Question
I have ringing in my left ear. It started about 10 weeks ago. No trauma or accident occurred to the ear. The ringing is adversely affected when there is any pulling away from the ear involving the muscles from my ear to my shoulder. This causes the ringing to increase in frequency and intensity. Two chiropractic visits aggravated the condition and it took over a day to recover from each. One visit had my head being pulled slightly and the other  a device was used to thump the left side of my neck. The thump was like turning on a switch, immediate frequency increase in the ringing. An oral surgeon recommended visiting a LMT. My LMT visits have helped some and the LMT's current recommendation is to have the lateral pterygoid muscle injected, to release it as it is constricted and will not release. Any thoughts on this matter?


Answer
Hi John,

Thanks for your question.

Sometimes, spinal manipulation (or any manual therapy approach such as massage therapy, physical therapy, or acupuncture) may helpful for symptoms that involve ringing in the ears (called tinnitus), if the cause is musculoskeletal.

However, there are many causes of tinnitus, including age-related changes to the bones and nerve supply of the inner and middle ear, viral and bacterial infections, side-effects of medications (including aspirin), problems with blood vessels and high blood pressure, excessive wax build-up in the ear, temperomandibular joint (TMJ) dysfunction, grinding and clenching of the teeth during sleep (bruxism), neurological problems, and on and on. (For a detailed medical discussion of tinnitus, including diagnosis and medical treatment, see this article: http://emedicine.medscape.com/article/856916-overview).

If you have experienced a worsening of symptoms following spinal manipulation, I agree that ceasing spinal manipulation is a good idea. Soft tissue therapy, whether performed by a chiropractor skilled in soft tissue therapy techniques or a licensed massage therapist, may also be a good idea, but you really should have a thorough medical evaluation by a otolaryngologist (an ENT doctor) to rule out any underlying medical pathology that may be causing your symptoms, especially if your symptoms persist or even worsen with conservative therapy approaches.

Regarding trigger point injections, they can be very helpful indeed if the trigger points in the taught and tense musculature are the cause of the tinnitus. The muscles of chewing, closing, and opening of the mouth (the masseter, temporalis, lateral and medial pterygoids), and the muscles of the front of the neck responsible for forward neck bending and rotating the neck to the opposite side (the sternocleidomastoid and anterior scalene). Success of trigger point injections depends on large measure upon the skill of the practitioner. The mechanical action of the trigger point actually penetrating the trigger point helps to physically disrupt the muscular nodule, and the anesthetic in the injection essentially kills the pain immediately.

You might even be able to work out some of the trigger points yourself as an adjunct to other therapeutic approaches (for a great explanation on how to do this, I highly recommend The Trigger Point Therapy Workbook by Clair Davies, New Harbinger Publications). This type of self-treatment might not be the cure-all for the problem, but might help if there are trigger points in tight and tender muscles that are contributing to the problem secondarily, rather than being a primary cause of the problem.

Finally, try to be patient as you go through the process of determining the cause of your tinnitus. Tinnitus can be a very frustrating problem for both the doctor or practitioner as well as the patient to try to correct or even ameliorate, because it can be a complex problems with wide and varied causes. Many times, a patient suffering from tinnitus goes through a lengthy trial and error period until by chance, process of elimination, or the good deductive reasoning of the practitioner an appropriate solution is found.

I hope that this helps to answer your question. Please feel free to contact me again to let me know how you have fared with finding the best treatment for this problem. I'd be very interested in knowing how you did. Best of luck.