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Gizmodo UK is part of Future plc, an international media group and leading digital publisher. When checked, Shutterstock's safe search screens restricted content and excludes it from your search results. We analyzed relationships among tinnitus relief, dizziness, and results of vertical autocorrelation studies of head movement to investigate the effect of greater occipital nerve block on the sensory and motor system in 2 patients with abnormal head movement.
Greater occipital nerve block (GONB) initially was performed to treat neck and posterior head pain associated with head trauma [1]. In a preliminary report, we showed that a system detecting head movement using magnetic sensors was useful in evaluating disequilibrium during stepping in place, and we found that vertical autocorrelation of head movement during stepping was related to degree of dizziness [4]. We compared relationships among tinnitus, dizziness, and results of vertical autocorrelation analysis of head movement in this study to investigate the effects of GONB on the sensory and motor systems. We studied 27 patients who ranged in age from 38 to 74 years (mean age 58.3) and who for more than 6 months sometimes felt dizziness recurring during walking.
We used GONB for treating tinnitus and dizziness in patients reporting tenderness over the skin in the area to be blocked. The system is composed of a three-space ISOTRAK apparatus and a personal computer (PC-98, NEC, Tokyo).
To evaluate selective attention, 20 grammatically correct but nonsensical four-segment sentences were presented together with multiple voices recorded on a compact disk. Considering the possibility of adaptation to the sentence competition test, we calculated the improvement as mean plus 1 standard deviation (SD) in the number of incorrect words in each segment of the sentences between a first and second test in 18 patients without treatment (mean age, 64.3 years) [5]. Figure 1 shows representative head movement in a patient with improvement on the competing word test and in the complaint of tinnitus.
Dizziness and autocorrelation of vertical head movement were classified as better, unchanged, or worse after treatment. Figure 4 shows results in the word perception test from a patient with tinnitus relief and a patient reporting no tinnitus relief. Table 1 summarizes effects of occipital nerve block on autocorrelation, dizziness, and tinnitus.
Our study showed that patients who had dizziness and had tinnitus relief after GONB also experienced de-creased dizziness. Endorphins produced in the brain in reaction to noxious stimuli tend to suppress or blunt the noxious feeling of pain [10, 15]. Our previous report showed that tinnitus patients with severe sleep disorders showed abnormal head movement, even without a perception of dizziness [5]. Our study showed that effectiveness of GONB on dizziness and tinnitus was not specific to patients with trauma. This study was presented at the Twenty-Fifth International Congress of the Neurootoiogicai and Equilibriometric Society, March 19-22, 1998, Bad Kissingen, Germany.
Bristolians are once again being terrorised annoyed and enthralled by a low frequency humming sound, which was first recorded in the city in the 1970s. Presently, GONB also is used for treating dizziness and tinnitus, again mainly when associated with head and neck trauma [2]. The magnetic measurement system shows good reproducibility and is very sensitive to balance difficulties, even showing some degree of disequilibrium in many patients who do not perceive dizziness [4]. In studies involving electrical stimulation of the ear, relief of tinnitus was accompanied by improved selective attention [5], and patients with tinnitus relief after GONB sometimes noted improved attention.
Etiologies of dizziness included head trauma (n = 12), vertebrobasilar insufficiency (n = 4), temporomandibular joint disorders (n = 1), and peripheral vestibular disorders (n = 10).
Thirteen tinnitus patients without dizziness, ranging in age from 38 to 72 years, also were investigated before and after GONB. During the treatments, patient with abnormal vertical head movement and tenderness were selected for our study.
The source coil was placed at the vertex of a helmet, and the sensor coil was installed at a wooden post. Improved word perception in the presence of noise was observed in three patients with improved tinnitus but was not observed in two patients without improved tinnitus. No significant difference was referable to the block (p >.05) regarding improvement in autocorrelation among patients with dizziness and trauma, such patients without trauma, and tinnitus patients without dizziness.
On the basis of effect of treatment, tinnitus and autocorrelation of vertical head movement were classified as better, unchanged, or worse.
However, in another study, injection of local anesthetics into the deep muscles in normal subjects produced rotatory vertigo, deviation to the injected side during stepping, and a tendency to fall to the injected side [6]. Our previous report showed tinnitus relief after electrical stimulation of the ear to be related closely to improved head-movement control (unpublished data).
Such a distracting, internal noise induces the high activity in stress-susceptible areas [11], accompanied by increased sympathetic nerve tone. GONB using Xylocaine may have a similar action on continuously noxious stimuli in the occipital region.
Tinnitus relief after electrical stimulation is accompanied by improvement in sleep disorder symptoms and in head movement.
However, the percentage of patients showing improved autocorrelation among those reporting tinnitus relief was significantly higher than the percentage among patients without tinnitus relief (p = .001).

Nobodya€™s entirely sure whata€™s behind the noise, and every explanation put forward so far has raised eyebrows. The percentage of patients reporting tinnitus improvement (54%, or 7 patients) among 13 patients without a history of trauma was not significantly higherthan among 12 patients with trauma (33% or 4 patients). Accordingly, sentence competition tests were performed before and after GONB to evaluate changes in attention.
The parameter tested was vertical autocorrelation of head movement during stepping in place. Only 3% of untreated patients among those tested improved more than 2 SD from the original mean.
Horizontal and vertical autocorrelation befon treatment are shown in the upper panels and are shown after treatment in the lower panels. Note that decreased dizziness was accompanied by a better finding of vertical autocorrelation of head movement (trauma = patients with trauma). Two of the three patients with improved word perception were under treatment after traffic accidents, and the other had only tinnitus without dizziness.
The percentage of improved autocorrelation in patients reporting tinnitus relief was significantly higher than that in patients with no tinnitus relief (p =.001). Only one patient in our study (2.5%) complained of worse dizziness after GONB, whereas two other patients (5%) showed worse autocorrelation without reporting worse dizziness. This newer study showed that tinnitus relief almost always was accompanied by better autocorrelation of head movement.
Our previous report showed that electrical stimulation of the ear increased cutaneous digital blood flow in patients who reported tinnitus relief [12]. Being free from noxious sensation after GONB may cause patients to feel relaxed, with resulting improved selective attention. We therefore speculated that the mechanism of external electrical tinnitus suppression may be due to relaxation (unpublished data), resulting in improved attention.
Neurological studies on the sympathetic nervous system in the formation of traumatic vertigo of cervical origin. Increased selective attention and word perception in tinnitus patients treated with electrical stimulation.
Increased parasympathetic nerve tone following greater occipital nerve block in tinnitus patients. Increased parasympathetic nerve tone following electrical promontory stimulation in tinnitus patients.
Studies on nystagmus elicited from hippocampus in rabbits with reference to EEG and autonomic responses. Equilibrium tests with adrenaline loading: Their clinical value in the diagnosis of brainstem disorder as related to vertigo due to head injury.
Opioid involvement in electromyographic (EMG) responses induced by injection of inflammatory irritant into deep neck tissues. However, tinnitus improvement in patients with dizziness but without trauma was more frequent than that reported by non traumatic tinnitus patients without dizziness (p p =.001). Sampling frequency was 30 Hz, and duration of recording was approximately 17 seconds (511 data points). Therefore, when the number of incorrect words for each segment decreased over two, three, or four words, respectively, word perception was considered improved [5]. Sixteen of the 17 patients (94%) with improvement in dizziness showed better autocorrelation after treatment, but a patient reporting decreased dizziness with treatment showed worse autocorrelation. Tinnitus relief was associated with greater improvement in vertical autocorrelation of head movement than that in association with no tinnitus relief (p =.001). A discrepancy is evident between improved dizziness in our study and worse dizziness in other studies [6]. The percentage of improved autocorrelation in patients with tinnitus relief is significantly higher than that seen in patients with no tinnitus relief (p =.01), as shown in Table 2.
We previously reported that improved attention after electrical stimulation of the ears may be associated with tinnitus relief [4].
The effectiveness of external electrical stimulation on tinnitus in 39 of 77 patients (51%) was significantly higher (p = .01) than that after GONB in tinnitus patients without dizziness (15%).
A word perception test suggested that improved attention after GONB was related to relief of tinnitus and dizziness.
Proceedings of the Twenty-third Congress of the Neurootological and Equilibriometric Society, Bad Kissingen, Germany, 1996;35-38.
Think for example of an employee on the shop floor of a machine hall, or visitors to a discotheque or dance party… or even yourself in your car on a busy motorway, surrounded by other traffic.
Dizziness improved in 8 of 13 patients (62%) with trauma, similar to improvement in 8 of 14 patients without trauma (57%). Four patients among the 27 with dizziness and 1 patient of the 13 patients with tinnitus only were requested to repeat what they had heard.
Figure 2 shows horizontal and vertical autocorrelation results with respect to the movement shown in Figure 1.
In all, three patients (including this one) declined in terms of autocorrelation after treatment.

Overall, the results suggest that tinnitus relief after GONB may be related to improved attention. One of 14 patient with tinnitus relief (7%) showed worse vertical autocorrelation, and 4 of 24 patients without tinnitus relief (17%) showed worse vertical autocorrelation.
In our previous report, we found that improved autocorrelation suggested improved dizziness [4].
Our study showed tinnitus relief to be associated with improved attention and improved head movement in tinnitus patients with dizziness. However, effectiveness of tinnitus suppression in patients with no trauma after GONB (54%) was similar to that seen in patients after external stimulation. Improved word perception test results in the presence of noise suggested that improvement in tinnitus and dizziness after occipital nerve block was related to improved attention.
GONB was performed by injecting a local anesthetic (1% lidocaine [Xylocaine], 5-10 ml) into the tender area near the greater occipital nerve. Scores were compared for each segment in 20 sentences before and after occipital nerve block.
Horizontal autocorrelation was normal, indicating that the patient could step rhythmically. Note that the frequency of vertical autocorrelatior after treatment is twice that of horizontal wave, showing normal findings. The apparent etiology of tinnitus in both patients in Figure 4 was the socalled whiplash syndrome. The percentage of patients with worse vertical autocorrelation results showed no significant difference (p > .05). However, injection of Xylocaine into the superficial layer of muscle produces little imbalance [7] because muscle spindles are sparser than in deeper muscles [8].
The discrepancy in effectiveness of tinnitus suppression between GONB and external electrical stimulation suggests that improved attention after GONB may not be of sufficient benefit for many tinnitus patients without dizziness to experience relief of tinnitus. However, prior to treatment, vertical autocorrelation was abnormal because the frequency of vertical head movement was less than twice the horizontal head movement. Receptors mediating the oculocervical reflex are distributed densely in the capsules of the upper cervical joints. Answering how tinnitus relief after GONB might be associated with decreased dizziness necessitates consideration of actions of GONB on the neck. Increased sympathetic nerve tone involving the amygdala, hippocampus, hypothalamus, and equilibrium centers of the brainstem has been noted also in posttraumatic patients [4].
The effectiveness of tinnitus suppression seen after GONB is similar between patients with dizziness and trauma and tinnitus patients with no dizziness, possibly reflecting central effects of trauma. An interesting comparison is the manner in which GONB acts on the sensory system in the case of tinnitus and effects that may involve the motor system in dizziness. The area infiltrated in an occipital nerve block includes the attachments of the semispinalis and trapezius muscles. The greater occipital nerve is a sensory branch of the second cervical nerve; the major aim of GONB is to relieve occipital muscle tension headache and muscle stiffness. Increased sympathetic nerve tone in the equilibrium center would tend to induce disorders of eye movement and balance. GONB may be effective only for patients experiencing noxious stimuli that disrupt attention. The midshipman fish explanation was more up our alley, but the Scottish Association for Marine Science dismissed that one, saying they wouldn't be loud enough to keep people awake. As these muscles belong to the superficial layer, Xylocaine injected at this site has little effect on balance. When noxious stimuli in patients with disturbed head movement were relieved after GONB, increased parasympathetic nerve tone and improved attention would cause decrease of dizziness and tinnitus. Continuous noxious stimuli from the neck muscles would induce stress, resulting in increased sympathetic nervous tone, which may evoke tightening of muscles around the neck and shoulders in response to noxious stimuli [9], disturbing head movement in patients. Although external electrical stimulation is the first choice for treating tinnitus at our clinic, GONB remains an option for tinnitus patients with occipital tenderness and dizziness.
Relief of headache and muscle stiffness causes patients to feel comfortable and sometimes permits them to turn their heads with greater ease. GONB, however, decreased dizziness in roughly equal fractions of patients with and without trauma in our newer study.
In some other patients with tinnitus relief after GONB, digital blood flow increased, suggesting increased parasympathetic nerve tone [10]. Therefore, especially in tinnitus patients without trauma, other mechanisms independent of the autonomic nervous system may be operating to relieve tinnitus.

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