title: Chronic Cervicogenic Tinnitus Rapidly Resolved by Intermittent Use of Cervical Collar.
abstract: BACKGROUND
  Cervicogenic tinnitus is not a generally accepted pathogenetic subtype, which might be subsumed under the concept of somatosensory tinnitus. After the personal experience of therapy-resistant tinnitus in context with a cervical pain syndrome (CPS) and successful add-on treatment with cervical collar (CC), the idea was pursued in several individual treatments in patients.
  
  
  METHODS
  Reporting one particular case with chronic tinnitus, considered untreatable, that rapidly improved with exclusive treatment by CC use. Thereafter, tinnitus was experimentally replicated by head inclination, the respective neck-head angles, and cerebral blood flow was measured.
  
  
  RESULTS
  Chronic subjective tinnitus of a 20 years duration completely disappeared within 4 weeks with an intermittent short time application of CC. Thereafter, tinnitus was deliberately again induced by head inclination, set on with anterior tilt of 14°, reaching maximum strength by 23°. Tinnitus stopped with return to neutral head position. Blood flow in the vertebral arteries on both sides was unchanged during head inclination with prevalent tinnitus; however, blood flow was physiologically reduced with head rotation though not accompanied by tinnitus.
  
  
  CONCLUSIONS
  In a single case of chronic tinnitus, we found that treatment with CC rapidly led to full remission. Blood flow reduction in vertebral arteries was unrelated to tinnitus. However, tinnitus could be resumed by constrained head postures. Experimental tinnitus replication (by inclination) points to an underscored role of upper posterior cervical muscle groups, matching with animal experiments, also in concert with other triggers including psychological factors.
authors.affiliation: Clinic for Psychiatry and Psychotherapy II, BKH Günzburg, Ulm University , Günzburg , Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Bechter
authors.affiliation: HKM HandelsKontorMeindl GmbH Gundelfingen , Ichenhausen , Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wieland
authors.affiliation: Department of Neurology and Neurological Rehabilitation, BKH Günzburg , Günzburg , Germany.
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Hamann
keywords: cervical collar; cervicogenic headache; cervicogenic tinnitus; tinnitus mechanisms; tinnitus treatment