Thursday, September 21st, 2017

Welcome!

June 1, 2009 by  
Filed under Uncategorized


Picture1All five Health Talk shows now on YouTube on Burcon Chiropractic Channel. https://www.youtube.com/channel/UCqBwa5H3YEf56u7uxpJO3FQ Trailers on Michael Burcon Channel. Complimentary DVDs of last year’s seminar available for $5 shipping and handling. Please click on green Health Talk icon above. Latest news on Facebook at Burcon Chiropractic Research Institute. Michael T. Burcon, BPh, DC started researching Meniere’s disease (MD) fifteen years ago after having three MD patients quickly recover from their vertigo under upper cervical specific chiropractic care. His papers have been published in the Journal of Vertebral Subluxation Research and the textbook, Upper Cervical Subluxation Complex, a Review of the Chiropractic and Medical Literature, by Kirk Ericksen in 2004. Burcon has established a link between both Meniere’s disease and Trigeminal neuralgia (TN) with whiplash injuries that misalign the base of the skull with the top of the neck creating a lesion affecting the Eustachian tube via the Trigeminal ganglion. About half of these traumas are caused by vehicular traumas and the other half from injuries involving head/neck trauma. Burcon believes that the correlation was not made because it takes an average of fifteen years from the time the patient was injured until the onset of symptoms.
Patients typically get diagnosed with MD or TN in middle age. Their injuries most often happened during high school or college years from a car accident, sports injury or fall on their heads. Few patients list these old injuries on their doctor’s admission paper work. In fact, they have often forgotten about them, believing they were not hurt if they were not admitted to the hospital.

Many patients go years before getting diagnosed. Then they often are not given a clear choice of treatment plans. It can be particularly aggravating to try to explain to a friend or loved one, or employer, about Meniere’s. They see you when you are not experiencing an episode and think, “You don’t look sick to me.” Vertigo is to dizziness what migraine is to headache. If you have not experienced vertigo, it is hard to understand how devastating it can be.

Comments

25 Responses to “Welcome!”
  1. Mary Thomas says:

    Interesting how this site lists both tradtional and alternative medicine with references to help us decide about a treatment plan. Looks pretty new. Hope more stuff is added soon.

  2. Lori says:

    I must admit this has given me an avenue to travel. What would be nice is to have some information as to what percentage of individuals actually have all the the symptoms. For instance, I have everything except the nausea, involuntary jumping of eyes. The feeling of imbalance while driving is a bit scary however. Thank goodness that has subsided.

  3. Brad Timerson says:

    Ever since being diagnosed with a form of Meniere’s (secondary endolymphatic hydrops) in April, I have been looking for a comprehensive source of information. Thank you for this webpage! My symptoms are typical of Meniere’s Disease but without the vertigo. I only get dizzy if I spin quickly, usually with my eyes closed. My tinnitus is pretty much unchanging, although some nights it is louder than usual. My hearing loss is in the low and mid-frequencies at about -50 decibels (I think). I also hope that many more resources are made available here. I ask that those with good and bad experiences will post comments so that those of us looking for possible solutions can learn from these experiences.

  4. Ann Mitchell says:

    I have had 2 very bad episodes of vertigo/vomiting, along with A-FiB and ambulance to the hospital for 3 days. This last episode was 2 days ago, with vertigo,vomiting but no A-Fib.
    Ambulance to hospital but only there for 3 hrs because the vertigo had lessened and no A-Fib to deal with. I am going to look into the Atlas Bone – with my local chiropractor first, and then with Dr. James in Denver, CO (I live in Basalt CO). I would welcome any comments on this. I am female, 74, active, retired.

  5. p falcone says:

    I had been diagnosed now about 5 years and no doctor has been able to help. I have seen numerous doctors and informed them that when I get a stiff neck my vertigo becomes extreme. No one listened to me. Then I went to my elbow doctor for tennis elbow and informed him that my middle finger is numb. He sent me to a spine specialist, low and behold he touched the side of my neck, I saw stars. He took an xray and found that the spine area between my head and my shoulders have no cartalidge. I knew what was always causing my vertigo, but no one would listen.

  6. Blake Barnett says:

    Love the info on this site and I need more help. You see, I am one of those people with everything associated with Menieres and severly. I have been searching almost daily for one of those studies that take on actual participants either for tests, experimental meds, or both. Can anyone help me find one? Im really tired of being sick 4 times a month!!!

    • Julie Chammings says:

      Go to http://www.clinicaltrials.gov and enter the word meniere (without the s) you get a long list so you need to then select the option to not show completed trials.

      There are 4 trials currently recruiting volunteers and 1 that hasn’t started yet. Good luck!

  7. James says:

    I’ve had tinnitus for (?)years but just started experiencing balance / dizziness issues in June 2011. My initial research led me to believe (still suspecting) that I dislodged otoconia by purposely sleeping with a thin pillow with a foam cylinder under my neck. I had done this to alleviate neck stiffness. I’ve been doing the Brandt-Daroff exercises for a month now, but the symptoms just won’t completely go away. Yesterday I felt so good I took a bike ride for the first time since the onset of the dizziness. I felt great, but I’m digging here again today because the dizziness returned this afternoon even worse than at first! When I found this site I was surprised to learn about Dr. Burcon’s success treating this condition through cervical adjustments. I was especially interested because I had a fairly severe whiplash injury 20+ years ago, the result of being rear-ended in a car accident. I was hit so hard from behind that my bucket seat was ripped from the floor depositing me in the back seat! My injury never manifested in any severe way, just a nagging stiffness and reduced range of motion that I’ve managed to live with. It might also be noteworthy (now that I think about it) that over these 20+ years I’ve lost 2 inches in height!

    Another variable that I suspect but can’t be sure of is the fact that I switch between regular bi-focal glasses and short distance computer monitor bifocals often. And they are a new, stronger prescription, 2 months old.

    Now I must decide how to navigate my health insurance to get them to pay for a chiropractic assessment of my problem. Any suggestions in this regard would be appreciated.

    Also, if Dr. Burcon is reading here, I would appreciate recommendations for appropriate practitioners in my area. I’ll provide my zip-code through email.

    Thanks,
    –James

    • Dr. Mike says:

      James,

      It is interesting that you know that you have a neck problem. Most of my patients deny it. Their whiplash injuries happened so long ago that they have forgotten them. I have a similar injury, am shorter due to disc problems and also get BPPV. I treat it the same as Meniere’s. The most common cause of both is either from auto accidents or falling on your head.

      The relationship between the ears and the eyes is complicated. It is discussed in Health Talk III. The DVD is free if you pay $5 for shipping.

      I will need to see cervical x-rays to properly direct you to the best doctor. Our manager, Nicole, may be able to help with your insurance. Her number is 616.575.9990. She is in Mon, Wed & Fri.

      Good health,
      Dr Burcon

  8. Penny Smith says:

    I am so glad a friend of mine found an article on Dr. Burcon and gave it to me, which led me to this web site. I was officially diagnosed in June 2011 with Meniere’s (although it was suspected for the past two) and it has affected both ears equally. I have all of symptoms given with the exception of the migraines.

    It was a relief to know that that the aural fullness, brain fog, sweating, anxiety and depression were all part of the disease, along with the tinnitus and hearing loss. In my case it appears to be genetic as well as years of allergy suffering. But I am being told that stress played a major part in how fast I deteriorated in a very short time span. Within a couple of weeks I went from 10% hearing loss to 50% hearing loss. I had all of the tests to rule out something else and also had the tests for balance, etc.

    I had tubes put in my ears to help with the fluid in the middle ears which has helped the vertigo. The tinnitus is sometimes unbearable which of course increases with my stress level. I am on a no sodium diet, a diuretic, a anthistamine/decongestant, and a steroid nasal spray. If I miss any one of these, I can see a change in my symptoms, but the biggest offender seems to be the stress.

    Which is my purpose for writing. I am curious what you have found out about how stress affects the disease. There are some days where it is hard to cope and concentrate with all of the noise going on.

    I currently see a Dr. in West Michigan who practices the NUCCA technique which also focuses on the Atlas bone but it doesn’t seem to be doing much help.

    Thanks so much for the research you have done. I will continue to watch for updates.

    • Dr. Mike says:

      Penny,
      Stress is a relatively new word and originally was not meant to be negative. The important thing is how you respond to stress. Your over all plan sounds good, but I am willing to guess that you have an additional subluxation in your neck besides your atlas misalignment. Tinnitus tends to be more of an axis (C2) problem, and problems dealing with stress tend to go with a C5 misalignment.
      We are having a Christmas party at Frederik Meijer Gardens on Tuesday evening, December 6 at 6 pm. If you would like to attend call 575-9990. Tickets are only $10 and include admission to the Park and a book signing by Dr Tomasi. We will be filming Health Talk IV and it will be on UStream starting at 7 pm.
      Good health, Dr Mike

  9. pat says:

    I am so unsure what to do about my meniers.My ear doc. is now checking to see if I may have a anti immunne ear deafness. one year ago my hearing in my left ear died completely. now my left ear goes up and down . when ;it geos down, I am put on prednesone, and it goes back up for about amonth , then back down again. I am dizzy almost every day. I did have a whip lash about 18 years ago, from being hit from behind. I get head aches every day. I have had two MRI’s and they were both clear. I am 72 Any help would be great.
    Pat Klassen
    New Hope, Minnesota

    • Dr. Mike says:

      Please go to http://www.upCSpine.com to find a good chiropractor near you.

      • Khin says:

        Is my hearing gntiteg worse?im 12 years old. 3-4 months ago i went on a plane but while i was on the plane i had this stupid cold and i kept blowing my nose so my ears were gntiteg plugged. and you know how on a airplane if you’ve been on one your ears randomly get plugged and u cant really hear anything. well, my cold + me being on a flight managed to worsen by hearing a little when i got off my plane.one time on a plane my ears started hurtng super badly and i couldnt get my ears unplugged. when i got home ffrom the flight i realized my hearing was reduced because some sounds felt distant. i still have good hearing its just not 100% :/. and a few weeks ago i felt my hearing even dropped. i dont know why i didnt do anything that could’ve caused it. it just feels weird!btw if u guys think im crazy that i think im losing a bit of my hearing heres a example why im 100% sure:when i was in school after my trip, we had a fire alarm. and outside our classroom we have a fire alarm bell that is so loud i have to cover my ears everytime i hear it. but after my trip when i had this fire alarm. the ring was loud but i didnt even need to cover my ears.

  10. Alice says:

    Dear Dr. Burcon,

    I’m 46 years old.
    I’ve had constant middle ear problems in my left ear for over at least 25 years now.
    Since march 2011 I have had severe and many attacks of Menieres and Trigeminal Neuralgia (also on the left site of my head).
    Most recent is a pulsatil tinnitus.
    (Been to hospital, now on drugs (Carbamazepine, Betaserc), MRA shows nothing wrong).

    Do you think M and TN are perhaps connected (docters say coincedence) and do you also think there is a link with my middle ear problems which I have allready most of my life?
    Is there a possiblity that all of these problems can be due to misalignment of my UC you think?

    I would appriciate your view on this very much,

    Most sincerely,
    Alice.

    • Dr. Mike says:

      Dear Alice,
      This is a very good question! Meniere’s disease is really a middle ear problem. The muscle that opens the Eustachian tube is supplied by the mandibular branch of the Trigeminal nerve. The pressure keeps building until a membrane ruptures in the inner ear and you have a drop attack.
      Many of my patients have been diagnosed with MD and TN, and several more exhibit some symptoms of both diseases. If you are referred to an ENT by your primary care physician they would say you have Meniere’s. If you are referred to a neurologist they might diagnose you have Trigeminal neuralgia. Same thing with Glossopharyngeal neuralgia. Some times Bell’s palsy is the first symptom of your whiplash injury that sets the stage for these more serious problems later in life.
      You should consider attending our seminar on Saturday, June 23, 2012 in Grand Rapids, MI. More info at http://www.BurconChiropractic.com

  11. Gordon says:

    I was diagnosed with Meniere’s in May 2012. I have only had 3 incidents of vertigo w/ spinning, but suffer daily from what I call wobbliness (the feeling of being on a boat). I also have the other standard symptoms such as fullness in the ear, ringing and low tolerence to noise. Steroids, low-salt diet, diuetics have had little effect on eliminating the symptoms. It is interesting reading Dr. Burcon’s research because I did suffer a concussion in high school (I’m now in my mid-50′s) after falling on my head on the basketball court. I also suffer from scoliosis. I am considering endolymphatic sac decompression, but thought a visit to a chiropractor would be worthwhile. I would want them to be familiar with Dr. Burcon’s research so as to get the most out of the visit. I live in south Florida. How do I find a doctor who might help me?

    • Dr. Mike says:

      Please call my wife, Jane, at 616.575.9990. Thank you, Dr Mike ps If you send us films of your neck, I can offer you a free phone consulation.

  12. Dr Mike says:

    This is one of the happiest follow-up blogs I’ve ever written. I posted a week or so ago about being diagnosed with Meniere’s disease. It is an inner ear disturbance, affecting one ear. It is of unknown origin, with no cure. I have a mild form, (only roaring in my ear, partial hearing loss and mild vertigo,) but it can cause severe vertigo, vomiting, and complete hearing loss. I was diagnosed and told by my ENT that my only option was a diuretic to reduce the fluid in my ear, but there was nothing to stop the inevitable decline. He’s a great doc: he did 4 surgeries on my son, starting when he was only 18 months old. I couldn’t believe that’s all he had to offer.

    Not at all happy with the idea of slowly losing my hearing; and possibly falling down and throwing up, I started down the research path and discovered an article about a chiropractor in Michigan, Dr. Burcon. Years ago, he had patients in his practice who were suffering from MD, and had a quick recovery from vertigo after adjustment to the upper cervical vertebrae. He began piecing together histories and discovered that past injuries, (on average, 15 years old and primarily whiplash,) had left these patients with an unresolved upper cervical misalignment that resulted, years later, in the development of Meniere’s due to compression, “creating a lesion affecting the Eustachian tube and/or the Trigeminal ganglion.”

    He developed a specific protocol of care, and was able to eliminate vertigo in 291 out of 300 patients. I contacted him directly at his Michigan office, and he told me more about the treatment, and whom I could see in the Los Angeles area, (there are only two chiropractors who are well versed in this treatment.)

    I had my first on Tuesday. After a series of tests and 9 x-rays, he told me my skull and spinal column were indeed misaligned, and showed me where and by how much (only 2 mm!) After two tiny adjustments, I went home with the same roaring/rushing sound in my ear that I’d had for five months.

    However, when I woke up the next day, it was gone, and I could hear perfectly well. No kidding. As explained, and as I already understood about chiropractic, adjustments don’t hold (especially if the injury is old, and the body has been compensating for it for years.) So, by the end of the day, the roaring was back, but not nearly as loud. I went again today, and will go every two days or so, until the muscles and tendons in my neck begin to return to their healthy position. This may take a few months, but the fact that I woke up symptom free and able to hear after 5 months, made me a very happy person. Dr. Hall told me “If you aren’t greatly improved by the end of this, I must be doing something wrong and you can blame me, because I know this works.” I believe him 100%.

    Moral of the story? Be your own advocate, don’t blindly listen to one doctor, think outside the Western Medicine box, try everything. And if you find something that works, share it with everyone you can!!!

    - Lee

    • Dr. Mike says:

      Thanks for taking the time reaching out to other patients!

    • Yaya says:

      INTRODUCTION — Tinnitus is a perception of sound in prmotxiiy to the head in the absence of an external source. It can be perceived as being within one or both ears, within or around the head, or as an outside distant noise. The sound is often a buzzing, ringing, or hissing, although it can also sound like other noises.Tinnitus can be continuous (a never ending sound) or occur intermittently. Although both may have a significant impact on the patient, the latter is not usually related to a serious underlying medical problem. The sound may be pulsatile or non-pulsatile. Pulsatile tinnitus raises more concern for underlying significant pathology, though non-pulsatile tinnitus may also be associated with underlying disease.The epidemiology, pathogenesis, and diagnosis of tinnitus will be discussed here. The treatment of tinnitus is discussed separately. (See Treatment of tinnitus ).EPIDEMIOLOGY — According to the American Tinnitus Association, an estimated 50 million people in the United States have chronic tinnitus, persisting for greater than six months [1]. For 12 million, it is severe enough to interfere with daily activities. These people are effectively disabled by their tinnitus to varying degrees.Tinnitus is more common in men than women and the prevalence increases with age [2,3].IMPACT OF TINNITUS — The impact of tinnitus on an individual can be significant. Some individuals experience tinnitus, while others suffer from it. Overall, about 25 percent of tinnitus sufferers report an increase in tinnitus severity over time [4]. Chronic tinnitus is unlikely to remit completely, but often becomes less bothersome over time, especially in the setting of hearing loss.The impact of tinnitus can be consistently measured by two outcome instruments: the Tinnitus Handicap Inventory (show figure 1) [5] and the Tinnitus Reaction Questionnaire [6]. Studies of these instruments indicate that the degree of disability perceived by tinnitus patients, and its impact on the patient’s quality of life, does not correlate with loudness, type of tinnitus, or length of time with tinnitus.Concurrent mood disorders can increase the perception of disability. Increased tinnitus disability also has been demonstrated in patients with insomnia [7].ETIOLOGY/PATHOGENESIS — Tinnitus can be triggered anywhere along the auditory pathway (show figure 2). It is believed to be encoded in neurons within the auditory cortex. The majority of patients have sensorineural tinnitus, due to hearing loss at the cochlea or cochlear nerve level.Somatic sounds may be perceived as tinnitus, and originate in structures with prmotxiiy to the cochlea. These sounds are often generated in vascular structures, but may also be produced by musculoskeletal structures. Somatic sounds are most often associated with pulsatile tinnitus and continuous tonal tinnitus (single pure-tone) is usually not somatic in origin.In a retrospective review of 84 patients with pulsatile tinnitus seen in a neurology department, 42 percent were found to have a significant vascular disorder (most commonly a dural arteriovenous fistula [AVF] or a carotid-cavernous sinus fistula) [8]. In 12 patients (14 percent), nonvascular disorders such as paraganglioma or intracranial hypertension (due to a variety of causes) explained the tinnitus. Thus, patients with pulsatile tinnitus should be thoroughly evaluated. (See Diagnosis below).Vascular disorders — Pulsatile tinnitus is most commonly, though not exclusively, vascular in etiology. Some vascular tinnitus, such as venous hums and tinnitus due to atherosclerotic plaque narrowing of vessels, can be non-pulsatile.Arterial bruits — Arterial vessels near the temporal bone may transmit sounds associated with turbulent blood flow, especially if the loudness of the sound exceeds the hearing threshold in that ear. The petrous carotid system is the most common source, although other arteries may also be involved [9]. An arterial bruit is not itself a serious condition, although the patient may require an evaluation for underlying atherosclerotic disease.These patients usually do not have other otologic complaints (eg, hearing loss, vertigo, aural fullness). As with many other causes of tinnitus, their tinnitus is greatest in quiet environments (eg at night).Arteriovenous shunts — Congenital arteriovenous malformations (AVMs) are rarely associated with hearing loss or tinnitus. Acquired arteriovenous fistulas (AVFs) are more likely to be symptomatic. Dural AVFs are often associated with dural venous sinus thrombosis, which may occur spontaneously or be associated with infection, tumor, trauma, or surgery. Large dural AVFs can result in intracranial hemorrhage; early detection and treatment (surgery and/or vascular embolization) can be life-saving for high grade lesions.Paraganglioma — This is a vascular neoplasm arising from the paraganglia cells found around the carotid bifurcation, within the jugular bulb, or along the tympanic arteries in the middle ear. Also known as glomus tumors, they commonly cause a loud pulsing tinnitus that may interfere with hearing. The lesion may be visible through the tympanic membrane as a reddish or blue mass, or may be palpable in the neck. As the tumor enlarges, it may cause hearing loss because of impingement on the ossicular chain (conductive loss) or the labyrinth or cochlea (sensorineural loss). Other cranial nerves may also be affected (eg, facial nerve or lower cranial nerve palsies).Venous hums — These may be heard in patients with systemic hypertension, increased intracranial pressure (often due to pseudotumor cerebri), or in patients with a dehiscent or dominant jugular bulb (abnormally high placement of the jugular bulb). The latter may also cause a conductive hearing loss. Tinnitus in patients with a venous hum is often described as a soft, low-pitched hum that may decrease or stop with pressure over the jugular vein, with a change in head position, or with activity [9].Neurologic disorders — Pulsatile tinnitus of muscular origin can result from spasm of one or both of the muscles within the middle ear (the tensor tympani and the stapedius muscle). These muscles are enervated by cranial nerves V and VII respectively. Such muscle spasms can occur spontaneously, because of local otologic disease, and also in the presence of neurologic disease such as multiple sclerosis. Patients may also complain of hearing loss or aural fullness associated with these muscle spasms. Tympanometry and otoscopy can be particularly useful in diagnosing middle ear spasmodic activity.Clicking noises or irregular or rapid pulsations may also result from myoclonus of the palatal muscles that attach to the Eustachian tube orifice. Myoclonus of the palatal muscles most often is caused by an underlying neurologic abnormality, such as multiple sclerosis, microvascular disease affecting the brainstem, or neuropathy related to metabolic or toxic etiology; the history and physical examination should include a search for other neurologic disease.Eustachian tube dysfunction — A patulous eustachian tube can cause tinnitus with sounds similar to an ocean roar that may be synchronous with respiration [9]. It most commonly occurs after significant weight loss or after external beam radiation to or near the nasopharynx. The symptoms may disappear when the patient lies down. Patients can also complain of an unusual awareness of their own voice (autophony) and of ear discomfort. The cause of these symptoms is a eustachian tube that remains abnormally patent, allowing too much and then too little aeration of the middle ear space with respiration.Other somatic disorders — Somatic non-pulsatile tinnitus is commonly caused by temporomandibular joint (TMJ) dysfunction [10]. It has also been associated with whiplash injuries [11] and other cervical-spinal disorders [12]. Tinnitus may improve when patients respond favorably to treatment for symptoms of TMJ dysfunction and craniocervical disease. The exact neurophysiologic mechanism for the generation of tinnitus from either the TMJ or the cervical spine is not known, but may involve disinhibition of the dorsal cochlear nucleus [11].Tinnitus with a machine-like or pulsing character is sometimes associated with intracranial lesions, such as chondrosarcoma, aberrant carotid artery, and endolymphatic sac tumors.Tinnitus originating from the auditory system — Most tinnitus is due to a sensorineural hearing loss with resulting dysfunction within the auditory system. The auditory system includes the cochlear end-organ, the cochlear nerve (with its projections to and from the cochlea), the brainstem (site of the cochlear nuclei), and the primary and secondary auditory cortical projections (show figure 2).Etiologies of tinnitus generated from within the auditory system are as varied as the types of noises that patients report (show table 1). The presence of tinnitus often is an early indicator of cochlear hair cell dysrunction or loss, as in the case of prolonged noise exposure [13], Meniere’s syndrome (also characterized by aural fullness and vertigo), or ototoxicity.Ototoxic medications — Tinnitus is commonly caused by ototoxic medications (show table 2). Ototoxicity affects the various components of the cochleovestibular end-organ. When such structures are damaged, a change in neural firing between the end-organ and the remainder of the auditory system can be exhibited by hearing loss, distortions in hearing, or tinnitus.Presbycusis — Presbycusis (sensorineural hearing loss with aging) or any acquired high frequency hearing loss is commonly associated with tinnitus (often described as a high-pitched ringing sound, crickets, or bells in the ear) along with the hearing loss.Otosclerosis — This is a condition of abnormal bone repair of the stapes footplate bone (third bone in the ossicular chain) and of the otic capsule. Tinnitus can result when otosclerosis damages cochlear structures. Progressive otosclerosis can result in fixation of the stapes footplate and worsening conductive hearing loss (see Etiology of hearing loss in adults , section on otosclerosis).Acoustic neuroma — Tumors compressing or stretching the cochlear nerve can cause tinnitus; tinnitus can be the presenting sign of a schwannoma of the vestibular nerve within the cerebellar-pontine angle or the internal auditory canal (acoustic neuroma). (See Acoustic neuroma ).Chiari malformations — Tinnitus is one of the auditory signs associated with a symptomatic Chiari malformation and occurs when low lying cerebellar tonsils causes tension on the auditory nerve [14].Other etiologies — Hearing loss due to a variety of causes, including vascular ischemic events, infection, nerve compression, genetic predisposition, congenital hearing loss, endocrine or metabolic damage to the auditory system, can produce tinnitus to a variable degree. (See Etiology of hearing loss in adults ).Tinnitus may occur with barotrauma to the middle or inner ear (often associated with vertigo and hearing loss) and with fluid in the middle ear (eg, with otitis media).Pathogenesis — Recent pathogenetic theories target the central nervous system as the source or generator of all tinnitus that does not have a somatic origin, even in patients whose associated hearing losses are due to cochlear injury [15]. PET scanning and functional MRI studies indicate that the loss of cochlear input to neurons in the central auditory pathways (such as occurs with cochlear hair cell damage due to ototoxicity, noise trauma, or a lesion of the cochlear nerve) can result in abnormal neural activity in the auditory cortex. Such activity has been linked to the perception of tinnitus [16,17].A current theory likens tinnitus to phantom pain perception that is thought to arise from a loss of suppression of neural activity [18-20]. Known neural feedback loops act to help tune and reinforce auditory memory in the central auditory cortex. Disruption of auditory input or the feedback loop may lead to the creation of alternative neural synapses and to loss of inhibition of normal synapses.Tinnitus has also been likened to a type of auditory seizure [21], and antiseizure medications have had limited success in some patients [22]. Abnormal auditory-evoked magnetic field potentials associated with tinnitus can be suppressed in selected patients with intravenous lidocaine [23], confirming a central tinnitus phenomenon and potentially indicating a physiologic mechanism for lidocaine sensitive tinnitus (see below).Electrical stimulation, with round window electrodes or promontory stimulation, can suppress tinnitus in patients with profound hearing loss [24,25]. Electrical promontory stimulation may suppress abnormal spontaneous activity of cochlear nerve fibers; alternatively, it may provide background activity that acts to suppress abnormal central neural connections in patients with baseline sensorineural hearing loss and tinnitus. Cochlear implantation for hearing loss has had a secondary result of relieving tinnitus, with reported success for tinnitus improvement varying from 34 to 93 percent [26,27].Many patients with tinnitus exhibit signs of anxiety and/or depression [28], and elevated serum serotonin levels have been found in some tinnitus patients [29]. Serotonin and GABA receptors are found throughout the auditory system, and neurotransmitter abnormalities may play a role in some patients with tinnitus [29-31].These theories encompass disruption of normal neural firing patterns along the entire auditory pathway, from the end organ to the auditory cortex. They may explain tinnitus in patients who do not exhibit hearing loss, as well as in patients who recover from temporary hearing loss (eg, noise-induced hearing loss) but develop tinnitus that is persistent.DIAGNOSIS — It is important to keep in mind that tinnitus is frequently a sign of hearing loss or other cochlear injury, and may be the only complaint in a patient with a central nervous system lesion. History and physical examination are the first steps in establishing the etiology of tinnitus. All patients with continuous tinnitus, regardles of the character of the tinnitus, should have an audiological evaluation. Other tests are warranted in specific circumstances.History — The history in patients with tinnitus should include a description of the tinnitus (episodic or constant, pulsatile or non-pulsatile, rhythmicity, pitch, quality of the sound), as well as inciting or alleviating factors. Patients should be asked about previous ear disease, noise exposure, hearing status, head injury, and symptoms suggesting TMJ syndrome. All medications and supplements should be reviewed. The history should review other medical conditions, including hypertension, atherosclerosis, neurologic illness, and prior surgery. Patients should be specifically asked about depression, anxiety, and insomnia which can both exacerbate tinnitus and magnify its impact on quality of life.Tinnitus that is distinctly pulsing or is described as rushing, flowing, or humming is usually vascular in origin. Patients often describe an increase in frequency and intensity with exercise, and some may recognize a connection with their pulse. Changes in intensity or pitch with head motion or body position (lying down versus sitting or standing) also strongly suggest a vascular tinnitus.Clicking tinnitus almost always has a physiologic explanation. Myoclonus of the palatal muscles or middle ear structures can occur spontaneously, but may also suggest significant neurologic disease. Some patients report a mechanical sounding tinnitus that is not tonal in nature. A diligent investigation searching for vascular or somatic causes is warranted for this rare complaint.Tonal descriptions of tinnitus can help in the evaluation of a patient for a specific diagnosis or treatment.A high-pitched continuous tone is by far the most commonly described type of tinnitus. High-pitched tinnitus is frequently a result of a sensorineural hearing loss or may suggest cochlear injury.Low-pitched tinnitus is often seen in patients with Meniere’s disease, although it also can be idiopathic.Physical examination — A complete head and neck examination, including cranial nerve examination and evaluation of the tympanic membrane should be performed in all patients. Palatal myoclonus may be suppressed upon wide jaw opening; thus, its absence on oral examination does not rule out the diagnosis (nasopharyngoscopy may be indicated when suspicion is high).In patients with suspected vascular tinnitus, auscultation over the neck, periauricular area, temple, orbit, and mastoid should be performed in various positions. The effects of positioning and vascular compression of the neck on the involved side should be noted. Tinnitus of venous origin can often be suppressed by careful pressure on the jugular vein.Specialized testing Suspected vascular tinnitus — Patients with infrequent episodes of pulsatile tinnitus or those with short duration, mild tinnitus can be initially observed.However, because frequent or constant pulsatile tinnitus can herald a potentially life-threatening illness, all of these patients require evaluation by an otolaryngologist or neurotologist. When physical examination does not reveal a specific vascular or musculoskeletal source in these patients, further investigation to rule out a central nervous system (CNS) lesion such as a dural arteriovenous fistula (AVF), arteriovenous malformation (AVM) or aneurysm, or a skull base tumor should be carried out.The gold standard for AVF diagnosing intracranial vascular lesions is angiography. These lesions often can also be diagnosed noninvasively with MR angiography [32] or CT angiography [33]. High resolution CT scanning is required to delineate the extent of involvement of the skull-base if a paraganlgiolma is suspected and may be sufficient to evaluate other CNS lesions in selected patients. MRI can diagnose a Chiari malformation, vasculitis, CNS tumors, multiple sclerosis, and may indicate the presence of increased intracranial pressure (such as that seen in pseudotumor cerebri), or tumors. Many patients require both contrast MRI and contrast CT because of the varied nature of disorders that cause pulsatile tinnitus. If both of these studies are normal, and suspicion for a vascular lesion remains high, angiography or MR angiography is warranted.Our current protocol involves audiometric testing followed by an extnesive history and physical exam, which guides additional diagnostic testing. When an intracranial vascular lesion is suspected, we obtain an MRI with contrast initially, followed by CT/CT angiography and subsequent interventional angiography in appropriate circumstances.Suspected auditory system tinnitus — For patients with tinnitus that is suspected to originate within the auditory system an initial battery of audiometric tests is essential in the evaluation. This battery includes a pure-tone audiogram, tympanometry, auditory reflex testing, determination of speech discrimination abilities, and otoacoustic emissions testing. These tests identify asymmetries between the two ears and indicate abnormalities in the middle ear, cochlea, and brainstem; as well, they can define the site of abnormality within the auditory system or confirm normal functioning. Such testing is performed in an audiologist’s office, ideally one affiliated with an otolaryngology department or practice.Asymmetry in hearing function, reflex testing, or otoacoustic emissions, in patients with no identified otologic abnormality, should be followed-up with auditory brainstem resonse testing (ABR or BAER) and imaging studies (eg, MRI) to rule out inner ear anomalies, CNS lesions and neurologic disease. Further workup may involve neurologic or neurosurgical consultation, endocrine evaluation, or angiography.SUMMARY AND RECOMMENDATIONS Tinnitus affects 50 million people in the US, and interferes with daily activity in a quarter of those affected. Prevalence is greater in men and increases with age. (See Epidemiology above).Pulsatile tinnitus is most commonly vascular in origin and requires thorough evaluation. Differential diagnosis includes intracranial arteriovenous malformation, arteriovenous fistula, arterial bruit, and paraganglioma. Clicking pulsatile tinnitus may indicate a neurologic disorder causing myoclonus of palatal muscles or of the muscles in the inner ear. (See Vascular disorders above and see Neurologic disorders above).Tinnitus is most commonly due to abnormalities within the auditory system, often with unexplained etiology, but may be associated with sensorineural hearing loss, ototoxic medications, infection, vascular ischemia or acoustic neuroma. (See Tinnitus originating from the auditory system above).All sensorineural tinnitus is believed to be generated within the central nervous system, with cochlear abnormalities leading to loss of inhibition of cortical auditory neurons. Serotonergic neurotransmitters may play a role. (See Pathogenesis above).Evaluation of tinnitus should include a thorough history, an examination including auscultation for bruits in patients with possible vascular tinnitus, and a complete head and neck examination in all patients. (See Diagnosis above).Patients with pulsatile tinnitus, other than those with infrequent intermittent symptoms, should have otolaryngologic investigation and may require contrast CT scanning, contrast MR scanning and/or angiography. (See Suspected vascular tinnitus above). Audiometric testing is indicated for patients with tinnitus suspected of arising within the auditory system. (See Suspected auditory system tinnitus above).

  13. Dr Mike says:

    This is one of the happiest follow-up blogs I’ve ever written. I posted a week or so ago about being diagnosed with Meniere’s disease. It is an inner ear disturbance, affecting one ear. It is of unknown origin, with no cure. I have a mild form, (only roaring in my ear, partial hearing loss and mild vertigo,) but it can cause severe vertigo, vomiting, and complete hearing loss. I was diagnosed and told by my ENT that my only option was a diuretic to reduce the fluid in my ear, but there was nothing to stop the inevitable decline. He’s a great doc: he did 4 surgeries on my son, starting when he was only 18 months old. I couldn’t believe that’s all he had to offer.

    Not at all happy with the idea of slowly losing my hearing; and possibly falling down and throwing up, I started down the research path and discovered an article about a chiropractor in Michigan, Dr. Burcon. Years ago, he had patients in his practice who were suffering from MD, and had a quick recovery from vertigo after adjustment to the upper cervical vertebrae. He began piecing together histories and discovered that past injuries, (on average, 15 years old and primarily whiplash,) had left these patients with an unresolved upper cervical misalignment that resulted, years later, in the development of Meniere’s due to compression, “creating a lesion affecting the Eustachian tube and/or the Trigeminal ganglion.”

    He developed a specific protocol of care, and was able to eliminate vertigo in 291 out of 300 patients. I contacted him directly at his Michigan office, and he told me more about the treatment, and whom I could see in the Los Angeles area, (there are only two chiropractors who are well versed in this treatment.)

    I had my first visit on Tuesday. After a series of tests and 9 x-rays, he told me my skull and spinal column were indeed misaligned, and showed me where and by how much (only 2 mm!) After two tiny adjustments, I went home with the same roaring/rushing sound in my ear that I’d had for five months.

    However, when I woke up the next day, it was gone, and I could hear perfectly well. No kidding. As explained, and as I already understood about chiropractic, adjustments don’t hold (especially if the injury is old, and the body has been compensating for it for years.) So, by the end of the day, the roaring was back, but not nearly as loud. I went again today, and will go every two days or so, until the muscles and tendons in my neck begin to return to their healthy position. This may take a few months, but the fact that I woke up symptom free and able to hear after 5 months, made me a very happy person. The doctor told me “If you aren’t greatly improved by the end of this, I must be doing something wrong and you can blame me, because I know this works.” I believe him 100%.

    Moral of the story? Be your own advocate, don’t blindly listen to one doctor, think outside the Western Medicine box, try everything. And if you find something that works, share it with everyone you can!!!

    - Lee

  14. Mike says:

    I have been experiencing the symptoms of Meniere’s except for the severe vertigo, I have noticed a loss of balance and occasionally get dizzy. Last December I had what the Dr. called a “panic attack” and the tinnitus has been constant ever since and my ears feel like they are full of water. In addition I have regular heart palputations and my hands and feet somethings start sweating profusely. Since the December incident I went through a bout where I felt bad and the doctor put me on Zoloft thinking it was depression. The Zoloft has helped the anxiety but the tinnitus and feeling in the ears has nt improved. I have had a CT, MRI, and MRA and nothing was found. My doctor things it’s neurological and is sending me to a specialist. Would a neurologist consider Meniere’s or am I better off going to an ENT? I need to do something, the tinnitus sounds like a jet engine and wears me out by the end of the day.

    • Dr. Mike says:

      What Meniere’s and panic attacks have in common are whiplash. I would suggest meditation for the tinnitus instead of Zoloft, but I do not have a degree in prescriptions. A neurologist might give you a different prescription than an ENT, but an upper cervical specific chiropractor can give you treatment that will help correct your problem. The sweating and heart palpatations can be secondary to Meniere’s or an upper cervical subluxation complex.

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