relief (the tinnitus is severe and has completely upended my entire life, luckily I have been off from work during this time but I have been averaging an hour or 2 of fractured sleep a night since onset).

I was already a very high anxiety person prior to the onset of tinnitus so this has greatly exacerbated things, I'm curious if anyone can chime in on their experience particularly if you have "head tinnitus" and anxiety as opposed to depression.

I've gone down the rabbit hole on threads, studies and forums as I'm worried about making my tinnitus worse or other unintended side effects (I have panic attacks on Marijuana and have never been one for any drugs recreationally or medicinally aside from CBD) but am hoping since this is a low dose it can serve as a sleep aid and a bit of anxiety reliever to cope with these early stages while I attempt treatments in the form of prolotherapy/PRP for what I believe is upper cervical instability induced tinnitus and maybe even TRT which I have an appointment set for tomorrow.

In addition, if anyone can advise as to how long the drug takes to show effect if any I'd appreciate it. Different threads seem to refer to 3-4 weeks.

I appreciate you all.

@Stacken77, @DebInAustralia, @glynis, @Michael Leigh, @Lukee, @kingsfan.

Hi

I started Nortriptyline at 25 mg and moved up to 50mg in a span of a month and half . One of the negatives I guess with nortriptyline is that it does indeed take a while to start working. In my case, It took about 5 to 6 weeks to start noticing significant improvements in anxiety and depression. Not as quick as modern SSRIs, but still effective once it kicks in. For neuropathic pain like migraines, it quickly worked for me. No effect on my tinnitus. Nortriptyline helps me stay asleep.

 

[IntotheBlue03]

Excellent, thank you @ZFire! Does it make you feel out of it at all? I read people feeling like they're in a "zombie" state if they get less than 6 hours of sleep. Glad to hear no spike in tinnitus for you at least. Do you feel like it helps you deal with the anxiety that comes along with tinnitus?

Also, does the sleep aid portion of it work on day 1 or does that also take time?

 

[Michael Leigh]

In addition, if anyone can advise as to how long the drug takes to show effect if any I'd appreciate it. Different threads seem to refer to 3-4 weeks.

Hi @IntotheBlue03.

Tinnitus can be very stressful in the early stages which you are in. An antidepressant can help to prevent a person from becoming too down. Stress makes tinnitus worse and tinnitus makes stress worse, so it can become a vicious cycle. Since your doctor has prescribed you an antidepressant my advice is to take it. It can take up to 6 weeks to reach full effect.

I believe is upper cervical instability induced tinnitus and maybe even TRT which I have an appointment set for tomorrow.

I think it is too soon for you to be starting a long term treatment such as TRT or CBT, although some light not too in depth counselling will probably help. You need to give yourself time to get used to the tinnitus. Are you sure the tinnitus is caused by cervical? If you were a regular user of any type of headphones including earbuds or headsets, your tinnitus could be noise induced, especially if you are oversensitive to sound, which could indicate hyperacusis. This is one of the most common causes of tinnitus.

My advice is to keep far away from all forms of recreational drugs.

I wish you well,
Michael

 

[ZFire]

Does it make you feel out of it at all? I read people feeling like they're in a "zombie" state if they get less than 6 hours of sleep

Not really. There are times where I feel quite drowsy during the day, but not often.

Do you feel like it helps you deal with the anxiety that comes along with tinnitus?

I think it does. I don't panic much anymore when I feel like the tinnitus is becoming distressful. Right now, I'm currently in a spike, but this time I'm handling it way better than before with a sense of optimism.

Also, does the sleep aid portion of it work on day 1 or does that also take time?

If my memory serves me right, I do recall my sleep being improved during the 2nd week after starting Nortriptyline. I knew my sleep was getting better by then because I was finding it much more easier to fall back to sleep if I ever woke up in the middle of the night. Compare to pre Nortriptyline with tinnitus distress, if I woke up in the middle of the night, It would be almost impossible for me to get back to sleep.

 

[IntotheBlue03]

Hi @Michael Leigh,

Thank you for all the valuable feedback. I believe and hope my tinnitus is cervical related due to the fact that I have upper cervical and lower cervical spinal injuries. There's extensive information on this, for example, if you follow regenerative medicine like PRP or Prolotherapy. I did Prolotherapy for 5 years to other areas of my spine and recovered 80% of functionality as I was very previously close to being disabled from lumbar, thoracic and cervical injuries. However, during this time period I did not treat my upper cervical, and my tinnitus, which has been intermittent for the past 5 years also coincided with other autonomic, digestive and visual disturbances.

My tinnitus is also somatic in nature, changing pitch and volume with jaw clenching and other neck movements like cervical rotation, etc. I am having my first upper cervical PRP treatment on Monday so we will see the results in 1-2 months.

Lastly and I do not recall if I posted this in my original thread, but the tinnitus became chronic the day I performed a digital motion X-ray with exaggerated movements that I never do. Of course correlation is not causation but have to keep this in mind moving forward.

Please see the following for reference if interested:

 

[Greg Sacramento]

Was curious if you could lend your insight to my inquiry above. I am very impressed with your expertise and insight into somatic related tinnitus. I am curious about what further testing I should look into. Thanks kindly.

Sorry I missed your tag.

Bilateral Tonal Tinnitus (between 14 kHz-15 kHz roughly) No Hearing Loss based on 2 "normal" audiograms (not testing in High Frequency)

DCN input from several CNS loci, including the somatosensory system of the head and upper neck.

ENT based on ear fullness and random bouts of ear pain

I have cervical injuries based on MRIs and a Digital Motion X-ray I took the DAY of tinnitus onset (hoping it was due to cervical irritation from extreme movements for the X-ray).

From all I quoted above, it does appear that your sternocleidomastoid muscles have involvement, but can't say more without seeing notes from Digital Motion X-ray. MRI should be helpful.

Try warm compress on sides of neck for a few minutes whatever you have periods of bending your head forward. If this helps, even slighty, then most likely your SCMs were tight.

 

[Michael Leigh]

believe and hope my tinnitus is cervical related due to the fact that I have upper cervical and lower cervical spinal injuries.

Thank you for submitting the videos @IntotheBlue03. If you were not a regular user of headphones and not exposed to loud noise, then your tinnitus is unlikely to be noise induced. However, you have mentioned being oversensitive to sound and usually (but not always) this is an indication of noise induced tinnitus.

Take care,
Michael

 

[IntotheBlue03]

Hi @Michael Leigh,

Thanks again for the feedback I have been a user of headphones quite a bit so I am keeping this factor in mind as well, other than that there was no loud noise event during the day of onset.

I'm actually curious as to how tinnitus could be intermittent for so long if it's noise induced? I've experienced this on and off for the past 5 years so logically to me it doesn't make sense that I could have fluctuating hearing loss across that span of time but maybe you can fill me in on any medical background I'm missing when it comes to noise induced hearing loss.

In addition, I've noticed also the hyperacusis and ear fullness varies depending on my neck position. I have been very concerned that this could be AEID but so far I do not have sudden SNHL of any kind and did not respond to a low dose course of Prednisone.

 

[IntotheBlue03]

Hi @Greg Sacramento,

Thank you so kindly for your valuable input and time. I'm including my Cervical DMX Report and most recent Cervical MRI Report in case you'd like to provide further insight.

You are 100% correct about my SCMs and a number of other neck/shoulder muscles that have been actively overrecruited during this period and identified by both acupuncturists and the chiropractor that performed the DMX. I do recall an increase in neck pain prior to the DMX which prompted me to locate the facility.

Again I am more than thrilled that you have taken the time to review my post and thank you. One additional question I had for you as I can't recall where I had seen it but I believe another user mentioned that they had some white floaters or flashes in the eye that you advised could be due to some artery impingement? I believe they had an upper cervical issue but I am experiencing something similar and I am most curious about your opinion on this.

 

[Matchbox]

I'd be very surprised if it were AIED.

 

[Greg Sacramento]

Much in radiological notes @IntotheBlue03 could indicate somatic issues from cervical straightening caused from muscle spasms.

Posture history of bending head forward/down and then a single incident of twisting neck or lifting head from a backward surface may be physical cause. I have all your issues - my camel's back was broken from lifting my head off a dental headrest.

Most likely non concerning is having floaters from non pulsatile blood pressure change within arteries. For you, most likely caused from twisting neck and shoulders while both emotionally and physically tense.

70% of those with pulsatile tinnitus also have other forms of tinnitus. This gets very involved, but blood pressure changes from stress can cause vein, artery and organ concerns. High blood pressure can also cause arteriosclerosis.

Muscle pressure to C-spine will need treatment along with very gentle treatment of tilt of C1-C2. Very important is to address alar and accessory ligaments with lateral overhang of C1 on C2 - see views #8 and #9.

Warm moist compresses on neck and under brain stem without applying too much pressure is needed.

Liquid Glycinate Magnesium is needed. Use a small amount 3-6 times a day with no more than 400 mg total a day. Taking a tablet once or twice a day would not help.

 

[IntotheBlue03]

@Matchbox, I hope you're right and would love to hear your thoughts. It's now been a month with random attacks of ear fullness and definite inflammation bilaterally so I'm on edge as I question whether to do another round of high dose Prednisone or if I'll wake up with SSHL at any given point.

Any rational thought to bring me back from the brink is welcome.

 

[IntotheBlue03]

@tofurky, thought I would share the following videos with you that are very informative on PRP/Prolotherapy when it comes to tinnitus and related illnesses:

 

[Greg Sacramento]

@IntotheBlue03, I addressed a member of my former team and agreement per tinnitus may be (80%) alar and accessory ligaments with lateral overhang of C1 on C2 - views #8 and #9.

Alar ligament damage can take up to 2 years for complete healing.

Mentions of C4 -C7 unlikely cause that is also discussed in #9 and MRI as you don't have spurs or rupure disks.

Prolotherapy, PRP, or stem cells may only provide either temporary or small amounts of relief, but may be worth a try with a 25 gauge needle at atlantoaxial.

When you get up in the morning, try to use good head posture for at least one hour. Easy does it with head posture after getting up. Bad head posture after getting up may pressure your vertebral artery. Bad head posture can also cause ear fullness.

Use magnesium in the way that I discussed and also use a warm moist compress on neck without pressure and also focus on high end of back of neck.

 

[Greg Sacramento]

@IntotheBlue03, for your piece of mind, I should say that overall your MRI notes show less concerns than your DMX notes. That's very obvious.

Your MRI notes should be accurate, but contrast would show better needed detail.

MRI notes a straightening of cervical spine, but not much truama noted with that. Your C1 may be a questionable area. Not sure about trust with that - with DMX. If DMX C1 notes are truthful, then that could be a tinnitus issue.

We never trusted studies ordered and read by a chiropractic.

 

[IntotheBlue03]

Hi @Greg Sacramento,

Thank you so kindly for the additional valuable insight from you and your former colleague. I concur regarding the credibility of the chiropractor's report and had my Prolotherapist review the actual DMX video as well.

Curious why you feel I may not obtain much improvement from PRP/Stem cells/Prolotherapy? I'm aware that the upper cervical can technically only be treated posteriorly so I am hoping to gain enough improvement from posterior ligament treatments so I can avoid a PICL with Regenexx in Colorado which could treat the Alar & accessory ligaments but it's much riskier.

Will absolutely take your advice on posture, Magnesium and the warm compresses. Do you know of any weighted posture device I could use to try and restore my cervical curve?

Lastly if you have time, curious as to how the C1/Alar/Accessory ligaments can cause tinnitus in your opinion?

This is all great info. I cannot thank you enough!

 

[Greg Sacramento]

@IntotheBlue03, several times in the last two days, I thought about posting the Regenexx article as it's informative, but like you, we question the treatment.

From article:

"In the case of the alar and transverse ligaments, the former type of ligament injury is much more common. This means that the upper neck bones become unstable and move around too much. Just like other areas of the spine, when this happens the facet joints (in this case C0–C1 and C1–C2) can be beat up by that movement, leading to arthritis. The muscles and tendons that should stabilize this area become overwhelmed and injured. Finally the nerves can become irritated."​

This can easily cause tinnitus as the C1 vertebra is so close to the ears.

Any of this can also cause tinnitus instantly from lifting and turning neck against resistance where muscle spasms pressure the C-spine: Nerves, occipitals, ligaments, tendons, facet joints, soft tissue. Your MRI, other than straightening of C-spine is near remarkable. It doesn't appear there's too much of a tinnutis concern below C1 - a trapped nerve or a tear in a muscle such as a SCM. Arteries for you are doubtful. (quote from radiologist) 20-25% chance other than alar ligaments as (your) cause of tinnitus.

(I've had 4 years of prolotherapy that took me from near disabled with severe chronic pain from cervical and thoracic injuries to minimal pain now). However, my upper cervical (C0-C2) was never treated due to lack of imaging availability with a digital motion X-ray.

I quoted this in a post above from article, but since you had success with prolotherapy, I go for it @ C0-C1. It's worth a try. If this doesn't work, consider a nerve study.

Prolotherapy, PRP, or stem cells may only provide either temporary or small amounts of relief

alar ligament treatment (regenexx.com)

Do you know of any weighted posture device I could use to try and restore my cervical curve?

Not sure to what degree of straightening. It may be risky to try treatment at this time for this. Many have C spine/neck problems, but most don't get tinnitus, unless there's sudden impact.

Will absolutely take your advice on posture

Like this.

Stay in touch.

 

[IntotheBlue03]

Hi All,

Just updating my original thread for documentation purposes. 2-3 days of high dose Prednisone (60 mg) took my 9/10 central tinnitus to a 2/10 after 5 weeks of no relief. It also reduced the accompanying hyperacusis. Unfortunately I feel now that I'm tapering off that's starting to increase but I'm interested in doubling up on anti-inflammatory supplements and the fantastic Greg Sacramento's recommendations to see what happens.

What was interesting is I did labwork both for my CRP and TNF-a in the past couple of weeks and they were both very low/within normal limits (CRP was high during tinnitus onset) but it's clear to me I must still have an inflammatory issue after responding to high dose Prednisone so well. In addition, I believe this is further evidence that my somatic tinnitus is indeed neuromuscular related and hopefully not sensorineural related (I have also had a third audiogram, Tympanometry and OAE done all last week prior to Prednisone dosing with again normal scores).

After this course I will double up and document my original thread.

 

[IntotheBlue03]

Hi @Greg Sacramento,

Hope you are faring well and doing better this week and I hate to trouble you again but I just obtained my most recent cervical MRI. Curious if this changes your opinion regarding whether my tinnitus is stemming from upper cervical or lower cervical and if maybe I should consult an IR. Always appreciate your valuable insight!

 

[Greg Sacramento]

I should consult an IR.

Yes - within a highly qualified state university medical system with expertise in cervical causes of tinnitus. Not sure if Caring Medical can help you. Additional imaging may be needed.

Cause is probably from what we discuss - C1 - or from mentions in MRI IMPRESSION.
IMPRESSION #1 is technical cause - (a specialist may ask about your cervical history per therapy treatment, dental history, injuries, posture habits and history of sensitivity to sound.

Also, thought as to Motion X Rays causing impingement.

Look for the word impinges in IMPRESSION #2, #3 and #4. Each one can cause tinnitus.

Alar ligament damage most always causes tinnitus.

When cause is determined - a treatment should really help.

Stay in touch.

 

[IntotheBlue03]

Hi All,

Adding normal Acoustic Reflex Test and normal Auditory Brain Stem Response Test in my process of elimination and case building for cervical somatic tinnitus.

 

[Greg Sacramento]

@IntotheBlue03, according to MRI notations, you have ventral thecal sac impingement at C3-C4 and C4-C5.

How to Treat Thecal Sac Impingement: A Comprehensive Guide (quantumbooks.com)

"This sac is filled with cerebrospinal fluid. It helps protect the nerve tissues and it also holds spinal fluid. This fluid is one of the most important parts of our body because it helps us in various ways. When a person suffers from thecal sac impingement, the spinal fluid doesn't have a normal flow which can lead to pain, tinnitus, and headaches."

Research more on ventral thecal sac impingement of the cervical spine with tinnitus. There are many conservative treatments. I recommend seeing a cervical IR before letting any therapist touch your neck.

The other concern noted in Motion X-rays is alar ligaments with comparison to titling C1.

Tinnitus with ventral thecal sac impingement usually is not as loud as an alar ligament tear with a tilting C1, but it can be. With this, occipital nerve excitement can add to somatic element. This can be tested by laying on back with head to pillow to see if tinnitus temporary increases.