Hearing ringing in silence. Clinical case

Hearing ringing in silence

Boy, 24 years old. Complaints of hearing ringing sound in silence in the ears, more on the left side, numbness of the right side of the body from foot to ear. The ringing has been bothering him for more than half a year. In addition, after carrying firewood in basement with low ceiling in position with neck bent, the entire right side of the body began to be numb. At the time of his visit to me, he is undergoing treatment at the neurologist, the numbness has remained only in the right ear and in the fingers and toes of the right hand and foot.

Objective examination: tilting head forward with flexion in the neck causes intensification of tinnitus and tugging pain in the cervico-thoracic junction, more on the right side. Turning to the left causes increased tinnitus in the left ear, much less than in the right.
Nerve tension tests are positive, SLUMP test causes the appearance of a pulling sensation in the cervicothoracic junction. Mobility of the brachial plexus nerves on the right is less than on the left. On palpation a slight soreness of the muscles of the inferior thoracic and upper thoracic regions is noted.

Diagnosis: tinnitus of cervical origin, cervicogenic tinnitus of low intensity, bothers only in silence. Plus, consequences of traumatic disturbance of nerve tissue mobility in the area of the cervicothoracic junction. Overload by long, uncomfortable position of maximum flexion with additional burden in the hands.

Treatment: neurodynamic sliding techniques for improvement of nerve tissue mobility, mobilization of facet joints of the cervical spine until painfulness disappears, mobilization of the upper neck eliminates tinnitus when bending forward and turning to the left.

Results: gradual disappearance of symptoms after two months, 1-2 sessions a week. The quickest result was complete painless movement in the cervical spine. Then numbness disappeared (the patient's responsibility and regular exercises at home helped a lot here). Tinnitus stayed the longest, its intensity decreased noticeably (it stopped disturbing sleeping), stopped intensifying when bending forward. I still work with ringing in a slight sense when I turn to the left (after session this symptom disappears completely, but then comes back in a small amount). Some background noise remains, which is noticed if he pay attention to it.

Ringing sound when silent. Conclusions.

Extremely interesting case because of its complexity. Simultaneous presence of tinnitus and transient disturbance of nerve conduction and painful restrictions of mobility in the cervical spine. Accordingly, the situations and methods of treatment were chosen to be so different.
This case also illustrates the possibility of cervical tinnitus of mechanical origin (ringing sound intensity varied with neck movements) and its treatment with suitable methods.
Also, we would like to note the gentleness, smoothness and correspondingly safety of the chosen methods. No high-speed manipulations of the bony type were used at all. Everything was done by other methods with the minimum necessary force.