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Up C Spine - Is your Head on Straight?

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Date	14-jan-2004
Title	Cervical vertebra-induced hearing and equilibrium disorders. Recent clinical aspects
Author	Elies, W.-HNO Clinic; ENT Department of Tüebingen University
Main Condition/ Disease	Hearing Disorders - vertigo, tinnitus, hearing loss
Source	HNO. 1984 Dec;32(12):485-93
Abstract	As quoted: "The contribution of cervical spine disorders to cochleovestibular symptoms was based on the evaluation of patients complaining of dizziness and/or inner ear hearing loss, treated in the ENT Department of Tubingen University between 1977 and 1982. Cervicogenic vertigo was provoked by movements of the cervical spine, but the latter rarely caused tinnitus and never induced hearing loss. The diagnosis between a vascular or proprioceptive nystagmus may be made on the presence of lesions of the cervical spine. These are disorders of the cranio-cervical or the thoraco-cervical region especially and much less often due to osteochondrosis of the vertebrae. The findings of a cervical osteochondrosis has no diagnostic value unless vertigo is provoked by head movements. In cervical vertigo the thoraco-cervical region should be examined to prove a thoracic outlet syndrome. In selected cases operative treatment is possible, eg. transoral resection of the dental process of the axis, resection of the posterior arch of the atlas, myotomy of the anterior scalenus muscle or decompression of the vertebral artery."
Summary	Elies suggests in this paper that in cases where the patient has vertigo or vertigo accompanied with deafness, the cervical spine should be examined for causes. Elies indicates that the close antomic relationships within the c-spine to the vertebral arteries, sympathetic nervous system fibres and propprioception can influence changes in the vestibulo-cochlear (hearing & balance) system. Further the function of vertebral arterial flow of oxygenated blood can be impaired. This impaired, reduced flow Elies suggests cannot be compensated in the 'circle of wills'. Certain neck movements can result in impingement of blood supply, which can result in slight discomfort to serious neurological symptoms. Symptoms related to hearing and imbalance can be related to irritation to the sympathetic system in addition to vascular reasons. Thus the two main reasons appear to be either of vascualr compression origin or irritation of proprioceptoprs in the upper cervical spine. In the paper Elies also found a correlation between some patients with scoliosis, poor neck posture and vestibular cochlear symptoms. This seems to correlate also with the understanding of upper cervical chiropractic observations. Any malformations (congenital or otherwise) as well as subluxations of the cranio-cervical junction, thus reducing the space for neurological and vascular structures can cause neurological and otological symptoms. Elies also discusses other causes which appear to mimic the findings of Fernandez-Noda (see my site) regarding cerebral thoracic outlet syndrome (CTOS), with compression of blood supply and nerve plexus resulting in CTOS-like symptoms independent of movement of the neck. Within 18 months the author found 12 patients to exhibit vestibular cochlear symptoms as a result of compression by scalenes. A scalenectomy in 3 patients resulted in reduced symptoms, again similar to the work of Fernandez-Noda. In the author's opinion proprioceptive vertigo is best treated with conservative therapy and chiropractic has special mention.
Keywords	Vertigo, tinnitus, hearing loss, cerebral thoracic outlet syndrome, chiropractic

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