Pulsatile Tinnitus Caused by Sports Injury

[PTinSC]

I'm frustrated like everyone else who has PT. If you want to cut to the chase and see what my question is, then go to the last paragraph, otherwise, here's my story:

I had a head to head collision playing soccer. I came in with speed and hit heads with an almost stationary player... we were trying to head the same ball.

Instant clogged feeling in my right ear, 15 minutes later and it turned into PT... 13 months later it still rears its ugly head. I've had shoulder injuries in the past, especially on my right side which were likely poorly healed due to lack of treatment... the VA is my primary treatment. Because of the shoulder injuries, I sometimes get a shooting pain and an almost frozen neck that runs from the base of my skull to my mid-shoulder blade (trapezius)

VA had little answers. I had a CT scan and an MRI, but I doubt their abilities. I paid to see a private orthopedist and they said my shoulders look fine, pains are likely neck related. I paid to see a private ENT and he told me a blood vessel likely shifted due to the blunt force. When asked if I have to deal with this forever, he all but said yes, which I already expected at that point.

I would be remiss if I didn't seek all avenues and seek advice from others with PT knowledge. Friends and wife think a chiropractor can possibly, "Knock something back in place" and get rid of the PT... I'm skeptical. I feel like it may be all my injuries coming back to haunt me and am considering physical therapy on my shoulders/neck to work it out over time. Is there any success with physical therapy to rid sports injury induced PT (or any PT for that matter), or success with a chiropractor approach? Thanks for listening to me blather on...

 

[Greg Sacramento]

I'm frustrated like everyone else who has PT.

Yep, it can be simple or complex as to cause.

I paid to see a private ENT and he told me a blood vessel likely shifted due to the blunt force. When asked if I have to deal with this forever, he all but said yes, which I already expected at that point.

One ready needs to go advanced research for blood vessel input - trauma or not.
The jugular vein is often discussed as a vessel of concern with blunt force or twisting of neck. Some can slow PT or stop it temporary by turning the neck to one side or gently pressing the jugular vein and for others it has no effect. If no effect is the case, then something else also has involvement. It could be axonal or blood flow concerns directly related to the ear.

I guess that you said that a MRI and CT didn't show cause. Maybe axonal tests are needed - SSEP, BAER, VEP or EEG.
Two possible treatment very successful from research - steroids for inflammation and endovascular treatment.

I wouldn't give up. From research you will note that a neurosurgeon is the doctor of value, not an ENT.

 

[PTinSC]

One ready needs to go advanced research for blood vessel input - trauma or not.
The jugular vein is often discussed as a vessel of concern with blunt force or twisting of neck. Some can slow PT or stop it temporary by turning the neck to one side or gently pressing the jugular vein and for others it has no effect. If no effect is the case, then something else also has involvement. It could be axonal or blood flow concerns directly related to the ear.

I guess that you said that a MRI and CT didn't show cause. Maybe axonal tests are needed - SSEP, BAER, VEP or EEG.
Two possible treatment very successful from research - steroids for inflammation and endovascular treatment.

I wouldn't give up. From research you will note that a neurosurgeon is the doctor of value, not an ENT.

Thank you for your feedback. I can actually change the sound of the PT by pressing on the back right of my neck towards the base of the skull... everything seems to be isolated to the right side neck/shoulder.

I haven't thought of a neursurgeon but did consider a vascular surgeon.

I've been taking a slow approach mostly because I have to save to see these doctors... that and because it took almost 2 months for the VA to get me in for the CT (kind of a long wait considering they were checking for a concussion) and an almost 2 more months to see an ENT who spent more time fixing my compacted ear rather than talk about my PT.

Giving up isn't in the cards just yet... I so desperately want to be back to my pre-PT self again, and unlike "typical" ringing in the ear tinnitus, I know PT can be pinpointed and treated. I'm trying to find that one solution no doctor has been able to pinpoint... it's just hard paying for these doctors on a small business owner's salary, so I'm selective on who to see next.

Thanks again for you willingness to listen and offer input.

 

[Greg Sacramento]

Thank you for your feedback. I can actually change the sound of the PT by pressing on the back right of my neck towards the base of the skull... everything seems to be isolated to the right side neck/shoulder.

I haven't thought of a neursurgeon but did consider a vascular surgeon.

That's actually better news than what could be.
Knowing this, a vascular surgeon would be better.

Stay in touch.

 

[PTinSC]

I've been thinking about dry needling my trapezius. With the shoulder/neck injuries and localized pain at the trapezius, I'm banking in a hope and a prayer. Some scientific studies show about a 25% chance of a partial improvement and a 25% chance of full cessation of tinnitus.

If nothing else, perhaps it will help with my shoulder/neck pains...

 

[PTinSC]

A quick update. A few months ago, I did some dry needling along with physical therapy with no effects.

This thread fell off my radar for a little bit, but it reminded me to try to see a vascular surgeon. Still haven't given up in this!

 

[Greg Sacramento]

@PTinSC
https://www.symptoma.com/en/ddx/neck-pain+pulsatile-tinnitus
Take the quiz = answer questions on right side of page.

 

[tiniturtle]

What you need is an MRA and possibly an MRV. I developed two dural arteriovenous fistula after relatively mild head injuries. They both caused pulsatile tinnitus, and were also dangerous. The good news is they are also curable, especially if you go to a good doctor. The fistula can be eradicated as well as the pulsatile tinnitus. Regular MRI and CT will not pick these up. The only definite method of diagnosis is with a cerebral angiogram, but often an MRA or MRV will indicate or show hints of one of these existing.

The type of doctor you want to consult with are commonly called neuro-interventional radiologists, or interventional radiologists. Most doctors don't even know what to look for. These guys will.