A recent study in German found significant differences for people experiencing somatosensory tinnitus when they received manual therapy of the neck and jaw. Before we talk about how specific upper cervical chiropractic care may be able to help people who experience tinnitus, there are a few keywords we should clarify.
Tinnitus. Specifically, we are referring here to somatosensory tinnitus, which is a persistent ringing in the ears/head that is brought about by abnormal nerve signaling in your body. This is different from neurodegenerative tinnitus (aka industrial deafness or tinnitus), which is caused by nerve damage and prolonged exposure to loud or industrial noises. Somatosensory tinnitus is like a type of radio static that occurs in the brain when sensory nerve signals from some part of your body (namely your neck and jaw) end up firing with the wrong neural network in your brain which ends up producing a persistent noise and/or dizziness. Thus, correcting the problem in the periphery (i.e., addressing the cause of the problem if it is in your jaw or neck), the idea is that it can help the tinnitus you experience.
Manipulation. The word literally means “by hand,” so we are referring to manual methods of healthcare such as massage, trigger point, physiotherapy, or chiropractic which do not use drugs or surgery. That said, I personally do not like this word because of its negative connotation (e.g., to manipulate someone). So while the word may be correct (and while we will use it for the purposes of this article), I would argue that a far better term would be physical therapy.
Tinnitus & Chiropractic Manipulations
So, back to the article now. What the researchers did for these people were a series of soft tissue manipulations (i.e., physical therapy) in order to stretch excessively tight muscles of the jaw and neck, and to strengthen weak muscles in other areas. What they found was that by improving the balance of the system that there were able to accomplish statistically significant changes in tinnitus.
Now, this is not exactly the same type of manipulation for tinnitus that chiropractic would typically use. The focus of chiropractic is on what is known as an adjustment or correction or vertebral alignment. So, how do we draw the connection? In brief, the key thing that a chiropractor asks themselves vs other forms of manipulation just for muscles is, “Why are the muscles tight in the first place?” Muscles don’t simply tighten on their own accord. They tighten because the structure, the function, or the neurology demands it.
What do we mean by that?
Let’s look first at structure and function. Let’s use a silly example that you only chew your food on the left side of your face (assume that you had a tooth extraction and can’t chew properly on your right side). As a consequence, your jaw muscles on the left side of your face become tighter due to overuse relative to the right side. This type of muscular imbalance may be just one example of what we are talking about.
Then let’s consider neurology. Muscles tighten in response to nerve signals. Therefore, if you have tight muscles - and let’s also assume that you’ve had massage or trigger point work but those muscles just tighten straight back up as soon as your session is over - it would suggest that there is actually an underlying nerve issue that is causing those muscles to be tight in the first place.
So, with the idea of how chiropractic works is by focusing on the joints because of their impact on the nerves and spinal cord. If the joints in your neck or jaw are not moving properly, they can send an abnormal cascade of nerve signals that cause the surrounding muscles to tighten. Therefore, but using chiropractic manipulation to get the neck and jaw moving properly, the idea is that they are able to reduce abnormal nerve function and reduce muscle tension, thereby also assisting with tinnitus.
Tinnitus after a Chiropractic Manipulation
Now, there are some people we have seen in our own practice who report experiencing tinnitus after a chiropractic neck manipulation. Certainly, we don’t like to hear of these cases.
(Personal aside - No one in the entire health or medical arena has it all figured out. We know lots, and there is still lots about the human body we don’t. Though we don’t always agree on the best choice of care, I do believe that as human beings first, we care about helping people by doing the best we can with the information we have at the time. So if/when anyone should EVER experience any type of unexpected or adverse event such as tinnitus following a chiropractic manipulation or any other therapy either (e.g., medications), I do not believe they would ever cause it, and that they actually feel sick to themselves if that has happened).
Nevertheless, when this happens, what it suggests is that there is some type of connection between those structures and the sensation of tinnitus. In other words, it is perhaps the exactly right area but in the wrong direction. For all the complexities of the human body (many of which are still beyond us), people may have any number of internal asymmetrical features that may cause their bodies to function in unexpected ways. As a result, what we may feel or detect with manipulation on the surface may not match what is actually occurring on the inside.
Again, it might be the right idea but in the wrong direction. OR even the right direction but the wrong sequence. Many people who experience tinnitus, frequently do require chiropractic manipulation to help them. However, if/when they may also have other conditions such as an underlying TMJ disorder, the neck condition might only be the tip of the iceberg. Therefore, even if it was a neck injury per se that brought about the tinnitus, it might require more than just chiropractic manipulation to resolve the underlying issue.
However, another possibility is that it may require a more precise method of care to bring things back under control. Here is where a different approach known as upper cervical specific chiropractic may be able to help people with tinnitus.
Upper Cervical Chiropractic and Tinnitus
Upper cervical specific refers to a general division of general chiropractic that focuses on the health and alignment of the upper neck, and its relationship with the nerve system in disorders such as tinnitus, dizziness, and vertigo (among many others). There are a few different methods of upper cervical chiropractic (including the NUCCA and Atlas Orthogonal Techniques), but the one that we use predominantly is known as the Blair Technique.
The Blair Technique, which was developed in the USA recognises that all human beings are structurally different on the outside and the inside. Thus, while our general features are pretty much the same, the subtle details including the size and orientation of the joints in our spine are different. Thus, what we may think is going on from the outside may not match what is actually happening on the inside.
So what a Blair upper cervical chiropractor does for people with tinnitus that is so different from general chiropractic manipulation is a series of customised diagnostic images that show the exact location, direction, and degree of vertebral alignment in your upper neck so that we know what the most appropriate vector for correction should be. By being as precise as possible, our focus is on restoring the normal alignment, motion, and stability over a period of time so that your nervous system is able to function the way it is supposed to. When that happens, the principle is that your body is able to heal the way it is designed.
References
Biesinger E, Reisshauer A, Mazurek B. [The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus]. [Article in German] HNO. 2008 Jul;56(7):673-7. doi: 10.1007/s00106-008-1721-2. https://www.ncbi.nlm.nih.gov/pubmed/18560742
Hölzl M, Behrmann R, Biesinger E, et al Selected ENT symptoms in functional disorders of the upper cervical spine and temporomandibular joints. HNO. 2019 Mar;67(Suppl 1):1-9. doi: 10.1007/s00106-019-0610-1. https://www.ncbi.nlm.nih.gov/pubmed/30742234
Michiels S, Van de Heyning P, Truijen S, et al. Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? Man Ther. 2016 Dec;26:125-131. doi: 10.1016/j.math.2016.08.005. Epub 2016 Aug 26. https://www.ncbi.nlm.nih.gov/pubmed/27592038
Ralli M, Altissimi G, Turchetta R, et al. Somatosensory Tinnitus: Correlation between Cranio-Cervico-Mandibular Disorder History and Somatic Modulation. Audiol Neurootol. 2016;21(6):372-382. doi: 10.1159/000452472. Epub 2017 Jan 19. https://www.ncbi.nlm.nih.gov/pubmed/28099967
Ralli M, Greco A, Turchetta R, et al. Somatosensory tinnitus: Current evidence and future perspectives. J Int Med Res. 2017 Jun;45(3):933-947. doi: 10.1177/0300060517707673. Epub 2017 May 28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536427/
Fobbe A, Bökel A, Lesinski-Schiedat A, Gutenbrunner C, Sturm C. Pilotstudie: manualmedizinische Methodenevaluation zur Modulierbarkeit des Leitsymptoms Tinnitus : Eine prospektive randomisierte Studie [Pilot study: evaluation of manual methods for modulating the cardinal symptom tinnitus : A prospective randomized study] [published online ahead of print, 2022 Aug 3]. HNO. 2022;10.1007/s00106-022-01198-2. doi:10.1007/s00106-022-01198-2. https://pubmed.ncbi.nlm.nih.gov/35920880/