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Category: Scientific Studies
Date 7-nov-1994
Title Doppler Sonography of Vertebral Arteries in Patients with Tinnitus
Author Mehmet Koyuncu, MD; Onur Çelik, MD; Cemal Lűceli, MD; Erol İnan, MD and Ahmet Öztürk.
Main Condition/ Disease  Hearing Disorders – Tinnitus
Source Auris . Nasus . Larynx (Tokyo) 22, 24-28 (1995)
Abstract As quoted: “The accuracy and the reliability of extracranial vertebral artery Doppler flow for the detection of the possible cause of the tinnitus was studied prospectively and Doppler findings were compared with controls. Vertebral artery measurements have been made in 28 patients (56 vertebral arteries) with tinnitus and 12 sex- and age-matched controls. Maximal flow velocity and mean flow velocity were measured and total vertebral artery flow was calculated by adding flows from the right and left sides. When compared with each other and controls, there was significant difference with respect to mean flow velocities of the right and left vertebral arteries in the patients with tinnitus (p<=0.05), and also total mean flow velocity between patients with tinnitus and controls (p<=0.05). It has been concluded that Doppler sonography gave useful information on the vertebral artery flow in patients with tinnitus.”
Summary According to Koyuncu et al in this paper “the blood supply to the brain stem, cerebellum, and medulla (containing the vestibular and cochlear nuclei, and the labyrinth) is the two vertebral arteries (VA), the basilar artery (BA), and their branches.” They state further that occlusions of arteries, which supply auditory mechanisms, are known to be “a common cause of tinnitus, vertigo, dizziness, etc.” [2]” and “If a dominant VA is occluded, then blood flow to the AICA (anterior inferior cerebellar artery) may be diminished markedly and both auditory and vestibular fluctuations and symptoms may occur. [3]” In other words the vertebral arteries are responsible for blood supply to the auditory pathway and if interfered with (compressed, occluded) are known to cause hearing disorders. This is very common throughout the research material. Doppler sonography can be used to detect even small occlusions. “The aim of the study”, according to Koyuncu et al, “was to investigate the flow of the vertebral arteries in patients complaining of tinnitus and compare results with the control subjects.” They note that “Tinnitus was bilateral and all patients had it in the head as well as in both ears.” The authors used color Doppler ultrasound to image and measure the flow in the vertebral arteries simultaneously. They explored the “extracranial portion” of the artery “behind the mastoid” process. The “mean vertebral artery follow velocity and maximal peak velocity were assessed” and they arrived at “a total or net vertebral artery flow” by measuring flow in both arteries. The results indicated that “The mean flow velocity was significantly different when comparing the right and left vertebral arteries of the patients with tinnitus (0.025<p<=0.05), and also the mean velocity of the total vertebral artery flow was significantly different in comparison with patients with tinnitus and controls (0.025<p<=0.05).” The maximal flows in the arteries showed “no significant difference”. Koyuncu et al go on to conclude that “normal vertebral arteries” show a peak flow of around 20 to 40 cm/sec, and “in cases with significantly diminished flow, this value will typically be less than 10 cm/sec [11]”. Maybe it can be concluded that altered flow through vertebral arteries may result in tinnitus, and maybe further we can say that this altered flow due to narrowing of the vertebral arteries may be as a result of occlusion of one or other of the arteries by ligaments or muscles of the cervical spine. I suggest this most likely occurs at either the skull base or the base of the neck at eth connection to the shoulders, due to an upper cervical misalignment between skull and atlas (C1) or atlas and axis (C2).
References See the paper for a full list of references used by Koyuncu et al.2. Yoo T.J., Shulman A, Brummet RG et al: Specific etiologies of tinnitus. Tonndorf J, Feldmann H, Vernon J. et al (eds): Tinnitus, diagnosis, treatment, p357, Lea and Febiger, Pennsylvania, 1991.3. Rock EH: Vascular dizziness and transcranial Doppler ultrasonography. Ann Otol Rhinol Laryngol 98:1-23, 1989.11. Bendick PJ, Glover JL: Hemodynamic evaluation of vertebral arteries by duplex ultrasound. Surg 3:523-530, 1986.
Keywords Vertigo, tinnitus, dizziness, vertebral arteries, Doppler sonography, basilar insufficiency

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