Presentation
- 60 y-o auto dealer having had four neck surgeries to remove cancerous tumors and cysts
- Presents with left-sided tinnitus, the side where most of the surgical scars are
- Lymph nodes had been removed during surgery
- Left-sided ‘hissing’ rated at 10/10, and is accompanied by neck pain
- Symptoms ease with heat at night, ice in the morning, and sleeping on the left side
Evaluation, clinical reasoning & treatment strategizing
- Very asymmetrical face and neck surface anatomy
- The neck was very puffy
- Limited AROMs and PROMs, especially head rotation to the left, indicating a possible shortening of the left SCM in combination with the right obliquus capitis inferior. Lateral flexion was restricted bilaterally ++, indicating the scaleni and other lateral flexors
- Confesses that he drinks up to eight diet cokes per day at his stressful job
Treatment
- Trapezius and SCM were of initial interest, followed by semispinalis capitis, the splenii, deep head of masseter, digastric and MFR of the left ear
- All neck muscles were treated L > R
- Later treatments included extra-oral muscles, palatini muscles, and later the full intra-oral protocol, of which he is not fond
- Later, the gentler CRAFTA cranial manipulation protocol was employed
- An MLD therapist was recommended to reroute lymph drainage of the neck
Results and follow-up
- Within three treatments his weekday tinnitus had dropped to 5/10, then to 3/10, then at the 6 week mark 1-2/10.
- Interestingly, his tinnitus improved on weekends when he stayed at his lake house
- During the five treatment years he has seen me 52 times. Often he reports no symptoms
- He has been thoroughly evaluated by Dr. Hopkins a Personal Health MD, and co-treated with an acupuncturist knowledgeable in tinnitus