CERVICAL SPECIFIC PROTOCOL FOR 100 MENIERE

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CERVICAL SPECIFIC PROTOCOL FOR 100 MENIERES
PATIENTS

• THE 25th ANNIVERSARY OF THE
• PROSPER MENIERE SOCIETY
• The 12th International Symposium and Workshops on
  Inner Ear Medicine and Surgery

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Prosper Meniere 1861

• Director of the Paris Institute for Deaf-Mutes
• First described the condition that was later
  named for him

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Andrew Taylor Still, MD, Founder of Osteopathy

• Watched three of his children die of spinal
  meningitis in the 1870s, after being treated by
  having their skin burned with hot irons and
  having leeches applied to their open wounds
• Bloodletting was the most common medical
  treatment at that time

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Wilhelm Conrad Roentgen

• Took the first x-ray in October 1895 of his wife
  Frau Berthas hand
• Awarded the first Nobel Prize in Physics 1901
• Later, his wifes hand was amputated and soon
  after she died of cancer caused by his experiments

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Harvey Lillard, September 18, 1895

• Black male janitor presented with almost total
  deafness
• Case history he was working in a stooped,
  cramped position when he felt something pop and
  heard a crack in his neck, immediately losing his
  hearing

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D.D. Palmer, Magnetic Healer

• Discovered a bump on the back of Mr. Lillards
  neck at level of C2 (Axis)
• Performed the first chiropractic adjustment
• Within ten minutes Mr. Lillards hearing was
  fully restored

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BJ Palmer, DC

• Son of DD Palmer
• Took over Palmer Chiropractic College from his
  father
• Started researching upper cervical specific
  chiropractic in 1931

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William G Blair, DC

• Started researching the atlanto-occipital joints
  in 1951
• Started teaching his technique in 1961
• The Blair technique is the only non-orthogonal
  upper cervical specific technique today

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2 Superior Articulations of C1 (Atlas)

• Before you can know the correct vertebral
  positions, you must first know all the existing
  asymmetries and malformations, William Blair.

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Atlas Subluxation

• Subluxated articular misalignments are analyzed
  as they displace the neural rings, thereby
  occluding the neural canal and compromising the
  cord space, Blair.

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My Own Experience

• Dr Perry Rush, instructor at Sherman College of
  Straight Chiropractic, introduced me to the Blair
  Technique in 1995, and gave me my first upper
  cervical specific adjustment.

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4 Blair Atlas Subluxation Listings

• Anterior and Superior on the Right (ASR)
• Anterior and Superior on the Left (ASL)
• Posterior and Inferior on the Right (PIR)
• Posterior and Inferior on the Left (PIL)

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Blair X-Ray Analysis of Atlas

• If the atlas tracts up or down on the left
  condyle, you will be able to see the misalignment
  being created and demonstrated on the right
  condyle.

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Over lap (ASR) and the under lap (PIL) of C1 in
relation to Occiput.
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Next we have atlas beneath the occiput. Atlas
tracts along the left condyle and will show the
creation of an anterior superior right (ASR)
subluxation first. It then follows through and
shows
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PIL (Posterior inferior on the left)
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Listings Determined by X-Ray

• View lateral edges of the two articulations
  between Occiput and Atlas on Nasium and AP Open
  Mouth or Oblique Protracto Views
• Overlapped Atlas determines Anterior and Superior
  listing on side of that articulation
• Underlapped Atlas determines Posterior and
  Inferior Listing on opposite side of subluxated
  articulation

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Before C1 PIL After C1 Juxta
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Lateral Cervical of Menieres Patient

• Note lack of normal cervical curve with kink
• Note posterior atlas
• The only cause of these two findings on an x-ray
  is whiplash

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Dr. Karel Lewit, Czechoslovakian neurologist
Typed 120 Cases in 1961

• Type I (a)- Menieres Disease with no neck pain
• Type I (b)- Menieres Disease involving neck
  symptoms
• Type II- Cervical Vertigo (dizziness after head
  movements)
• Type III- Mixed Cases of Type I Type II
  

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Lewits Proposed Causes of Dizziness

• Inner ear disorders
• Brain diseases
• Blood supply interference to the inner ear
• Direct nerve interference with balancing reflexes
• Combination of the above causes

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• Chiropractors refrain from assuming that the
  site of a symptom is the site of its cause. When
  an injury occurs in one area, the normal balance
  is disrupted, the body makes compensations and
  structural patterns are altered. Due to the laws
  of gravity, a new state of dynamic equilibrium is
  created.

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Other possible Morphologies of Atlas Subluxation
causing Menieres

• Irritates the nucleus of CN VIII, the
  Vestibulocochlear
• Irritates the nerve root of CN VIII
• Diminished blood flow from the vertebral artery
• Increased CSF pressure via the cochlear aqueduct
• Pressure on auditory tube
• Ears at different heights/angles due to kink in
  the neck

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My First Menieres Patient 1998

• 85 y.o. white female
• Case history whiplash in 1940s, R sided
  Menieres since 1954, colostomy and mastectomy
• Presented with vertigo, tinnitus, cervicalgia,
  LROM L arm, blindness L eye, numbness L thumb, R
  shoulder P!

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The Merck Manual

• Menieres disease is associated with
  endolymphatic hydrops
• The cause is unknown
• Treatment is empirical
• Question? What causes the edema that causes the
  dilation of the membranous labyrinth?

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Burcon Chiropractic Research

• 2000- Upper Cervical Protocol for Three Menieres
  Patients,
• Journal of Vertebral Subluxation Research
• Burcon Chiropractic
• 4362 Cascade Road, SE
• Grand Rapids, MI 49546
• [phone]
• drmburcon_at_aol.com
• www.BurconChiropractic.com

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Upper Cervical Protocol for Ten Menieres
Patients

• Presented at the 9th Annual Vertebral Subluxation
  Research Conference, Sherman College of Straight
  Chiropractic in 2001

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Dynamic Chiropractor 2003

• Parkinsons Disease, Menieres Syndrome,
  Trigeminal Neuralgia and Bells Palsy One
  Cause, One Correction

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Upper Cervical Protocol forTen Menieres Patients

• Same paper published in Upper Cervical
  Subluxation Complex, A Review of the Chiropractic
  and Medical Literature, by Kirk Ericksen.
  Lippincott, Williams Wilkens, 2004

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Upper Cervical Protocol for 30 Menieres
Patients

• 2005, Los Angeles, CA
• Poster presentation
• Exhibitor

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WZZM Channel 13

• ABC affiliate in Grand Rapids, MI
• Burcon Chiropractics Menieres research featured
  on the 6 and 11 Oclock News in 2005
• Resulted in 60 new Menieres patients

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Protocol for 100 Menieres Patients

• Extensive case history that includes at least two
  episodes of vertigo lasting at least 20 minutes
  each
• Sensorineural hearing loss confirmed by
  audiometry
• Tinnitus and/or
• Perception of aural fullness
• Patient must provide letter from ENT specialist
  confirming diagnoses with copy of test results

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Demographics

• 54 Females
• 46 Males
• Youngest 9 y.o.
• Oldest 93 y.o.
• Mean age 53 y.o.

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Cervical Syndromes

• Derifield/Thompson Cervical Syndrome Test- Hold
  patients shoes with thumbs under the heel, while
  applying very mild cephalic pressure. Lift the
  legs one inch off from the table, keeping the
  shoes one inch apart. Compare the welts to
  estimate the leg length differential. Notate
  differential of short leg to closest 1/8 inch.
  Instruct patient to slowly turn their head to the
  right, then to the left. If the legs change
  length only while turning to the right, notate
  the amount of change as a right cervical syndrome
  (RCS). If the legs change length only while
  turning to the left, notate the amount of change
  as a left cervical syndrome (LCS). If the leg
  length changes while turning the head in both
  directions, notate the total amount of change as
  a bilateral cervical syndrome (BLCS). If there
  is no change in leg length when the head is
  turned, there is no cervical syndrome. Perform
  following tests to determine which upper cervical
  vertebrae is subluxated.

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Orthoneuro Examination

• Modified Modified Prill Cervical Leg Check
  Protocol
• Interactive presentation at the 11th Annual
  Vertebral Subluxation Research Conference
• Determines which cervical vertebra to adjust
• Intraexaminer repeatability tested very good
• Interexaminer repeatability tested excellent

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Modified Blair X-Ray Protocol

• All 100 consecutive Menieres patients tested
  positive for upper cervical subluxations
• 3 Cervical x-rays taken and analyzed Lateral,
  A-P Open Mouth and Nasium
• All 100 film studies showed evidence of upper
  cervical subluxation and whiplash, although
  cervical trauma was denied by over 50 of
  patients.

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Level of Major Upper Cervical Subluxation

• C1 (Atlas) in 96 out of 100 consecutive cases
• C2 (Axis) in 4 out of 100 consecutive cases

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Observation

• When major symptom is vertigo with nausea, atlas
  is the major subluxation
• When major symptom is tinnitus with ear fullness,
  axis is the major subluxation

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Atlas Listings for 96 Menieres Patients

• 0- Anterior and Superior on opposite side of bad
  ear
• 1- Anterior and Superior on side of bad ear
• 2- Posterior and Inferior on side of bad ear
• 9- Posterior and Inferior bilaterally
• 84- Posterior and Inferior on opposite side of
  bad ear

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Most Significant Finding

• The primary cause of unilateral Menieres disease
  is an atlas subluxation with a listing of
  posterior and inferior on the opposite side of
  the involved ear
• This means that the atlanto-occipital
  articulation is subluxated on the side of the
  involved ear

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Improvement at 6 Weeks
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Negative Side Effects

• The only negative side effect noted was an
  increase in the frequency and magnitude of
  headaches in 3 patients, increasing in average
  from 2.3 to 5.7
• Headaches improved with 30 patients, decreasing
  in average from 5 to 2
• Headaches remained unchanged in 67, with the
  average staying at 3

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Improvement at 3 Months 6 Years (80 out of 100
Patients Responded)
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Other Improvements
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Comments

• I have felt safe enough to drive again.
• Weaned off my meds with no Menieres symptoms!
• I do not fall down anymore.
• I do not snore anymore.
• My wife says that I am easier to get along
  with.

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Suggestion

• Next time a patient presents with Menieres
  symptoms
• And brain tumors and MS are ruled out by MRI
• Refer patient to an upper cervical specific
  chiropractor
• Before resorting to surgery