Looking for Thoughts — Should I Push for an MRI? Is There Anything Else I'm Missing?

Hello all. Looking for thoughts and a bit of a sounding board here. I just reached my 9 month anniversary of this awesome thing called tinnitus. Yeah me!!!

A couple of points before I ask for advice.

• My tinnitus is somatic and unilateral. Moving my neck or jaw can modulate it greatly.
• I believe I had so mild a tinnitus in the past that unless it was totally silent I could not detect it. In Jan this year it suddenly hit HARD and has maybe gone down 25% since then. That's a guess though...
• Physical rehab to strengthen the neck muscles did nothing.
• I have been to multiple ENTs that pretty much said that everything looks OK and their theory is otitis media. They cant say with any degree of confidence though since when I had it only a small bit of liquid was in the ear.
• I had an MRA to rule our pulsatile because "sometimes" mine gets a weird pulse to it but that may just be the sound...The results came back totally normal.
• Thyroid tests came back normal
• I had a decent amount of neck soreness when this originally started along with intermittent headaches on the right side of my head(opposite of the tinnitus side). Pretty painful for 5 minutes at a time. The headaches went away a month into this but my neck in general gets stiff/sore.
• I saw a chiropractor (family friend) for 3 months but that did not do much.
• I wore a TMJ bite guard but it did not help even though I have mild TMJ.
• I went through all the homeopathic medicine and vitamins to no avail. CBD, Magnesium, Zinc, B12, D, etc...

My next steps are to try some acupuncture (cant hurt) and to also see a new neurologist.

So my question(s) are:

• Should I push for an MRI (w/o contrast)? Based on everything I read it's normal to get one with unilateral T but I don't seem to have the hearing loss to trigger the test to be ordered per multiple ENTs. My father and others in my family have MS so I am thinking if I talk to my neurologist about that it may be enough of a concern to do an MRI.
• Is there anything else I am missing to try?

I included my audiology test below for reference.

Just needed to get all this out on "paper" for others to talk to.

As always I value your thoughts. Thanks!!!

 

If I was in your shoes, I'd go for the MRI, and if that doesn't show anything, CT.
It's a bit of a fishing expedition...

 

@dayma We talked before. What you got going is pretty easy to narrow down to a few possible causes. I need to leave the computer, but if you wish we can talk again.

 

Always man. I am open to listening and talking to anyone!!!!

 

Also @dayma - check out the diagnostic flowchart: https://www.tinnitusresearch.net/index.php/for-clinicians/diagnostic-flowchart

 

Yeah, that's an awesome chart. I "think" I have everything covered. I still am missing the MRI though..

 

Heya. Have a chance to reach out to me on this in a conversation?

 

@dayma What you have going on can be treated to reduce T, but I need to compare your hearing loss to other gateways other than the auditory cranial VIII to judge both possible reduction and association to the intensity levels needed of applied therapy to a few areas. This usually takes a neurologist, audiologist and physical therapist all working together to accomplish this and then it's never achieved because of costs and time. I usually consider the gateways before I post to someone. Let me consider all of this and I will post later today.

 

Your OAE revealed issues/abnormalities in higher frequencies, there is a hearing problem.

 

@dayma Considering your hearing exam, lets hope that another gateway has some involvement. If you can modulate then the Inferior Colliculus might be open - Susan Shore. I'm not sure how much fusiform activity is taking place or what involvement there is with the dorsal root ganglia, but your spinothalamic pathway is probably open. So because you don't have cervical muscle response and little TMJ input, your main problem could be sinus - temporal - otitis media.

OR

Yes, maybe a cervical MRI. Have you had a X Ray of neck? Your C1 and C2 appears to mostly OK. Not sure how your posture is, but forward extension of head could be a problem - head bending. This would relate to deep fibers nerves and facet joints as well as neck muscle soreness. If forward head bending is the problem then there's one exercise that may greatly help. Breathe in and out while slightly tilting your head back of a half inch and then slowly gently raise your head.

I would ready start off with a neck X Ray of 4 views.

 

Actually I have had neck X-RAYs. My C2 and C3 show wear/arthritis due to me being a long distance runner. It has been an issue in the past. So I know there is wear there and chiropractor saw it also and did adjustments but not much else.

 

So I have some questions on this. You say no cervical muscle response? I am not sure what you mean. I can modulate my T moving my neck left, right, forward and back.

Also, I am not sure what "temporal - otitis media" is really. I understand the middle ear infection stuff but not the "temporal" piece.

Thanks man!

 

With facet arthritis - joints does it continue lower? This does appear to be one problem and with any extreme bending this can cause T. I also wonder if your ENT is fully determined about otitis media. There is treatments for facet arthritis, but I don't know which ones are best. Any method does take time.

 

Temporal headaches or sinus headaches is just found - 15% of the time with tinnitus. If you can modulate then there is some possibility that your T can be lowered. Where is Susan Shore.

 

My neck is mildly sore but the C2/C3 stuff usually radiatees all the way to my hip.

 

You do have lower ear canal volume in one side which can be caused by cranio facial pain syndrome or TMJ compression your ear canal. Do you ever feel fullness?

When my T went from manageable to unmanageable about 8 months ago... I had otitis media, I'm also an avid distance runner with no hearing loss. A lot of similarities!

 

How can I be sure if TMJ is compressing my ear?
There is any exam for that?

 

A rare source of tinnitus is damage to the neck. The concept here is not that the neck injury creates sound, but rather that neck input can modulate brainstem structures that are involved in sound generation. We believe it to exist based on cases that we have encountered through the years in our clinical practice. We think that cervical tinnitus is rare. However, there are some authors that state that it occurs "very often" (Montazem, 2000)

 

You mentioned you completed an MRA (done in a MRI machine), normally the sequence to get an MRA image involves a normal MRI sequence that is then digitally subtracted by the software to show the various vessels. If they provided you with a DVD copy of the images you might find that the MRI sequences are on the disk, or ask the imaging centre if they stored a copy. Saves going back for another scan potentially.

 

There are really only two things you'll find in an MRI, which might change the way you're treated. The first is an 'acoustic neuroma'; essentially a benign growth which presses into your auditory nerve. If you have this, they will monitor it, but they likely won't take it out unless you're really losing the plot, as brain surgery is seriously dangerous. The second finding is some sort of brain cancer - and naturally in that case it's a whole different deal. One thing to note though, is that brain cancer moves quickly; tinnitus as a first symptom would be rare, and it also wouldn't stay the only symptom for long: you would like develop balance and/or vision problems quite quickly too.

In the UK, rapid MRI is standard for people with unilateral tinnitus which started within the last few days or weeks, but if you've had it for longer - without other symptoms - then it's not usually considered that rapid MRI is needed. When I saw my ENT, they did some basic behavioural tests for non-tinnitus symptoms, and when I didn't have any they scheduled an MRI for a few months later.