After developing a case of tinnitus (consistent ringing in the ears), a patient conducts his own YouTube research on his DC's choice of treatments. Does his research hold up in court?
Posted in Case Studies on Monday, August 18, 2025
Paul Riley, age 54, presented to Tim Cooper, D.C.’s office with a chief complaint of neck and throat pain that had been present for three to four weeks. Although he said he had previous episodes of pain in that area, they were unlike his current pain. He described soreness and a feeling of a lump in his throat, which was on the left anterior lateral side of his neck, and was painful. He also described a history of left upper thoracic and neck pain, and occasional migraines. The upper back and neck pain was present on the day of the initial visit, as well, and the patient had a headache but not a migraine at the time of the visit. The patient described anxiety because of throat "pressure,” making him claustrophobic and anxious.
Initial Treatment
On examination, Dr. Cooper found a lump on the left anterior side of Mr. Riley’s neck, which he considered to be muscle spasm. He specifically considered whether the lump described by the plaintiff was in an enlarged lymph node, and concluded that it was not. The muscle spasm was in the sternoclinomastoid (SCM) muscle, which is located lateral to the trachea. Dr. Cooper said that muscle spasm in that area is fairly common with neck pain. Upon palpation, Dr. Cooper identified restricted movement and subluxations at C1, C4, C7, T2, T4, T8, L5 and S1. He performed adjustments in these areas using a Gonstead technique for the cervical spine, with an activator adjustment of C7, and also at T2. T4 and T8 were adjusted with the patient initially sitting, and with Dr. Cooper’s hand on the segment to be adjusted.
The patient then crossed his arms, laid back on the bench, and Dr. Cooper pushed downward on the patient's elbows to accomplish the adjustment. The lumbar spine and sacrum were adjusted using a Thompson technique with a drop table. The patient tolerated these treatments well, and was instructed to ice his neck and upper thoracic spine for 15 minutes 3 to 4 times per day. Dr. Cooper’s diagnoses were left brachial neuralgia, cervical neuralgia, thoracic neuralgia, and lumbar neuralgia.
The Second Visit: Improvements Reported
After the initial treatment, the plaintiff made an appointment for a second visit. On that date, the Mr. Riley described some improvements following the initial treatment. His neck lump was still sore but was described as "way softer." The patient thought he was 50% better, and had less anxiety as well. On examination, Dr. Cooper found similar abnormalities as he did on the first visit, but with some improvement. On the second visit, Dr. Cooper did not have to adjust the T2 segment.
Mr. Riley later claimed Dr. Cooper performed an occipital lift technique during this visit resulting in severe tinnitus, however, Dr. Cooper was adamant he did not perform an occipital lift procedure as alleged and he said he does not perform that maneuver in his practice. The home instructions he gave the plaintiff also reflect that the patient was improving; the patient was instructed to ice less than he had been, now 1-2 times per day, and he was asked to return for another visit in two days.
The Third Visit: New Symptoms Arise
At Mr. Riley’s next visit, he complained of an issue with his left eye, although Dr. Cooper did not further describe the problem in his records and he does not recall the exact nature of the eye complaint. Dr. Cooper said that it is not uncommon for patients to complain of some vision blurriness after chiropractic treatment. The patient's left neck pain had resolved, but he now was complaining of pain on the right. Dr. Cooper said this is also not unusual, as the patient's with pain on one side often will compensate by overusing muscles on the contralateral side, causing those muscles to become sewer. Significantly, Dr. Cooper documented in his notes that Mr. Riley reported that he had developed ringing in the ears and brain fog the day after his last treatment, although Mr. Riley alleged those symptoms began immediately following the occipital lift he claims Dr. Cooper performed.
Patient Visits a Neurologist
The day after his last treatment by Dr. Cooper, Mr. Riley saw a neurologist for complaints of ringing in his ears, anxiety, blurred vision, concentration problems, and crying. A MRA of the head and neck was ordered, which specifically looked for vascular injury in the head and neck, and no injury was identified. Further, an absence of an alleged ligament injury, or any structural injury, was documented in the multiple advanced imaging studies that were performed upon Mr. Riley’s neck. Of all of the multiple workups that Mr. Riley underwent to determine the cause of his symptoms, the only abnormalities were found by a chiropractor utilizing a digital motion x-ray study, which was felt to demonstrate vertebral malalignment indicative of a ligamentous injury. However, this diagnosis was inconsistent with what was found on multiple advanced imaging studies obtained by the various physicians Mr. Riley had seen.
Over the course of several years of treatment searching for an explanation for his symptoms, Mr. Riley underwent multiple MRIs, MRAs, and CT scans, none of which showed evidence of injury. These studies did identify multiple congenital anomalies that are risk factors for tinnitus, and an audiogram demonstrated hearing loss caused by noise exposure in the plaintiff's activities of daily living, a common cause of tinnitus. Dr. Cooper hired experts to testify in his defense, and these experts opined that Mr. Riley suffered from vestibular migraines and a superior semicircular canal dehiscence, which in combination with his hearing loss, was the likely cause of all of his symptoms.
The Lawsuit
Mr. Riley later filed a lawsuit against Dr. Cooper and his practice, alleging Dr. Cooper used a forceful and violent cervical spine adjustment that triggered what he described as a loud explosion in his head, the onset of intractable ringing in his ears (tinnitus), balance problems and visual field deficits, all of which persisted up to the present. The tinnitus causes concentration problems, and the balance and vision problems affect his ability to work as a carpenter on construction sites.
At his deposition, Mr. Riley described the alleged occipital lift he believed Dr. Cooper performed. He said that he heard a sound like egg shells cracking when Dr. Cooper performed this maneuver, and also immediately experienced ringing in the ears and feeling woozy. The ringing in the ears has been constant and at the same intensity from that treatment until today. He also described a loss of peripheral vision, which he said was like tunnel vision or a "narrowing" of his visual field, which is also present today, but has improved to some extent. Mr. Riley described numbness, tingling, and a loss of strength that affects only the left side of his body, but he said that did not develop until a couple of months after Dr. Cooper’s treatment of him. Mr. Riley learned the term “occipital lift” by doing research on YouTube to try and determine what adjustment Dr. Cooper had performed on him.
Dr. Cooper, at his deposition, testified he does not perform an occipital lift in his practice, but instead adjusts his patient’s cervical spine utilizing the Gonstead technique and activator.
At trial, Dr. Cooper relied on his testimony that he did not perform an occipital lift on Mr. Riley, and there was no definitive pathophysiological explanation for Mr. Riley’s development of tinnitus. Several potential explanations did emerge through discovery, however none have any connection to Dr. Cooper’s treatment.
A neuroradiologist retained by Dr. Cooper to testify in his defense discovered imaging studies revealed the patient had a semicircular canal dehiscence in his inner ear, which is likely either congenital or degenerative. He also had frequent noise exposure, including his occupation in construction and riding motorcycles. Mr. Riley also underwent an MRI of his brain and an angiogram which revealed a right sided high riding jugular bulb, as well as a prominent mastoid emissary vein. The defense argued that any one of these things are potential causes of tinnitus. Further, tinnitus is known to also be idiopathic at times.
The Outcome
At trial, Mr. Riley told the jury about the severity of his symptoms and how it has greatly affected his life, often times becoming very emotional. His wife testified as well, explaining how this condition has changed her husband. She too became very emotional. Mr. Riley’s argument at trial relied on the temporal relationship between his symptoms and Dr. Cooper’s treatment. His attorney stressed that Mr. Riley had no hearing, vision, or brain fog issues prior to the adjustment by Dr. Cooper. Although they could not explain the exact injury and the mechanism, they felt the only explanation for Mr. Riley’s symptoms as Dr. Cooper’s care given the timing of the condition’s onset. Plaintiff claimed, as a result of Dr. Cooper’s negligence, he incurred nearly $200,000 in medical bills. Mr. Riley’s attorney asked for damages totaling $1,690,887.56, which included the medical bills, past and future pain and suffering and loss of a normal life. Dr. Cooper’s professional liability insurance limit provided $200,000 in potential coverage.
The jury deliberated for seven hours, and when they returned to deliver their verdict, several of the jurors were crying. The verdict was returned in favor of Dr. Cooper and against Mr. Riley. In speaking with jurors following the verdict, they expressed sympathy for Mr. Riley and his condition, but felt Mr. Riley failed to establish that Dr. Cooper’s treatment was negligent and that his negligence proximately caused Mr. Riley’s condition.
What Can We Learn?
Dr. Cooper did not document exactly what type of adjustment he performed at each visit, instead listed the areas of adjustment. He was able to convincingly inform the jury of the types of adjustments he uses in his practice, and that he does not perform an occipital lift, but having the techniques utilized documented would have greatly helped in his defense.
Also, simply because a patient claims they were injured by your care does not equate to you being liable for their injury. Further investigation is needed to determine the true onset of the symptoms, the source of those symptoms and the pathophysiological mechanism by which the condition came about. At trial, the Plaintiff is burdened with establishing not only that there was an injury, but also that the care provider was negligent, or deviated from the applicable standard of care, and that this negligence was the proximate cause of Plaintiff’s claimed injuries.
About the Author
Austin C. Monroe is a trial attorney handling cases in Illinois. These cases have included chiropractic, physician and other health care malpractice, trucking and automobile liability, construction and premise liability, and other claims for catastrophic injury. Mr. Monroe has been heavily involved in complex cases, from the filing of suit through trial.
Mr. Monroe has been named an “Emerging Lawyer” by Leading Lawyers, Law Bulletin Media, awarded to less than 2% of lawyers licensed to practice in Illinois. He has also been named a “Rising Star” by Super Lawyers, Thomas Reuters, an honor given to no more than 2.5% of lawyers in the state.
Although this case study is based on a real case, names, dates and details have been changed to protect patient and doctor privacy.