Pain in the neck and, at the same time, a whistle in the ear. Or the feeling of a blocked ear, or unsteadiness when you turn. It is natural to connect the two, and online the link is taken for granted. In the scientific literature, however, the situation is more nuanced than that: part of this link is documented, another part has been repeated for years without evidence to support it.
This guide separates the two. We will look at what research really supports about the relationship between the neck and the ear, which mechanism is plausible and which is an anatomical myth, which signs require a doctor before any exercise, and what actually happens when the neck of someone with these symptoms is treated.
⚠ Important: read this before continuing
The exercises and advice in this article are general indications and may not be suitable for your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
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First of all: when the ear is not a neck problem
This section comes at the top and not at the bottom for a precise reason. Ear symptoms can be the first sign of problems with the inner ear, the auditory nerve or the vessels of the neck and skull. Attributing them to the neck and starting exercises means, in those cases, wasting precious time.
Go to the emergency room or see a doctor today if one of these pictures appears.
Sudden hearing loss. The international guideline on sudden deafness defines it as a drop in hearing that occurs within 72 hours and treats it as a condition to be recognised and managed quickly because, the authors write, early recognition and management can improve hearing recovery. It is never a neck problem: it is an urgent ENT assessment.
Pulsating tinnitus, in sync with the heartbeat. A noise that "pulses" in time with the heart belongs to a different category from ordinary tinnitus and requires medical assessment, because it may have a vascular origin.
Tinnitus always in the same ear, with hearing dropping on that side. A persistently one-sided symptom needs to be investigated by a specialist, not interpreted as muscle tension.
Intense and prolonged vertigo, with vomiting, or accompanied by double vision, difficulty speaking, numbness of the face, weakness in a limb or marked unsteadiness when walking. These are neurological signs: go to the emergency room, without waiting.
Ear symptoms that appeared after a neck trauma, such as an accident, a whiplash injury, or a sudden manipulation, especially if associated with headache or neck pain that is unusual for you. They should be assessed by a doctor before any manual therapy.
Fever, severe ear pain, discharge. This is an infectious picture: you need a doctor, not a physiotherapist.
Outside these cases, and after the ENT specialist has ruled out an ear pathology, it makes sense to look at the neck. And this is where the interesting part begins.
Neck and ear: what the research really says
Not all three of the symptoms usually discussed have the same level of evidence behind them. It is worth distinguishing them, because the difference changes expectations.
Tinnitus that changes with the neck exists and is recognised
This is the solid part. There is a subtype of tinnitus called somatosensory, in which altered information coming from the cervical spine or the temporomandibular area causes or modifies the perception of the noise. In 2018 an international group of experts (ENT specialists, audiologists, physiotherapists) completed a Delphi process with a final face-to-face meeting to set its diagnostic criteria.
Two details of that document are rarely reported, and they are the most important. The first: those criteria "strongly suggest" the presence of somatosensory tinnitus, and none of them has to be present in every patient. The second: the consensus arose precisely because there is no single clinical test, so much so that until then each group used its own criteria and estimates of frequency varied enormously from study to study.
Put simply: tinnitus of cervical origin is not an invention, but it cannot be "proven" with a test. It is hypothesised on the basis of clinical clues.
Cervicogenic dizziness is a diagnosis of exclusion
The link between the neck and balance also has recognised foundations, but of a proprioceptive nature, not circulatory: the cervical spine is very rich in receptors whose information is integrated with visual and vestibular information. When these three channels come into conflict, a sensation of instability can appear.
The point is how the diagnosis is reached. A review of the literature published in 2022 in the Journal of Clinical Medicine is explicit: cervicogenic dizziness is recognised from its clinical features, from some tests and by excluding the other possible causes of dizziness. The most promising test seems to be the cervical torsion test, but the picture remains that of a diagnosis by elimination. If someone tells you with absolute certainty that "it is the neck", they are going beyond what the literature allows. We have a dedicated article on this topic: neck and dizziness.
A blocked ear is the weakest part of all
Here it needs to be said clearly: there is no literature showing that the feeling of muffling comes from the neck. It is repeated in a great many popular articles, but the research on the subject concerns tinnitus, not the sensation of fullness in the ear.
The closest data comes from a systematic review from 2026 on tinnitus in temporomandibular disorders: some patients manage to modulate their tinnitus with movements of the jaw or neck, which points to a somatosensory contribution. However, it concerns the perceived noise, not the blocked ear.
The feeling of muffling has its own causes, well studied and located in the ear: dysfunction of the Eustachian tube, fluid in the middle ear, earwax plug, pressure changes. If it is your main symptom, the first professional to see is the ENT specialist. A link with jaw tension is clinically plausible (the relationship between the neck and the temporomandibular joint is real), but it remains a hypothesis, not an established fact.
And the story of the "squeezed" vertebral artery? It does not hold up
It is the most widespread explanation of all: the muscle spasm compresses the vertebral artery, less blood reaches the inner ear, and so the symptoms. It is intuitive, it sounds scientific, and it is the most fragile part of the whole reasoning about the neck and the ear.
A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy in 2019 gathered 31 studies with a total of 2,254 participants, measuring flow in the vertebral, internal carotid and intracranial arteries in various neck positions. The most telling result concerns precisely the most "extreme" position in the tests: sixteen studies found no significant haemodynamic changes even at maximum rotation of the head. Measurable drops appear in a minority of works (eight for maximum rotation, four for maximum extension combined with rotation), and in the three studies on high-velocity manipulations no one reported changes in flow. The authors' summary is clear: in most people, most neck positions and movements do not alter blood flow, and cervical positioning changes it much less than expected.
If the flow does not change significantly even when you rotate your head to the maximum, it is unlikely that a trapezius spasm while you sit at the desk alters it. The plausible mechanism of the link between the neck and the ear is neural, not hydraulic: afferents from the neck and jaw converge on brainstem structures shared with the auditory pathway, and from there can modulate what you hear.
This is not a nerdy detail. It changes the treatment: if the problem were circulatory, it would make sense to "unlock" the neck; if it is sensory modulation, it makes sense to work on mobility, motor control and reducing neck pain.
The signs that point towards the neck
From the 2018 international consensus and from clinical practice, some elements emerge that shift suspicion towards the cervical spine when it comes to neck and ear symptoms. Let us repeat it: these are clues, not proof.
- The tinnitus changes (in intensity, in pitch, in side) when you move your neck or jaw, when you clench your teeth or when you press on certain muscle points.
- The ear disorder appeared at a time close to a neck problem: a worsening of neck pain, a trauma, a change of workstation.
- There is ongoing neck pain, with stiffness or reduced movement.
- The symptoms fluctuate together: in the weeks when the neck is worse, the ear is worse too.
- On examination, hearing is normal and the ENT specialist has found no ear pathology.
Conversely, a symptom that is completely independent of the position of the neck, stable day and night, associated with a documented drop in hearing, should be looked for elsewhere.
What actually happens when the neck is treated
Here is the practical question: if the neck is involved, does treating it help? The honest answer is "it can help, with modest and non-guaranteed results".
For tinnitus there is a single randomised controlled study, from 2016, on 38 people who had both significant subjective tinnitus and neck disorders. All of them received multimodal cervical physiotherapy, 12 sessions over 6 weeks, but half started straight away and half after a wait of 6 weeks, to compare the treatment with the simple passing of time. At the end, the scores for tinnitus and for neck disorder had improved significantly. Immediately after the treatment 53% reported a substantial improvement in tinnitus; at the 6-week follow-up the result was maintained in 24%. The authors themselves write that larger studies are needed to demonstrate the effect.
For cervicogenic dizziness the evidence is more abundant. A systematic review with meta-analysis from 2022 analysed 13 randomised studies involving 898 patients: manual therapy reduces vertigo, cervical dysfunction and balance problems with moderate quality of evidence; adding exercise makes the effect stronger, but there the quality of evidence drops to very low. Only three of the thirteen studies specified the cause of the vertigo, and for post-traumatic forms the results were inconsistent.
How should all this be read, in practice? A course of cervical physiotherapy is a reasonable attempt when neck symptoms are present and ear causes have been ruled out. But if after a few weeks of serious work on the neck the neck pain improves and the ear stays exactly the same, the conclusion is not "keep going": it is that the symptom probably did not come from the neck, and should be looked for elsewhere.
An important tip: before trying these exercises, make sure you have received a correct diagnosis. People often think they have one problem, but the real cause of the pain is another. Doing the wrong exercises can make the situation worse instead of better.
The exercises: no shortcut "for the ear"
It is worth clearing up a misunderstanding: in the studies, the neck of people with both neck and ear problems is treated the way one treats any painful neck. There is no specific exercise for the ear. Anyone who proposes one to you is selling a precision that the research does not have.
Slow neck rotations. Seated, back supported, gaze horizontal: turn the head from side to side staying within a comfortable range, without seeking the point of maximum excursion. The aim is to restore fluidity, not to gain degrees by force.
Chin retraction. The classic chin tuck: pull the chin back as if forming a double chin, without lowering your gaze or tilting the head. Hold for a few seconds and release. It is the most widely used movement for reactivating the deep neck flexors.
Stretching of the lateral muscles. Tilt the head towards one shoulder and rotate it slightly, until you feel a moderate pull on the opposite side of the neck. The tension must be tolerable, never acute pain and never accompanied by dizziness: if vertigo appears during the movement, you stop and talk about it with a professional.
For a complete and orderly progression for a painful neck you can follow our neck pain exercise routine. Frequency and repetitions must be adapted to the case: prefer short sessions repeated during the day to one long session of effort.
Trigger points and muscles: how much they really matter
The maps of trigger points in the sternocleidomastoid and the suboccipitals that "refer" sensations to the ear have been circulating for decades, and it is material that every physiotherapist knows. It must be said, however, what they are: clinical descriptions drawn from observation, not experimental results. Even locating the points by palpation is a manoeuvre that is not very reproducible between different practitioners.
This does not make them useless. If you have a marked trapezius tension and pressing on a specific point changes the tone of your tinnitus, that is exactly one of the somatosensory modulations described in the 2018 consensus: it is useful clinical information. It becomes a problem only when the map is presented as the definitive explanation and the patient spends months having a point massaged without anything changing.
Posture, desk and stress: what can be said without exaggerating
The head projected forward and the hours in front of the screen appear in almost every article on the subject. It is right to address them, provided we do not turn an association into a proven cause: the studies linking posture and neck pain are largely cross-sectional, that is, they capture a relationship without proving the direction.
That said, adjusting the height of the screen, the support for the forearms and the frequency of breaks reduces the continuous load on the neck and costs little. If you work at a computer, our guide to desk ergonomics covers the practical side. The same goes for stress, which is often accompanied by neck tension and, independently, tends to make tinnitus more intrusive: the relationship between neck and stress is one of the aspects on which you can act without risk.
Online physiotherapy: what it can and cannot do
Telerehabilitation has a clear role in this scenario. A physiotherapist on a video call can assess neck mobility and pain, guide the tests that try to modulate the symptom with movements, build a progressive programme and, not least, tell you when the picture is outside their competence and needs to be referred to the doctor or the ENT specialist.
There is also a practical advantage that is not trivial: when you have unsteadiness or tinnitus that destabilises you, leaving the house for a session is tiring. Being followed from home removes a real obstacle.
It must be said just as honestly what a video call does not do: it does not replace the audiometric test, it does not rule out an ear pathology and it does not allow manual therapy, which is precisely the intervention with the best evidence for cervicogenic dizziness. In Ri-Hub pathways, telerehabilitation works on assessment, exercise and education, and refers you to the specialist when needed.
Conclusion
The relationship between the neck and the ear is narrower than it is made out to be, but it is not empty. Tinnitus that can be modulated by movements of the neck or jaw is a recognised subtype, with criteria shared at international level. Cervicogenic dizziness exists, and it remains a diagnosis of exclusion. The feeling of a blocked ear, on the other hand, has no evidence today of a cervical origin and deserves, first of all, an ENT specialist. And the explanation of the artery compressed by the spasm, however widespread, is not supported by the data on blood flow.
The practical consequence is simple. First you rule out the warning signs and the ear causes. Then, if the neck hurts and the symptom moves with movements, you try a course of cervical physiotherapy with realistic expectations: possible benefits, of modest size, which must be maintained over time. And if the neck improves while the ear stays the same, you stop insisting and look elsewhere. If you want to understand which of these scenarios you are in, Ri-Hub physiotherapists can assess your neck together with you and point you to the next step.
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Sources
- Diagnostic Criteria for Somatosensory Tinnitus: A Delphi Process and Face-to-Face Meeting to Establish Consensus, Trends in Hearing, 2018
- Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?, Manual Therapy, 2016
- Systematic review and meta-analysis of the therapeutic management of patients with cervicogenic dizziness, Journal of Manual & Manipulative Therapy, 2022
- Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment, Journal of Clinical Medicine, 2022
- Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review, Journal of Orthopaedic & Sports Physical Therapy, 2019
- Clinical Practice Guideline: Sudden Hearing Loss (Update), Otolaryngology–Head and Neck Surgery, 2019
- Psychoacoustic characteristics of tinnitus in temporomandibular disorders: a systematic review, CoDAS, 2026
Last source check: August 2026.
