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Category: Scientific Studies
Date 19-dec-2003
Title The Cervical vertebra as a cause of hearing disorders
Author M. Hülse – Professor of ENT, Faculty of Clinical Medicine Mannheim of the University of Heidelberg
Main Condition/ Disease  Hearing Disorders - Menieres Disease
Source HNO (1994) 42:604-613;This paper was presented in part at the German HNO Conference in Muenster 1993
Abstract Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that hearing disorders are reversible… the therapy of choice is chiropractic manipulation of the upper cervical spine.” M. Hülse, Professor of ENT, Heidelberg University.
Summary This paper by Hülse cannot be underestimated for its importance to chiropractic. Early in my research I came across it but I only had the abstract. I purchased the paper, which was in German. It’s taken me some time to receive the translation into English and following is my summation of the paper. When you put the results of this study and a multitude of others together with the Harvey Lillard adjustment of 1895 (see Green Books this newsletter), you will soon come to appreciate that despite some medical opinions to the contrary, dysfunction of the upper cervical spine may well be one cause of an abundance of hearing disorders like tinnitus, vertigo, otlagia (ear pain), fullness, deafness, otitis media and Meniere’s disease. To dismiss the link just because it is difficult to find an anatomical link is poor investigative research. The evidence is there in one form or another. You just have to open your mind, and investigate it for yourself and you don’t have to be a medical professional to read and understand medical papers. You’ll probably need help with the medical terms used, but over time you can gain that knowledge also.

If upper cervical chiropractic, as mounting evidence would suggest, has a positive impact for people suffering from these conditions, then research funds should be directed towards implementing well constructed studies using upper cervical chiropractic as a treatment.

In his paper, Hülse starts by listing three points of view as to the classification of hearing disorders known as ‘cervical syndrome’. These classifications being a vascular syndrome, resulting from a narrowing of the vertebral artery(s), a neural syndrome with irritation of the sympathetic nervous system, and in the Bartschi-Rochaix syndrome, being a disturbance in the functionality of the arteries and nerves, caused by ‘myogenic or articular dysfunction’.” I think that it is very possible that all three ‘syndromes’ could be as a direct result of a vertebral subluxation C0-C1-C2 including VBI.

According to Hülse, “scientific proof does not exist for ‘neurologic cervical syndrome’”, and thus treatment protocols are non-existent, although there are cases[2] where chiropractic adjustments have improved VBI. Jensen’s article describes two such cases, where the authors examined cerebral artery flow in the twp patients, both of whom exhibited signs of vertebrobasilar ischemia prior to chiropractic treatment. The adjustments entailed non-rotary cervical adjustments and a ‘diversified’ adjustment technique to the thoracic spine. The authors postulate the adjustments had the affect of normalizing the sympathetic nervous system, allowing for change in the vasospastic cerebral vascular arteries. Improvements were measured using Doppler sonography some months post adjustments. Improvements included tremor reduction and improved peak systolic flows in common carotid and vertebral arteries.

Hülse lists symptoms as a result of cervical syndrome as being “headaches, dizziness, vision disturbances, hearing disturbances and subjective ear droning.” Anyone who has studied it knows that these symptoms are consistent with people who have suffered whiplash injury. The author goes on to discuss there being quite a deal of research which links ‘vertebrobasilic’ insufficiency (VBI) or reduced blood flow through the vertebral and basilar artery system, to cochlear (inner ear) related symptoms and he goes on to state that “a forced posture with rotated head leads to dramatic decline in hearing ability”. He cites Boenninghaus (1959), Brusis[3] as explaining this hearing decline as a result of “a reduction of blood flow to the inner ear is caused by the awkward/wrong posture of the cervical spine region” and that “complete deafness has also been described.” Very interesting! Awkward or poor posture leads to a reduction in blood flow to the inner ear and as a consequence hearing disorders. (Note: regarding reduced blood flow to the inner ear, see papers[4],[5] in the www.upcspine.com research section).

According to the author “hearing disturbance can reach a mid to high level of severity” and “complete deafness has also been described”. It would seem that success via manual (chiropractic therapy) has been achieved and that “within minutes or hours of manual therapy, a significant improvement of blood flow can be achieved in the vertebral artery”. This leads Hülse to postulate that because these conditions appear to reverse after chiropractic intervention, something other than VBI is the cause of the symptoms. I think he concludes this because VBI may cause irreversible cochlear damage.

He suggests a proprioceptive influence through irritation of proprioceptors and nociceptors at the head to neck joint [cranio-cervical junction], and cites the movement segments C0/C1, C1/C2 and C2/C3 as being involved. That is the joint receptors in the upper cervical spine. A functional disturbance in these joints can lead “to a change in sensory and motor nerves and their regulatory capabilities”. He further states there are “proven connections from the neck to the core areas of the trigeminal, vestibular cochlear and vagus nerves”. Thus joint dysfunction can result in disturbance to the signals of these areas. He says that “lasting complaints” can follow “cervical trauma” and “can be explained as a functional deficiency in the cervical region. The therapy of choice with this type of neck trouble is chiropractic therapy”. Further Feldman[6], he notes, writes, “Hearing disturbance is one of more often observed cochlear vestibular damage post whiplash trauma.”

Of the 62 patients Hülse studied 24 had low frequency (up to 1000Hz) deafness, 33 had deafness at 5-10dB, and 5 had feeling of ear pressure, and subjective deafness without verification from audiometry. Audiometric tests indicated that the non-subjective hearing loss was no longer evident following chiropractic therapy.

“Proof that a functional deficit of the upper cervical spine causes the deafness, is because of successful manual therapy/chiropractic management. Not only do the subjective cochlear complaints disappear, but also low frequency deafness is no longer evident.” M. Hülse, Professor of ENT, Heidelberg University.

For example, one 43-year-old patient who was 13 weeks post whiplash from an automobile accident had “distinct proprioceptive cervical nystagmus of the left ear. After successful chiropractic treatment, not only did she not have vestibular symptoms, but her entire cochlear related symptoms had disappeared.”

Hülse also carried out retrospective examinations on 259 patients over a 5-year period. These patients had a functional deficit of the upper cervical spine, but had no primary deafness. With a battery of ENT and neuro-otological tests having been performed, and after ruling out other disturbances like VBI and more central nervous system related conditions, Hülse says, “it can be said that cochlear symptoms are linked to functional deficits in the upper cervical spine region.” Thus symptoms like deafness, tinnitus, a feeling of pressure in the ears, ear droning and otalgia are not unusual symptoms of functional deficits of the upper cervical spine.

In summary, Hülse concludes that deafness at low frequencies can be as a result of functional deficits of the upper cervical spine and …

“Cochlear symptoms are full reversible and curable if the functional deficit of the upper cervical spine is successfully approached with chiropractic treatment.” M. Hülse, Professor of ENT, Heidelberg University.

One thing that these studies do not mention however, is exactly what chiropractic manipulative technique was used. It would seem that it would make sense to mention this and to determine if there are any correlations between a particular technique and more or less successful reversal of the condition. Either way this is a powerful paper and adds weight to what is already known throughout many chiropractic offices throughout the World, that is, some hearing disorders can be helped with well-delivered and precision upper cervical chiropractic therapy.
References 2. Jensen TW. Vertebrobasilar ischemia and spinal manipulation. J. Manipulative Physiol Therap 2003;26:443-7.
3. Brusis T (1978), Sound deafness and its meaning. Demeter, Graefelfing. (see paper for more detail on this reference)
4. Mehmet Koyuncu, MD; Onur Çelik, MD; Cemal Lűceli, MD; Erol İnan, MD and Ahmet Öztürk: Doppler Sonography of Vertebral Arteries in Patients with Tinnitus ; Auris . Nasus . Larynx (Tokyo) 22, 24-28 (1995)
5. Damir Gortan MD, PhD; Division of Audiology; Dept. ENT, Zagreb University, Croatia: Transcranial Doppler sonography in patients with Meniere’s disease; Acta Media Croatia, 53 (1999) 11-14
6. Feldmann H (1984); “The opinion of the ENT specialist”

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