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Final Program


Final Program

Neuromodulation

400 - Silencing the Ring: Resolution of Post-Stroke Tinnitus Following Cervical Facet Radiofrequency Ablation

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: A 72-year-old male with persistent vertigo, left homonymous hemianopsia, and chronic tinnitus after a right parieto-occipital stroke presented with worsening tinnitus, cervicogenic headache, and neck pain following an acute cervical injury. Peripheral otologic causes were excluded, and the working diagnosis was post-stroke central tinnitus exacerbated by cervical facet arthropathy. 

Case Description: The patient sustained a cervical injury while operating machinery, resulting in acute neck pain with worsening tinnitus and numbness of the left thumb. His symptoms remained refractory to several months of physical therapy, acupuncture, and medications. Examination revealed cervical stiffness with pain radiating to the left shoulder and sensory changes in the left hand, while motor strength was preserved. Cervical spine MRI showed multilevel degenerative disc disease, arthritis, and facet hypertrophy. After dual diagnostic medial branch blocks confirmed facet-mediated pain, he underwent fluoroscopy-guided right C2–3 and C3–4 medial branch radiofrequency ablation (RFA). Following the procedure, he experienced complete resolution of axial neck pain and near-complete resolution of tinnitus, with sustained improvement over several months. 

Discussions: Tinnitus is a complex disorder and challenging condition that may arise from central neuroplastic changes as well as somatosensory modulation. The dorsal cochlear nucleus (DCN) integrates auditory and cervical afferent inputs, and aberrant signaling from C2-3 cervical medial branches can contribute to disinhibition and hyperexcitability, manifesting as tinnitus. Cervical facet hypertrophy may thus act as a somatic driver of tinnitus. By ablating nociceptive signaling, cervical RFA may reduce abnormal somatosensory input to the DCN and restore inhibitory balance. While traditionally reserved for axial neck pain, this case suggests RFA may also exert neuromodulatory effects on tinnitus. 

Conclusions: Cervical facet RFA may improve both axial neck pain and somatosensory-modulated tinnitus. Recognizing cervical contributions to central tinnitus expands therapeutic options and underscores the role of interventional physiatry in managing post-stroke neuroplastic sequelae.