Tinnitus 5: The Art Historian


  • 59 y-o New England historic society docent first experienced unilateral, left-sided tinnitus after spending a winter’s day at a lecture in a cold, smoky barn
  • She described shrugging her shoulders up to her ears for hours to stay warm
  • Went through the usual path of PCP (OTC, Zyrtec, Sudafed), Otolaryngologist (hearing test, negative), CT, MRI and MRA  were WNL
  • Prednisone, higher dose Prednisone, myringotomy (hole in the ear drum – same), P-Stim with an acupuncturist, TrP injections
  • She had telephone consults with the retired tinnitus expert Dr. Robert Levine formerly of Mass General Eye and Ear
  • Pulsatile in rhythm with the heartbeat, gets better when laying down, and when head leans to the right
  • Sometimes there is a pop, pop and sometimes there is ‘fullness’
  • Tinnitus disappears with yawning, mouth open wide
  • Came  to Myopain Solutions for myofascial work 7 months after onset

Evaluation, clinical reasoning & treatment strategizing

  • Assessment showed a scoliotic pattern of the spine and a right rotation of the upper body in the transverse plain
  • Cervical ROMs were reduced in lateral flexion ++ on the left, and + rotating left (tight left SCM, right OCI)
  • Symptoms changed or improved with isometric neck muscle RROMs
  • This finding encouraged me to believe she had somatosensory tinnitus
  • Because she got better with right lateral flexion I was led to believe I should work on the left-sided neck muscles that were being stretched out
  • She is right-handed


  • Initially, treatment was broad, addressing trapezius, levator scapula, left-sided OCI, Splenii, SCM and an introduction to the extra-oral muscles
  • Next, I added some work on digastric, myofascial mobilizations of the auditory meatus (ear), and MFR of the petrous cranial bone
  • RCL, deep neck flexors and scaleni to address the lateral flexion
  • I then included the intra-oral jaw muscles and the palatini muscles
  • Her improvements began almost straight away, to a point where she could “forget about it”
  • She was also getting TrP injections and P-Stim

 and follow-up

  • After a concentrated SCM on her third visit she reported a 1/10 the next day
  • The pulsing had ceased, but later she reported a high pitched constant ring
  • ROMs improved to WNL, and treatments became monthly for eighteen months
  • Homecare was big shrugs, ear tapping and neck stretching
  • She now sees me prn, mostly for other things