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Category: Other Papers
Date 16-sep-2003
Title Cervicogenic Otoocular Syndrome: A suspected forerunner of Meniere’s Disease
Author Burkhand Franz, Peter Altidis, Bandale Altidis, Greg Collis-Brown
Main Condition/ Disease  Hearing Disorders – Meniere’s Disease
Source International Tinnitus Journal, Vol. 5, No. 2, 125-130 (1999)
Abstract This study over 4 years involved 420 patients experiencing ear fullness, episodic vertigo, fluctuating hearing and tinnitus, the classic symptoms usually associated with Meniere’s disease. Of these, 182 patients had normal hearing, some Eustachian tube (et) dysfunction, mydriasis and interestingly ‘functional disorder of the upper cervical spine’; C1-C2 facet joint. A further 51 patients ‘mild’ hearing, some et dysfunction, mydrasis, elevated SP/AP ratio and again a ‘functional disorder of the upper cervical spine’. Above patients were given a diagnosis of Cervicogenic Otoocular (COO) Syndrome. Total of 187 patients had some sensorineural hearing loss, elevated SP/AP ratio, mydrasis, and ‘functional disorder of the upper cervical spine’, 186 of these had mild et dysfunction and diagnosed Meniere’s disease. Patients with COO responded to ventilation tube insertion, but Meniere’s patients’ response was mixed. The authors conclude that COO syndrome is suspected as being a forerunner to Meniere’s disease.
Summary If I read the abstract correctly, ALL 420 patients in the study had a ‘functional disorder of the upper cervical spine’; C1-C2 facet joint. Patients with these kinds of symptoms are observed on a regular basis, and some medical studies have suggested Eustachian tube dysfunction leading to endolymphatic hydrops being involved, whilst another [2] ‘suggested that a dysfunction of the autonomic nervous system is one of the causes of endolymphatic hydrops. Further Franz et al state, “a longstanding clinical observation maintains that a functional disorder of the cervical spine is frequently found in patients suffering from Meniere’s disease.” The authors assessed both the function of the Eustachian tube using 3 tests and function of the autonomic nervous system by observing patients’ pupil size. The facet joint dysfunction in the cervical spine was assessed by a physiotherapist, and included examination of “imbalance due to muscle shortening and weakness.” Further, brainstem audiological tests were carried out and the Meniere’s patients underwent a CT scan of the head.Almost all patients had visited either a physiotherapist or chiropractor at one stage in their lives, although there is no mention if the chiropractors were specialist upper cervical and I cannot draw any conclusions, from the paper, as to the type of treatment carried out by chiropractors or indeed physiotherapists. Very strikingly, 60% had a history of whiplash, which is of no surprise to me. Throughout medical literature, many whiplash victims exhibit symptoms associated with Meniere’s disease. The 182 patient group responded well to physiotherapy; of the 51 patient group, 43 responded to the insertion of a ventilation tube. Of the 187 patient group 46 had a tube inserted; 67.3% of the 43 had relief from their symptoms, 13.1% unchanged, with 19.6% improving.The authors conclude, “Eustachian tube dysfunction … contributes to the development of elevated SP/AP ratio.” Further, they argue there is “a strong argument that a Eustachian tube dysfunction upsets the SP/AP ratio.” And they think “a functional disorder of the upper cervical spine plays an important role…. and points toward a peripheral cause.” This peripheral cause may well lie in the “close [anatomical] relationship between the upper cervical ganglion and C1-C2 spinal nerves.” These same nerves innervate the “C1-C2 facet joints.” The authors conclude, “functional disorder of the upper cervical spine is regarded as a potential threat to the Eustachian tube, leading to a very mild dysfunction that upsets the SP/AP ratio of the inner ear.” Finally, it is suggested that COO may well be a forerunner to Meniere’s disease, but that this “can be determined only after long-term observations.”It would be interesting to investigate the effect of specific, precision upper cervical chiropractic on the patients in this study who did not respond to treatment and who later developed Meniere’s disease. C1-C2 facet joint dysfunction would seem to indicate the need for such therapy.
Keywords Meniere’s Disease, C1-C2 facet joint, Eustachian tube, vertigo, tinnitus, hearing loss, whiplash

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