Resolution of long Standing tinnitus following radiofrequency ablation of C2-C3 medial branches - A case report

Karina Gritsenko, William Caldwell, Naum Shaparin, Amaresh Vydyanathan, Boleslav Kosharskyy

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain. Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably eliminates tinnitus symptoms; a cause has yet to be determined. A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup performed by the primary care physician including blood tests for electrolyte imbalance, consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to provide etiology of the tinnitus. No other complaints were noted except for occasional minimal left sided neck pain. Cervical spine x-ray showed degenerative changes with facet hypertrophy more pronounced on the left side. Subsequently, the patient underwent diagnostic left-sided C2-C3 medial branch block, resulting in complete resolution of tinnitus for more than 6 hours. After successful radiofrequency ablation of left C2-C3 medial branches, the patient became asymptomatic. At one year follow-up, he continued to be symptom free. Sparce studies have shown interaction between the somatosensory and auditory system at dorsal cochlear nucleus (DCN), inferior colliculus, and parietal association areas. Upper cervical nerve (C2) electrical stimulation evokes potentials in the DCN, eliciting strong patterns of inhibition and weak excitation of the DCN principal cells. New evidence demonstrated successful transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for treatment of somatic tinnitus in 240 patients. This case indicates that C2-C3 facet arthropathy may cause tinnitus and radiofrequency ablation of C2-C3 medial branches can provide an effective approach not previously considered.

Original languageEnglish (US)
Pages (from-to)E95-E98
JournalPain Physician
Volume17
Issue number1
StatePublished - Jan 1 2014

Keywords

  • Auditory phantom perception
  • Cervical medial branch block
  • Cervical pain
  • Neuropathic pain
  • Radiofrequency ablation
  • Tinnitus

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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