title: Improving tinnitus with mechanical treatment of the cervical spine and jaw.
abstract: BACKGROUND
  Tinnitus affects approximately 30-50 million Americans. In approximately 0.5-1.0% of the population, tinnitus has a moderate to severe impact on their quality of life. Musculature and joint pathologies of the head and neck are frequently associated with tinnitus and have been hypothesized to play a contributing role in its etiology. However, specific physical therapy interventions to assist in improving tinnitus have not yet been reported.
  
  
  OBJECTIVE
  To describe the examination and treatment intervention of a patient with subjective tinnitus.
  
  
  METHODS
  The patient was a 42-yr-old male experiencing intermittent bilateral tinnitus, headaches, blurred vision, and neck tightness. His occupation required long-term positioning into neck protraction. Examination found limitations in cervical extension, bilateral rotation, and side bending. Asymmetry was also noted with temporomandibular joint (TMJ) movements. Upon initial evaluation the patient demonstrated functional, physical, and emotional deficits per neck, headache, and dizziness self-report scales and a score on the Tinnitus Handicap Inventory (THI) of 62. Resisted muscle contractions of the cervical spine in flexion, extension, and rotation increased his tinnitus.
  
  
  METHODS
  Treatment focused on normalizing cervical spine mobility through repetitive movements, joint mobilization, and soft tissue massage.
  
  
  RESULTS
  At 2.5 mo, the patient demonstrated a complete reversal of his tinnitus after 10 physical therapy sessions as noted by his score of 0 on the THI upon discharge. He also demonstrated objective improvements in his cervical motion. This case reflected treatment targeted at cervical and TMJ impairments and notable improvements to tinnitus. Future studies should further explore the direct and indirect treatment of tinnitus by physical therapists through clinical trials.
authors.affiliation: Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Kay
authors.initials: K
authors.lastname: Cherian
authors.forename: Neil
authors.initials: N
authors.lastname: Cherian
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.forename: James A
authors.initials: JA
authors.lastname: Kaltenbach
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology*; D003939:Diagnostic Techniques, Otological; D004244:Dizziness / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006261:Headache / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007568:Jaw / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008405:Massage / Q000379:methods; D026201:Musculoskeletal Manipulations / Q000379:methods*; D063806:Myalgia / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D019547:Neck Pain / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D053591:Referred Pain / Q000628:therapy; D011187:Posture / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D014012:Tinnitus / Q000150:complications / Q000503:physiopathology / Q000628:therapy*