Transcript Meniere`s Disease Research

Cervical Specific
Protocol & Results for
300 Meniere’s Patients
New Zealand College of Chiropractic
Upper Cervical Conference
Dr. Michael T. Burcon
Grand Rapids, MI USA
BurconChiropractic.com
MenieresResearch.com
Prosper Meniere, MD
Director 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’s
Subjective 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 Dx
1. 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 Lillard
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.
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, DC
Son 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.”
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,” Merck
Manual.
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.”
Based upon 470 consecutive cases diagnosed by
ENT's, presenting to my practice for care of vertigo.
Meniere’s Disease
is a Syndrome
caused by
Whiplash
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 hyperactivation of the Trigeminal ganglion when
symptomatic on PET scan:
Meniere’s disease
Migraine headache
Trigeminal neuralgia
Bell’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.
Anterior Occiput
Normal
Posterior Atlas
Rear ended auto accident
Posterior C5
Subluxation
Right Head Translation
“T-Bone” Vehicular Accident
Chiropractic Treatment
Detailed 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-Rays
All 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
Lesion
Pre-Adjustment (C1 PIL)
Patient with Right
Unilateral Meniere’s
6 Weeks Post (Juxta)
Patient is off Medication
and Symptom Free
Upper Cervical Protocol for
Ten 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
VERTIGO
10
8
Frequency 6
and Intensity 4
2
0
Series1
1
2
3
4
Time Span
1. Pre-adjustment
2. 6 Weeks Post-adjustment
3. 1 Year Post
4. 2 Years Post
5. 3 Years Post
6. 4 Years Post
5
6
Are you comfortable
with patients traveling
thousands of miles…
Expecting a miracle?