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RESEARCH LIBRARY - DOCUMENT [40]

Category: Scientific Studies
Date 9-may-2003
Title Transcranial Doppler sonography in patients with Meniere’s disease
Author Damir Gortan MD, PhD; Division of Audiology; Dept. ENT, Zagreb University, Croatia
Main Condition/ Disease  Hearing Disorders – Meniere’s Disease
Source Acta Media Croatia, 53 (1999) 11-14.
Abstract Summary: Study to assess correlation between vertebrobasilar (VB) pathology and hearing disorders in Meniere’s disease patients using transcranial Doppler sonography (TCD). A group of 65 people with Meniere’s disease manifestation was analyzed and correlated with TCD of VB circulation. A control group of 50 people with cardiovascular dysfunction did not completely match the Meniere’s study group. Statistical analysis showed a direct significant correlation between people with Meniere’s disease and pathological TCD findings of VB circulation. It is thought that around 28% of patients with Meniere’s disease suffer from insufficient supply of the vertebrobasilar circulation. TCD is an objective method of choice for the vascular diagnosis of hearing loss in patients with Meniere’s disease.
Summary Introduction: Gortan states “vascular lesions.. can lead to the onset of a triad symptom that includes hearing loss, tinnitus and vertigo.” These as you will come to realise are the classic trio of symptoms found in sufferers of Meniere’s disease. Gortan says “A potential etiology is vascular insufficiency in the inner ear supply.” Further “We believe that patients with insufficient VB circulation may also be potential candidates for the development of Meniere’s disease.” And “we speculate that vascular impairment in VB circulation, may be one of the etiologies of Meniere’s triad.”The study objective was to show and “assess the correlation between the velocity of VB circulation … as determined by using Doppler ultrasonography with the occipital access.” Gortan quotes a study by “Fujuta et al, which found abnormal results in 32% of 150 cases of vertigo using Doppler ultrasonography in determining circulatory velocity in the vertebral artery. Claussen et al found vascular lesions in 44% of 3600 patients with impaired hearing and equilibrium.” In other words using TCD as a diagnostic tool, they found “impairment of VB circulation is one of the frequent etiologies of hearing loss, tinnitus, and vertigo.”Patients and Methods: Gortan selected 65 patients with Meniere’s disease, and a control group of 50 people who had none of the Meniere’s triad but with cardiovascular dysfunction. TCD was used to “evaluate circulation in the basilar artery, left and right vertebral arteries, and posterior cerebral artery.”The statistical results of Gortan’s study show TCD “yielded abnormal results in ~28% of 65 Meniere’s patients and 16% in the control group of 50. Gortan states, “It [the results] would suggest the existence of latent vascular insufficiency in Meniere’s patients in cochleovestibular circulation due to insufficient vertebrobasilar supply. He goes on to say “The cochlear is known to be exclusively supplied through the internal auditory artery, inferior anterior cerebellar artery and basilar artery.” In conclusion he states, “These findings suggest that latent vascular vertebrobasilar insufficiency in Meniere’s disease is due to cochleovestibular circulation insufficiency.”This study reaffirms my suggestion that problems with blood flow through the vertebral arteries could be involved in hearing disorders. What the study doesn’t do is recommend an appropriate treatment protocol. It would be interesting to add TCD to upper cervical chiropractic analysis on Meniere’s and other hearing disorder’s patients. Where are the vertebral arteries (VA)? Answer: they run from the subclavian arteries at base of the neck in the shoulders and enter the foramen (holes) in the C6 vertebra (Note: in some rare cases it has been found they enter at C7). They travel the length of the cervical spine (neck), exit through the foramen in the atlas (C1) transverse process, pass across a groove on the atlas, pierce the posterior occipito-atlantal ligament, bend upwards into the foramen magnum and become part of the basilar artery which then forms part of the cerebral arterial circle of Wills (blood supply to the brain). Very tortuous loop me thinks? It would be reasonable to postulate that subluxations of the cervical spine (I suggest occiput to atlas; and possibly atlas to axis) could compress, occlude or traction the VA, thus causing faulty circulation. It would then be a reasonable assumption that if this is implicated in Meniere’s disease, that a well directed ‘specific’ upper cervical chiropractic adjustment might well reverse this disease. Various papers and stories will attest this to be the case.
References Refer to Gortan study.5. Gortan D, Berdnik-Gortan K. Vertigo in whiplash injuries of cervical spine. Neurol Croat 1994; 43: 153-165
Keywords Meniere’s Disease, vertigo, tinnitus, hearing loss, vertebrobasilar circulation,transcranial Doppler
 

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