Case Studies

The Sound of Hope

We experience life through our senses. Taste, touch, smell, sight, and sound work in harmony to help us understand and perceive the world around us. What happens when one of them stops working the way it should?

Neil lived a happy life – he was a successful architect in his mid-30s who had already enjoyed considerable professional and financial success, but in 2018, he was in a car accident – and that’s when everything started to change. While he was relatively unharmed, several months later, Neil started experiencing a stiffness in his neck and a persistent hissing in one ear which quickly spread to the other. It was unclear if these symptoms steamed from his accident or another cause.

The hissing in Neil’s ears became more intense and grew from a mild annoyance to a debilitating condition that completely upended his life. He couldn’t sleep, had trouble focusing, and began to notice unusual sensations in his face and neck that correlated with the continued tinnitus and nick stiffness.

Neil sought treatment at a major academic institution where he was diagnosed with tinnitus. His treatment plan failed to address the myriad of potential contributors to his symptoms. His medical team gave him an injection in his neck to treat the symptoms. When this resulted in a temporary injury to his brachial plexus―the network of nerves that sends signals to the arm from the spinal cord―he knew he needed to approach his treatment differently.

In the fall of 2021, after more than two years of living with tinnitus, Neil came to Private Health Management (PHM) and was examined by one of our top experts, Dr. Robert Simon, Chief Medical Officer of the Private Health Medical Group. A researcher at heart, Neil had done his homework and believed that he was suffering from a specific subtype of tinnitus called somatosensory tinnitus. After studying Neil’s symptoms and medical history, PHM confirmed his suspicions.

Somatosensory tinnitus is caused by muscles in the face and neck chronically contracting, which stimulates the brain’s dorsal cochlear nucleus and results in tinnitus. Somatosensory tinnitus is often overlooked or mismanaged because it requires comprehensive, multidisciplinary diagnostics and treatment.

The experts at PHM knew they had to move quickly. By administering a series of diagnostic injections in his neck, our team determined that treating various trigger points in his neck with a technique called “dry needling” could bring Neil some relief.

While Neil initially responded to the new treatment, his symptoms returned. Undeterred, PHM consulted with Dr. Claudia Barros Coelho a leading ear, nose, and throat physician in Brazil who specializes in the treatment of somatosensory tinnitus. Backed by this expert guidance, PHM developed a multi-faceted approach that included advanced diagnostic imaging of Neil’s spine to rule out other contributors—something not done at the academic institution. He also received a personalized diagnostic myofascial massage and injection technique to further define the cause of his symptoms. 

When Neil’s tinnitus returned, PHM organized a call with Dr. Barros Coehlo who felt that additional muscles also needed to be injected to address his symptoms and offer him some relief.

As part of his next phase of care, Neil is considering travelling to Brazil to receive a carefully crafted mapping of his trigger points and sequential dry needling sessions. Given the major vessels in the neck, this must be done with well-trained experts in this technique. PHM also arranged and reviewed an MRI of his cervical spine to rule out other causes for his symptoms.

When we met Neil, he had been let down by previous treatments and unable to find the answers he needed – even from a trusted academic center. PHM confirmed his diagnosis, gave him a team to support him throughout his healthcare journey, and helped him find peace of mind during a time that was marked by fear and anxiety. Today he is informed and empowered by innovative treatments that go beyond the typical standard of care. Neil’s story is not over, but he is armed with the information he needs to take his next steps and, with support from PHM, he is able to navigate his complex medical issues and make decisions with confidence. By having a correct diagnosis and a personalized treatment plan that that draws on the best of what’s possible in medicine, Neil can begin to look forward to a brighter future.

* Name changed to protect privacy

* Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Authors

Kristin Loker, DNP, NP-C

Managing Clinical Director | Nurse Practitioner

Kristin has more than ten years of combined advanced practice and nursing experience with a strong clinical background in orthopedics and dedicated experience in oncology and immunology.