Management of Neck Pain, Dizziness, and Tinnitus

Diagnostic Approach

The American Academy of Otolaryngology-Head and Neck Surgery suggests that Menière's disease presents with episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness 2
Temporomandibular Joint (TMJ) dysfunction can cause unilateral tinnitus that worsens with jaw movements, and may coexist with neck pain and dizziness due to associated cervical muscle tension 1
Vascular abnormalities, such as sigmoid sinus diverticulum/dehiscence or carotid artery abnormalities, should be considered if tinnitus is pulsatile, and may cause positional dizziness and referred neck discomfort 1
Cervical radiculopathy can cause neck pain radiating to the head/ear region, potentially mimicking or coexisting with tinnitus, and associated dizziness may occur from cervical proprioceptive dysfunction 4

The American College of Radiology recommends immediate escalation of care if focal neurological deficits, asymmetric or unilateral hearing loss, pulsatile tinnitus, history of malignancy, recent trauma, or prior neck surgery are present 4
Severe anxiety, depression, or suicidal ideation related to symptoms should be addressed, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 2

A targeted history should include assessment of tinnitus characteristics, such as laterality, duration, quality, pitch, loudness, and temporal pattern, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 3
Audiologic testing, including pure tone audiometry, speech audiometry, and acoustic reflex testing, should be considered for all patients, especially those with unilateral tinnitus or asymmetric hearing loss 3
Imaging studies, such as CT temporal bone or MRI with contrast, may be necessary to evaluate suspected bony abnormalities, middle ear pathology, or vascular anomalies 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends education and counseling about management strategies for all patients with persistent, bothersome tinnitus 3
Cognitive behavioral therapy (CBT) is recommended to reduce tinnitus-related distress and improve quality of life 3
Sound therapy may be offered as an option to provide auditory masking 3
Surgical repair or embolization may be indicated in severe cases of vascular abnormalities causing pulsatile tinnitus, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1