There are studies suggesting that functional disorders of the upper cervical spine may play a role in the development of ear-related symptoms such as tinnitus, vertigo, otalgia (ear pain), aural fullness, and certain hearing disturbances. In particular, neurophysiological interactions between the upper cervical spine and the auditory and vestibular systems are considered an important mechanism for explaining ear symptoms of cervical origin (Hülse, 1994; Bousema et al., 2018).
Therefore, particularly in individuals experiencing neck pain, restricted neck mobility, or ear symptoms that change with neck movements, assessment of the cervical spine, in addition to the ear structures themselves, may be an important component of the overall treatment approach.
How Does the Connection Between Hearing and the Neck Work?
Medical research has particularly focused on somatosensory and neurological interactions to explain how functional disorders in the cervical region may influence the auditory and vestibular systems.
1. Somatosensory and Neurological Interaction
The upper cervical spine, muscles, joints, and surrounding tissues provide a substantial amount of sensory input to the central nervous system. These sensory inputs can interact with the auditory and vestibular systems.
Particularly in tinnitus, the fact that movements of the neck or jaw can change the intensity or character of tinnitus is an important feature of a condition referred to as somatosensory tinnitus. Somatosensory inputs arising from the cervical spine have been shown to have modulatory effects on the auditory system (Bousema et al., 2018).
Because of this relationship, treatment of mechanical and functional problems originating in the cervical region may contribute to a reduction in tinnitus and other ear-related symptoms in appropriately selected patients.
2. The Cervical Spine and Changes in Hearing
The relationship between the upper cervical spine and hearing has also been investigated in previous clinical studies.
In a study published by Hülse in 1994, 259 patients with significant functional disorders of the upper cervical spine and symptoms of cervicogenic vertigo were evaluated. Subjective hearing disturbances were reported in 15% of the patients, while hearing threshold changes of 5–25 dB, particularly at low frequencies, were reported in 40% of the patients.
In addition, pre- and post-treatment assessments of 62 patients with vertebrogenic hearing disorders demonstrated improvements in audiometric and otoacoustic emission measurements. The researcher reported that these auditory disturbances could be reversible (Hülse, 1994).
What Do Clinical Studies and Treatment Outcomes Show?
Improvement in Low-Frequency Hearing Changes
Hülse’s study is one of the important clinical investigations examining the relationship between upper cervical spine dysfunction and the auditory system.
The study reported improvements in audiometric assessments following chiropractic treatment in patients with hearing disturbances associated with the upper cervical region. In particular, changes in low-frequency hearing were reported to be reversible following treatment (Hülse, 1994).
Randomized Controlled Trial in Sudden Hearing Loss
A randomized controlled trial published in 2015 divided 90 patients with cervicogenic sudden hearing loss into two groups.
The control group received routine medical treatment, while the other group received 10 days of chiropractic treatment in addition to routine treatment. The chiropractic treatment included local muscle relaxation techniques, trigger-point treatment, and bilateral traction techniques directed at the atlantoaxial joint.
Following treatment, improvements in hearing and neck pain were observed in both groups. However, the group receiving additional chiropractic treatment demonstrated statistically significantly better outcomes in hearing and neck pain compared with the control group (Zhou et al., 2015).
This study suggests that manual therapy directed at the cervical region may provide additional benefits alongside standard treatment in cases of sudden hearing loss considered to be of cervical origin.
Meniere’s Disease and the Cervical Spine
The relationship between the cervical spine and ear symptoms is not limited to hearing loss.
In a study conducted by Bjorne and Agerberg, 24 patients diagnosed with Meniere’s disease were followed for three years, and the outcomes of coordinated treatment directed at the temporomandibular region and cervical spine were evaluated.
Following treatment, significant and long-lasting reductions were reported in symptoms including vertigo, dizziness, tinnitus, aural fullness, neck and shoulder pain, and headache (Bjorne & Agerberg, 2003).
In an earlier controlled study, cervical spine-related signs and symptoms were also found to be more common in patients with Meniere’s disease than in the control group. Seventy-five percent of the patients reported a relationship between vertigo attacks and head and neck movements involving the atlanto-occipital and atlantoaxial regions (Bjorne, Berven & Agerberg, 1998).
Tinnitus and the Upper Cervical Region
In a study by Kessinger and Boneva, a 75-year-old patient with tinnitus, vertigo, and hearing loss received chiropractic treatment directed at the upper cervical region.
Improvements in the patient’s symptoms and audiological function were reported during the treatment process. The researchers suggested that these findings indicate that upper cervical manipulation may be beneficial for some patients with tinnitus and hearing loss (Kessinger & Boneva, 2000).
In Summary
- Scientific studies indicate that there is an important interaction between the upper cervical spine and the auditory and vestibular systems, and that functional disorders of the cervical spine may be associated with tinnitus, vertigo, aural fullness, and changes in hearing in some patients.
- Clinical studies involving patients considered to have cervicogenic symptoms have reported improvements in hearing, tinnitus, vertigo, and aural fullness following manual therapy directed at the upper cervical region.
- These findings highlight the importance of assessing the cervical region and incorporating appropriate manual therapy approaches into the treatment process for patients who experience ear-related symptoms alongside functional disorders of the cervical spine.
Scientific References
- Hülse, M. (1994). Cervicogenic hearing loss. HNO, 42(10), 604–613.
PMID: 8002367. PubMed - Zhou, X., Luo, H., He, J., Wang, R., Zhuang, Y., & Zhan, Q. (2015). A randomized controlled trials on treatment of cervicogenic sudden hearing loss with chiropractic. Zhongguo Gu Shang, 28(1), 62–65.
PMID: 25823136. PubMed - Bjorne, A., & Agerberg, G. (2003). Symptom relief after treatment of temporomandibular and cervical spine disorders in patients with Meniere’s disease: a three-year follow-up. Cranio, 21(1), 50–60.
DOI: 10.1080/08869634.2003.11746232. PubMed - Bjorne, A., Berven, A., & Agerberg, G. (1998). Cervical signs and symptoms in patients with Meniere’s disease: a controlled study. Cranio, 16(3), 194–202.
DOI: 10.1080/08869634.1998.11746057. PubMed - Kessinger, R. C., & Boneva, D. V. (2000). Vertigo, tinnitus, and hearing loss in the geriatric patient. Journal of Manipulative and Physiological Therapeutics, 23(5), 352–362.
PMID: 10863256. PubMed - Bousema, E. J., Koops, E. A., van Dijk, P., & Dijkstra, P. U. (2018). Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review. Trends in Hearing, 22.
DOI: 10.1177/2331216518800640. PubMed - The Effect of Physical Therapy Treatment in Patients with Subjective Tinnitus: A Systematic Review (2017).
This systematic review examined the effects of physical therapy interventions targeting the cervical spine and temporomandibular region on tinnitus and reported positive treatment effects across the studies evaluated. PubMed
