CERVICAL SPECIFIC PROTOCOL FOR 100 MENIERE’S PATIENTS THE 25 th ANNIVERSARY OF THE PROSPER MENIERE SOCIETY The 12 th International Symposium and Workshops on Inner Ear Medicine and Surgery

Prosper Meniere 1861 Director of the Paris Institute for Deaf- Mutes Director of the Paris Institute for Deaf- Mutes First described the condition that was later named for him First described the condition that was later named for him

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

Wilhelm Conrad Roentgen Took the first x-ray in October 1895 of his wife Frau Bertha’s hand Took the first x-ray in October 1895 of his wife Frau Bertha’s hand Awarded the first Nobel Prize in Physics 1901 Awarded the first Nobel Prize in Physics 1901 Later, his wife’s hand was amputated and soon after she died of cancer caused by his experiments Later, his wife’s hand was amputated and soon after she died of cancer caused by his experiments

Harvey Lillard, September 18, 1895 Black male janitor presented with almost total deafness 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 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, Magnetic Healer Discovered a bump on the back of Mr. Lillard’s neck at level of C2 (Axis) Discovered a bump on the back of Mr. Lillard’s neck at level of C2 (Axis) Performed the first chiropractic adjustment Performed the first chiropractic adjustment Within ten minutes Mr. Lillard’s hearing was fully restored Within ten minutes Mr. Lillard’s hearing was fully restored

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

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

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

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

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. 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.

4 Blair Atlas Subluxation Listings Anterior and Superior on the Right (ASR) Anterior and Superior on the Right (ASR) Anterior and Superior on the Left (ASL) Anterior and Superior on the Left (ASL) Posterior and Inferior on the Right (PIR) Posterior and Inferior on the Right (PIR) Posterior and Inferior on the Left (PIL) Posterior and Inferior on the Left (PIL)

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. 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.

Over lap (ASR) and the under lap (PIL) of C1 in relation to Occiput.

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…

PIL (Posterior inferior on the left)

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 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 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 Underlapped Atlas determines Posterior and Inferior Listing on opposite side of subluxated articulation

Before: C1 PIL After: C1 Juxta

Lateral Cervical of Meniere’s Patient Note lack of normal cervical curve with kink Note lack of normal cervical curve with kink Note posterior atlas Note posterior atlas The only cause of these two findings on an x-ray is whiplash The only cause of these two findings on an x-ray is whiplash

Dr. Karel Lewit, Czechoslovakian neurologist Typed 120 Cases in 1961 Type I (a)- Meniere’s Disease with no neck pain Type I (a)- Meniere’s Disease with no neck pain Type I (b)- Meniere’s Disease involving neck symptoms Type I (b)- Meniere’s Disease involving neck symptoms Type II- Cervical Vertigo (dizziness after head movements) Type II- Cervical Vertigo (dizziness after head movements) Type III- Mixed Cases of Type I & Type II Type III- Mixed Cases of Type I & Type II

Lewit’s Proposed Causes of Dizziness Inner ear disorders Inner ear disorders Brain diseases Brain diseases Blood supply interference to the inner ear Blood supply interference to the inner ear Direct nerve interference with balancing reflexes Direct nerve interference with balancing reflexes Combination of the above causes Combination of the above causes

“Chiropractors refrain from assuming that the site of a symptom is the site of it’s 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.” “Chiropractors refrain from assuming that the site of a symptom is the site of it’s 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.”

Other possible Morphologies of Atlas Subluxation causing Meniere’s Irritates the nucleus of CN VIII, the Vestibulocochlear Irritates the nucleus of CN VIII, the Vestibulocochlear Irritates the nerve root of CN VIII Irritates the nerve root of CN VIII Diminished blood flow from the vertebral artery Diminished blood flow from the vertebral artery Increased CSF pressure via the cochlear aqueduct Increased CSF pressure via the cochlear aqueduct Pressure on auditory tube Pressure on auditory tube Ears at different heights/angles due to kink in the neck Ears at different heights/angles due to kink in the neck

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

The Merck Manual Meniere’s disease is associated with endolymphatic hydrops Meniere’s disease is associated with endolymphatic hydrops The cause is unknown The cause is unknown Treatment is empirical Treatment is empirical Question? What causes the edema that causes the dilation of the membranous labyrinth? Question? What causes the edema that causes the dilation of the membranous labyrinth?

Burcon Chiropractic Research Upper Cervical Protocol for Three Meniere’s Patients, Upper Cervical Protocol for Three Meniere’s Patients, Journal of Vertebral Subluxation Research Journal of Vertebral Subluxation Research Burcon Chiropractic Burcon Chiropractic 4362 Cascade Road, SE 4362 Cascade Road, SE Grand Rapids, MI Grand Rapids, MI (616) (616)

Upper Cervical Protocol for Ten Meniere’s Patients Presented at the 9 th Annual Vertebral Subluxation Research Conference, Sherman College of Straight Chiropractic in 2001 Presented at the 9 th Annual Vertebral Subluxation Research Conference, Sherman College of Straight Chiropractic in 2001

Dynamic Chiropractor 2003 Parkinson’s Disease, Meniere’s Syndrome, Trigeminal Neuralgia and Bell’s Palsy: One Cause, One Correction Parkinson’s Disease, Meniere’s Syndrome, Trigeminal Neuralgia and Bell’s Palsy: One Cause, One Correction

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

Upper Cervical Protocol for 30 Meniere’s Patients 2005, Los Angeles, CA 2005, Los Angeles, CA Poster presentation Poster presentation Exhibitor Exhibitor

WZZM Channel 13 ABC affiliate in Grand Rapids, MI ABC affiliate in Grand Rapids, MI Burcon Chiropractic’s Meniere’s research featured on the 6 and 11 O’clock News in 2005 Burcon Chiropractic’s Meniere’s research featured on the 6 and 11 O’clock News in 2005 Resulted in 60 new Meniere’s patients Resulted in 60 new Meniere’s patients

Protocol for 100 Meniere’s Patients Extensive case history that includes at least two episodes of vertigo lasting at least 20 minutes each Extensive case history that includes at least two episodes of vertigo lasting at least 20 minutes each Sensorineural hearing loss confirmed by audiometry Sensorineural hearing loss confirmed by audiometry Tinnitus and/or Tinnitus and/or Perception of aural fullness Perception of aural fullness Patient must provide letter from ENT specialist confirming diagnoses with copy of test results Patient must provide letter from ENT specialist confirming diagnoses with copy of test results

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

Cervical Syndromes 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.

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

Modified Blair X-Ray Protocol All 100 consecutive Meniere’s patients tested positive for upper cervical subluxations All 100 consecutive Meniere’s patients tested positive for upper cervical subluxations 3 Cervical x-rays taken and analyzed: Lateral, A-P Open Mouth and Nasium 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. All 100 film studies showed evidence of upper cervical subluxation and whiplash, although cervical trauma was denied by over 50% of patients.

Level of Major Upper Cervical Subluxation C1 (Atlas) in 96 out of 100 consecutive cases C1 (Atlas) in 96 out of 100 consecutive cases C2 (Axis) in 4 out of 100 consecutive cases C2 (Axis) in 4 out of 100 consecutive cases

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

Atlas Listings for 96 Meniere’s Patients 0- Anterior and Superior on opposite side of bad ear 0- Anterior and Superior on opposite side of bad ear 1- Anterior and Superior on side of bad ear 1- Anterior and Superior on side of bad ear 2- Posterior and Inferior on side of bad ear 2- Posterior and Inferior on side of bad ear 9- Posterior and Inferior bilaterally 9- Posterior and Inferior bilaterally 84- Posterior and Inferior on opposite side of bad ear 84- Posterior and Inferior on opposite side of bad ear

Most Significant Finding The primary cause of unilateral Meniere’s disease is an atlas subluxation with a listing of posterior and inferior on the opposite side of the involved ear The primary cause of unilateral Meniere’s 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 This means that the atlanto-occipital articulation is subluxated on the side of the involved ear

Improvement at 6 Weeks

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 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 improved with 30 patients, decreasing in average from 5 to 2 Headaches remained unchanged in 67, with the average staying at 3 Headaches remained unchanged in 67, with the average staying at 3

Improvement at 3 Months – 6 Years (80 out of 100 Patients Responded)

Other Improvements

“Comments:” “I have felt safe enough to drive again.” “I have felt safe enough to drive again.” “Weaned off my meds with no Meniere’s symptoms!” “Weaned off my meds with no Meniere’s symptoms!” “I do not fall down anymore.” “I do not fall down anymore.” “I do not snore anymore.” “I do not snore anymore.” “My wife says that I am easier to get along with.” “My wife says that I am easier to get along with.”

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