Tuesday, November 3, 2009
Meniere's Disease and Upper Cervical Care
The basics of Meniere's and a little background.
by Michael T. Burcon, D.C.
Meniere's disease, or syndrome, is characterized by vertigo or dizziness, and some combination of four associated symptoms: nausea, inner ear pressure, low-frequency hearing loss and tinnitus. The cause of Meniere's disease is unknown, and the pathology is poorly understood. The attacks of vertigo appear suddenly, last from a few to 24 hours, and subside gradually. The attacks are associated with nausea and vomiting. The patient may have a recurrent feeling of fullness in the affected ear, and hearing in that ear tends to fluctuate, but worsens over the years. Tinnitus may be constant or intermittent.
Both the vestibular and cochlear nerves join the internal auditory meatus to form CN VIII, which enters the brain stem at the cerebellopontine angle. Meniere's is considered a common peripheral ailment, however it is often overlooked that although within the substance of the brain itself, the root entry zone of the eighth cranial nerve is considered a peripheral vestibular structure. An atlas subluxation may irritate this nerve root by compromising the size of the neural canal space. Rosenberg reported a case of cervical cord impingement observed with magnetic resonance imaging, bringing on signs and symptoms of medulla compression.
Also, dizziness related to perturbations in information received from proprioreceptors in the neck that feed into the vestibular system are not usually taken into consideration. This is a common result of even minor whiplash injuries. One theory has proposed that irritation of sympathetic nerves can elicit spasms within the vertebral artery, leading to decrease in blood flow to the brain stem.
The vertebral arteries reach the interior of the skull by ascending through the transverse foramina of the cervical vertebrae, turning medially along the upper surface of the posterior arch of atlas and then penetrating the posterior atlantooccipital membrane and the underlying dura to enter the subarachnoid space. Subluxation of atlas may diminish blood flow through the vertebral arteries and their intracranial branches, which supply the spinal cord, medulla, cerebellum and inner ear via the labyrinthine artery.
Finally, internal pressures of the body, specifically that of the cerebrospinal fluid, are rarely taken into consideration. The fluid spaces of the inner ear are connected to the CSF by the cochlear aqueduct, believed to be patent in most humans, so that pressure changes in CSF are transmitted directly to the ear.
The auditory tubes, responsible for equalizing pressure in the middle ears with the atmosphere, are controlled by the Tensor veli palatini and Salpingopharyngeus. These muscles are innervated by the Pharyngeal nerve plexuses, which have a contribution from Cranial Nerve XII. The hypoglossal canal lies under cover of about the middle of each occipital condyle, intimate to atlas.
Most normal individuals cannot appreciate the devastating impact of vertigo. The patient perceives that the world is spinning around them. Vertigo disrupts every aspect of life, since the patient loses the ability to do anything normally, especially when movement is involved. It can totally incapacitate the individual, often confining them to bed.
During my first year of practice, three patients diagnosed with Meniere's started under my upper cervical specific chiropractic care. All three improved dramatically after their first specific chiropractic adjustment of their top cervical vertebra, atlas. Two years later, they remain symptom free.
Over the next few days we will share the specifics of each case.