Cervical Specific Protocol & Results for 300 Meniere’s Patients

Cervical Specific Protocol & Results for 300 Meniere’s Patients

New Zealand College of Chiropractic Upper Cervical Conference

Dr. Michael T. BurconGrand Rapids, MI USABurconChiropractic.comMenieresResearch.com

Prosper Meniere, MDDirector of the Paris Institute for

Deaf Mutes

First to describe condition in 1861 that was later named after him.

Upon autopsy, it was later discovered that his first MD

patient did not have Meniere’s disease!

Medical Dx of Meniere’sSubjective diagnosis by exclusion:

Blood tests to rule out chronic inner ear infections

Brain MRI to rule out tumors or MS

Audiogram to test for low frequency hearing loss

Electronystagraphy measures Cochlear branch of CN VIII with alternating hot and cold water and air

Electrocochleography creates a graph from a needle that pierces the ear drum to access the inner ear

VEMP Test (Vestibular Evoked Myogenic Potential)

Meniere’s Disease Dx1. At least two spontaneous episodes of vertigo lasting at least 20 minutes.

2. Sensorineural low frequency hearing loss confirmed by audiometry.

3. Tinnitus and/or perception of aural fullness.

Medical Treatment

Avoid salt, caffeine, nicotine, alcohol and stress

Antivert, diuretics, anticholinergics, antihistamines, barbiturates, antidepressants and/or sleeping pills

Steroids (Oral or injected into ear)

Inner ear hair cell destruction with Gentamicin

Endolymphatic shunt to drain endolymph

Labyrinthectomy (Inner ear destruction)

Vestibular neurectomy (Brain surgery to sever nerve)

Injections

Endolymphatic Sac Surgery

Success rate after 2 years

Vertigo eliminated: 38%

Placebo effect: 35%

Vestibular Dissection

Inner Ear Destruction

September 18, 1895

Harvey LillardBlack male janitor presented with almost

total deafnessCase 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.

D.D. Palmer, D.C., Magnetic Healer

Discovered a bump on the back of Mr. Lillard’s neck at the level of C2 (Axis)

Performed the first chiropractic adjustment, restoring Harvey’s hearing.

BJ Palmer, DCSon of DD Palmer

Took over Palmer Chiropractic College from his father

Started researching upper cervical specific chiropractic in

1931

””Chiropractic is specific, or it is nothing.”Chiropractic is specific, or it is nothing.”

Endolymphatic Hydrops

“The accumulation of the fluid of the membranous labyrinth of the ear, thought to be caused by the over production or under absorption of that fluid,” MerckManual.

Question: What is the Cause of the problem?

Meniere’s is not an inner ear disease. It is a middle ear syndrome highlighted by Eustachian tube dysfunction, caused by an upper cervical subluxation complex.

Ménière's disease not only includes the symptom complex consisting of attacks of vertigo, low-frequency hearing loss, and

tinnitus but comprises symptoms related to the Eustachian tube, the upper cervical

spine, the temporomandibular joints, and the autonomic nervous system.

“Insertion of a middle-ear ventilation tube can temporarily alleviate Ménière's symptoms,

suggesting Eustachian tube dysfunction (ETD) is a contributing feature. Clinical practice also shows that

treating disorders of the upper and lower cervical spine and temporomandibular joints can lessen Ménière's disease symptoms. Similarly, stellate ganglion blocks can be beneficial in controlling Ménière's disease symptoms, highlighting the

influence of the autonomic nervous system. In this hypothetical reflex pathway, irritation of facet joints

can first lead to an activated anterior cervical sympathetic system in the mediolateral cell column; simultaneously leading to an axon reflex involving

nociceptive neurons, resulting in neurogenic inflammation and the prospect of ETD. This reflex

pathway is supported by recent animal experiments.”

Meniere’s Disease Meniere’s Disease is a Syndrome is a Syndrome

caused by caused by WhiplashWhiplash

Based upon 470 consecutive cases diagnosed by ENT's, presenting to my practice for care of vertigo.

It takes an average of 15 years from the time of the trauma before

the onset of symptoms.

WHIPLASH:

Cervical subluxation complex comprised of vertebral facet fixation with the skull

positioned anteriorly and tilted or translated laterally, creating neurogenic inflammation resulting in peripheral autonomic nervous

system sympathetic irritation, reduced vertebral artery blood and CSF flow,

increased mandibular branch CN V motor activity affecting the tensor veli palatini,

causing Eustachian tube and TMJ dysfunction and irritation to the nucleus of CNVIII.

All of the following conditions exhibit hyper-activation of the Trigeminal ganglion when

symptomatic on PET scan:

Meniere’s diseaseMigraine headache

Trigeminal neuralgiaBell’s palsy

Additionally, patients with one of these conditions are twice as likely to experience another one of these

conditions in their lifetime.

More than 9 out of 10 benefit from cervical specific chiropractic care.

Where would this 29 year old female patient be referred?

Neurologist or ENT?

Left sided face pain, sore throat, left ear pain, pain radiating down left arm, balance problem, trouble swallowing, low back pain, hip pain, cervicalgia, hearing

problem, insomnia and sensitive lips.

It is called an upper cervical subluxation complex,

because it is complex!

There is no one chiropractic technique

that works best…

for every patient,every time.

Normal

Anterior Occiput

Posterior Atlas

Rear ended auto accident

Posterior C5 Subluxation

Right Head Translation

“T-Bone” Vehicular Accident

Chiropractic TreatmentDetailed case history including letter from ENT

and copies of tests used to DX MD

Titronics TyTron C-3000 cervical thermographs

Modified, modified Prill leg check analysis

Modified Blair Cervical X-rays

Adjustments as determined by pattern work

15 minute rest after adjustment with re-check

Thermography

Pre and Post Adjustment Graphs of Patient with Right Unilateral Meniere’s

C5 Adjusted PIL with Pierce technique

Atlas adjusted PIL with Blair technique

Followed by 15 minute rest before re-scan

William G Blair, DC

Started researching the atlanto-occipital joints in 1951

The Blair technique is the only non-orthogonal upper cervical

specific technique

Clarence E. Prill, D.C.1925 - 2005

The Prill Chiropractic Spinal Analysis Technique did not utilize x-rays

Blair modified Prill checks from arms to legs

“Modified” Modified Prill Leg Check Protocol

Interactive presentation at 11th Annual Vertebral Subluxation Research Conference

Intraexaminer repeatability tested very good

Interexaminer repeatability tested excellent

Cervical Syndromes“Most significant indication of upper cervical subluxation,” Dr Burcon.

Derifield/Thompson Cervical Syndrome Test- Hold patient’s 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.

First Published by Ruth Jackson, MD in 1956

Modified Blair X-RaysAll 300 consecutive Meniere’s patients tested positive

for upper cervical subluxations.

3 Cervical X-rays taken and analyzed:Lateral, A-P Open Mouth & Nasium.

All 300 film studies showed evidence of upper cervical subluxation and whiplash, although cervical

trauma was denied by over 50% of these patients.

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)

Atlas listings for 300 Patients

0- Anterior and Superior on opposite side of involved ear

18- Anterior and Superior on the side of the involved ear

12- Posterior and Inferior on the side of the involved ear

270- Posterior and Inferior on the opposite side of the involved ear

Levels of Cervical Involvement

Upper Cervicals

When atlas is the major subluxation, vertigo with vomiting are the major symptoms.

When axis is the major subluxation, hearing loss, ear fullness and tinnitus are the major symptoms.

Pairs of Subluxations

Atlas and C5 most common

Axis and C6 next most common

Both pairs are the next most common:these patients typically can not drive or work. They rarely leave their homes.

Side Posture with Drop Upper Cervical Adjustment

BJ Palmer, DC

Pre-Adjustment (C1 PIL) 6 Weeks Post (Juxta)

Patient with Right Patient is off Medication

Unilateral Meniere’s and Symptom Free

Lesion

Upper Cervical Protocol forTen Meniere’s Patients

Same paper published in Upper Cervical Subluxation Complex,

A Review of the Chiropractic and Medical Literature, by Kirk Ericksen. Lippincott, Williams & Wilkens, 2004

0

24

68

10

Frequency and Intensity

1 2 3 4 5 6

Time Span

VERTIGO

Series1

1. Pre-adjustment

2. 6 Weeks Post-adjustment

3. 1 Year Post

4. 2 Years Post

5. 3 Years Post

6. 4 Years Post

Are you comfortable with patients traveling thousands of miles…

Expecting a miracle?