Diagnostic Value of Clinical Cervical Spine Tests in Patients With Cervicogenic Somatic Tinnitus

Tinnitus can be associated with many different aetiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine. The diagnosis of cervicogenic somatic tinnitus(CST) is made when the predominant feature is the temporal coincidence of appearance or increase of both neck pain and tinnitus. To assess the diagnostic value of clinical cervical spine tests in CST. Consecutive adult patients suffering from chronic subjective non-pulsatile tinnitus were included in the study. The exclusion criteria were vertigo, Meniere’s disease, middle ear pathology, intra cranial pathology, cervical spine surgery, whiplash trauma, temporomandibular dysfunction. Full ENT examination to classify patients in CST and non-CST population. Physical therapy examination included completion of the Neck Bournemouth Questionnaire(NBQ) and clinical cervical spine tests: manual rotation test, adapted Spurling test(AST), trigger points tests and strength and endurance of deep neck flexors. In all 87 tinnitus patients participated, of which 37 (43%) were diagnosed with CST. CST diagnosis becomes less likely when NBQ scores <14 points (sensitivity 80%, likelihood ratio(LR):0.3, post-test probability(PTP):19%). Absence of trigger points corresponds with a LR of 0.3, a sensitivity of 82% and a PTP of 22%. A positive manual rotation and AST indicate a higher probability of CST (LR:5, specificity of 90%, PTP:78%)).

Clinical cervical spine tests can support the diagnostic process of CST. An NBQ score <14 points and the absence of trigger points can assist in the exclusion of CST. In contrast, a positive manual rotation and AST can help to include CST. It is advised that these tests be included in a multidisciplinary assessment of patients with suspected CST.