Meniere’s Disease and hearing problems caused by cervical neck instability

Ross Hauser, MD

In this article, we will discuss the various problems of ear pain, ear fullness, sound sensitivity, and hearing problems. Included in this discussion will be problems of Tinnitus and Meniere’s Disease. This is a companion to my other article: Neck pain Chronic Sinusitis and Eustachian Tube Dysfunction.

A Meniere’s Disease sufferer and their symptoms

Often we will get an email from someone who will describe their challenges this way:

I have Meniere’s disease in my left ear. I have symptoms of tinnitus, hearing loss, extremely sensitive to noise, and vertigo attacks that come on randomly and are mild to extreme. The vertigo attacks have also increased in frequency, I have one or more attacks a day. Further I have brain fog, a mild sense of loss of being in reality, and blurry vision.

Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo – a sensation of a spinning motion – along with fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in the ear. In many patients, low-frequency hearing loss is seen (People can hear higher tone voices like that of women and children but have difficulty hearing the “deep” voices of men and women. Meniere’s disease comprises symptoms related to the eustachian tube, the upper cervical spine, the temporomandibular joints, and the autonomic nervous system. The cervical spine, temporomandibular joint, and eustachian tube all are connected through the autonomic nervous system as well as peripheral nerves such as the trigeminal nerve.

All of these symptoms can easily appear if some condition were causing fluid to accumulate in the inner ear because of eustachian tube dysfunction. The eustachian tube is normally filled with air. It connects the inner ear with the pharynx to equalize pressure on both sides of the eardrum between the atmosphere and the inner ear. It is normally closed but opens when we swallow, yawn, or chew. When descending in an airplane or scuba diving, ear pain and potentially even eardrum rupture may develop if the eustachian tube does not open quickly enough to release the increasing pressure. With improper functioning of one or both Eustachian tubes, the body cannot appropriately regulate inner ear pressures, resulting in poor balance, tinnitus, dizziness, vertigo, and a host of other symptoms.

Let’s go back to a 1998 study reported in the medical journal Cranio. (1) Here doctors reported that 75% of patients with Meniere’s disease show a strong association with head and neck movements in the atlanto-occipital and atlantoaxial joints triggering attacks of vertigo. Cervical spine disorders and symptoms were significantly more in the Meniere’s patients than in a control group. The physical examination findings of tenderness to palpation of the transverse processes of the atlas, axis, trapezius, and levator scapulae muscles were also significantly more in the Meniere’s group. These are all findings one would suspect in upper and lower cervical instability.

“Vestibular Dizziness of Meniere’s Disease, Benign Paroxysmal Positional Vertigo, and Cervicogenic Dizziness may be a spectrum of the same disease.”

Our common theme is that a myriad of neurological-like, cardiovascular-like, and hearing-related symptoms and conditions are connected, in many people, by an underlying cervical spine instability that causes compression and herniation of arteries, veins, and nerves throughout the neck. In the case of ear fullness, this compression would also prevent the proper drainage of the ears and associated symptoms.

Vertigo and dizziness are one of the most common and least understood symptoms

Now let’s move forward to a 2021 study (2) that builds on information presented in the 1998 paper. Here are the observations of this research team suggesting a similar connection to problems in the neck.

“Vertigo and dizziness are one of the most common and least understood symptoms. Vestibular vertigo of Meniere’s disease and Benign Paroxysmal positional vertigo (BPPV – dizziness caused by moving your head) and cervicogenic dizziness (dizziness traced to neck pain) are classified as separate entities. Cervicogenic dizziness is not considered the domain of Otolaryngologists, as it is mainly related to neck proprioceptors (neck movements). Headache and neck pain, have been found to be associated with both Meniere’s disease and Benign Paroxysmal positional vertigo, so is cervicogenic dizziness.”

The doctors of this study then sought to make a connection and an association between cervical signs and symptoms in patients with Vestibular Vertigo of Meniere’s disease, Benign Paroxysmal Positional Vertigo, and cervicogenic dizziness. To do this they examined 132 patients complaining of vertigo and diagnosed with Meniere’s disease, BPPV, or cervicogenic dizziness looking for symptoms and signs related to neck, shoulder, and muscle tightness and asymmetry. What did they find?

• “Most of the Meniere’s Disease patients  (80% for unilateral and 88.23% for bilateral), Benign Paroxysmal Positional Vertigo (75%for right-sided BPPV, 66.67% for left-sided BPPV) and cervicogenic dizziness (90%) had associated symptoms of neck pain or headache and were found to be positive for neck tightness and/or asymmetry of the shoulder.
• Headache was more common in patients with Meniere’s Disease.”

Observation: “Vestibular Dizziness of Meniere’s Disease, Benign Paroxysmal Positional Vertigo, and Cervicogenic Dizziness may be a spectrum of the same disease with underlying myofascial problems. Meniere’s Disease of Idiopathic or primary type needs to be revisited as Cervicogenic (Endolymphatic) Hydrops.”

Endolymphatic hydrops is a disorder of the middle ear caused by vestibular system dysfunction. The vestibular system is the body’s sensory system that regulates balance and spatial orientation (understanding where you are in your environment). It sits in the inner ear and works by adjusting fluid levels that act as the balance mechanism.

In other word’s there is much more to a possible successful treatment of Meniere’s Disease and it lies in understanding where the accompanying cause of dizziness is coming from.

In this video Ross Hauser, MD discusses general problems of ear pain, ear fullness, sound sensitivity, and hearing problems.

Below is the transcript summary and explanatory notes:

• As the video starts, Dr. Hauser makes a connection between cervical spine/neck instability and cause problems related to the ear and hearing.
  • Our website has numerous articles on hearing problems as they related to cervical spine instability and chronic neck pain and dysfunction. Each article is supported by updated medical research and citation. These articles include:
    • Tinnitus as a symptom of cervical spine instability
    • Whiplash associated disorder
• Many patients we see have ear pain, ear fullness, or sensitivity to sound.
• Some of these people have a long medical history that may include visits to the ENT and other specialists and doctors. Some may get a diagnosis of Meniere’s disease.
• In many of these patients, their problems of tinnitus, Meniere’s disease, dizziness, ear fullness, decreased hearing, or sensitivity to sound may be traced to problems of cervical spine/neck instability.
  • A connection between cervical spine instability, dizziness, and the development of other symptoms including ringing in the ears is discussed in our article Cervical Vertigo and Cervicogenic Dizziness
• Eustachian Tube Dysfunction
  • The eustachian tube is the canal that connects the inner ear and the upper throat. It regulates the pressure within the inner ear.
  • Eustachian Tube Dysfunction can occur when the muscles of the eustachian tube, the tensor veli palatini, the levator veli palatini, the salpingopharyngeus, and the tensor tympani, do not perform their job of opening and closing the tube. This can cause fluid build up in one ear as opposed to the other. This can cause problems of inner ear fullness, ear pain, and loss of sense of balance. Cervical spine instability can cause muscle disruption.

Proper Eustachian Tube function vs. dysfunction. In this illustration, the proper opening of the Eustachian Tube is shown to require the action of the tensor veli palatini and the levator veli palatini muscles innervated by the vagus and trigeminal nerves. When these muscles do not operate normally, fluid builds up in the middle ear potentially causing the problems of ear discomfort, ear fullness, pressure, pain, dizziness, and even partial or complete hearing loss.

The patient was treated for cervical spine instability, of which hearing problems were one symptom.

• In the above video at 1:44 Dr. Hauser discusses this case history:
  • A recent patient had been given hearing aids and had used them for much of the last ten years
  • After three Prolotherapy sessions (dextrose injections described below) the patient has significant hearing improvement.
  • NOTE: The patient was treated for cervical spine instability, of which hearing problems were one symptom. This treatment can help improve hearing in many people, it does not improve hearing in every patient. A careful evaluation of each person is needed to give a realistic assessment of possible outcomes.
• At 2:23 Explaining cervical spine instability relationship to hearing dysfunction
  • When there is cervical spine instability, the vagus nerve which controls the levator veli palatini muscle, and the trigeminal nerve which controls the tensor veli palatini muscle, can be compressed causing dysfunction of these muscles. For many people, restoring cervical spine stability restores the proper function of these muscles and alleviates problems of Eustachian Tube Dysfunction.
  • Of note, the tensor veli palatini helps dampen sound. If there is tensor veli palatini dysfunction, problems of sound sensitivity may occur.

Ross Hauser, MD discusses ear and jaw popping and the reason why people feel the need to do this, especially those with upper cervical instability and cervical dysstructure due to ligament laxity throughout the neck. He also discusses some of his favorite gizmos for ear popping and pressure relief.

Tips for popping or opening your ears: Below the image are explanatory notes

Tips for popping ears: Most of the patients we see have already “mastered” or tried these techniques to help with ear popping. These techniques do provide temporary symptom alleviation for many.

1. Swallowing can help pop ears. This is simple swallowing. If swallowing does not initially help, some people find it helpful to swallow a little water.
2. Yawning can help pop ears. A number of helpful things can happen here. One, you are swallowing air and, two you are manipulating your jaw. This can help equalize the pressure inside and outside of your ears.
3. The valsalva maneuver:
   • Pinch your nostrils closed with your fingers try to keep your cheeks neutral or pulled in rather than puffed out. Next, blow air gently through your nostrils. This generates pressure in the back of the nose which helps open the eustachian tube.
4. Toynbee maneuver:
   • Pinch your nostrils closed with your fingers while swallowing.
5. Applying a warm washcloth
6. Nasal decongestants
7. Ventilation tubes that are surgical inserted to drain the ears.
8. Frenzel maneuver
   • Pinch your nostrils closed with your fingers and use your tongue to make a clicking or “K” sound.
9. Use an Eustache
10. Shower or steam
11. Chew gum

Prolotherapy injections and Cervical Realignment Therapy for cervical neck instability and a possible answer for ear problems

The ear problems described in the above video can be caused by many physical challenges. We will not suggest that every incidence of hearing problems or ear pain can be treated by addressing chronic neck pain and chronic spine instability.

The patient case story begins at 1:08 in the below video

• The patient first noticed hearing problems 5 years prior. The patient is a school teacher and could no longer hear her students properly.
• The patient made an appointment with an audiologist and had her hearing tested.  Her hearing tested poorly and she was given hearing aids. This was in 2014.
• In 2019, the patient sought treatment for cervical spine instability at C1, C2, C3. Incidentally, she noticed that her hearing had improved and thought it odd that she could hear without the hearing aids.
• The patient describes her ear fullness as “being underwater.” As if people were talking to her above water and she was underwater. As cervical spine stability returned, the patient no longer had a need for hearing aids.

Loud Noises

Another ear symptom that can occur post whiplash and/or with upper cervical spine instability is sensitivity to loud noises. This occurs because the tensor tympani (one of the muscles involved in proper Eustachian tube functioning) innervated by the trigeminal nerve is not functioning properly. It is attached to the stapes (inner ear bone) and helps maintain the ossicles in proper position to protect the inner ear from excessive sound levels.

A patient’s dizziness and vertigo can be aggravated by different neck movements. For instance, when the person would lay down the symptoms would resolve after a few minutes. Vertigo, dizziness and ringing in the ears, can all occur because of inner ear problems caused by defective middle ear pressure regulation from upper cervical spine instability / atlantoaxial instability.  Atlantoaxial instability can also contribute to these symptoms because of other mechanisms including vertebrobasilar insufficiency, inaccurate cervical spine afferent signals, and its interference with various vestibular-ocular and spinal reflexes.

When one understands the anatomy of the upper cervical spine and how injury to it affects that areas neurology, it is easy to see how the best explanation for common symptoms that often go without an adequate explanation or treatment regime are easily explained by atlantoaxial instability.

Research on cervical instability and Prolotherapy

Caring Medical Regenerative Medicine Clinics has published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. Prolotherapy is an injection technique utilizing simple sugar or dextrose. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problem of tinnitus. It should be pointed out that we suggest in our research that “Additional randomized clinical trials and more research into its (Prolotherapy) use will be needed to verify its potential to reverse ligament laxity and correct the attendant cervical instability.” Our research documents our experience with our patients.

In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal.(1) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.

We demonstrated in this study that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions, including disc herniation, cervical spondylosis, whiplash injury, and whiplash-associated disorder, post-concussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.

In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to:

• nerve irritation and vertebrobasilar insufficiency with associated:
  • vertigo,
  • tinnitus, hearing problems
  • dizziness,
  • facial pain,
  • and migraine headaches.

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo – a sensation of a spinning motion – along with fluctuating hearing loss, ringing in the ear (tinnitus) and sometimes a feeling of fullness or pressure in the ear. In many patients, low-frequency hearing loss is seen. Meniere’s disease comprises symptoms related to the Eustachian tube, the upper cervical spine, the temporomandibular joints and the autonomic nervous system. The cervical spine, temporomandibular joint and Eustachian tube all are connected through the ANS as well as peripheral nerves such as the trigeminal nerve.

All of these symptoms can easily appear if some condition were causing fluid to accumulate in the inner ear because of Eustachian tube dysfunction. With improper functioning of one or both Eustachian tubes, the body cannot appropriately regulate inner ear pressures which can result in poor balance, tinnitus, dizziness, vertigo and a host of other symptoms.

References:

1 Bjorne A, Berven A, Agerberg G. Cervical signs and symptoms in patients with Meniere’s disease: a controlled study. Cranio. 1998;16:194-202.  [Google Scholar]
2 Jain S, Jungade S, Ranjan A, Singh P, Panicker A, Singh C, Bhalerao P. Revisiting “Meniere’s Disease” as “Cervicogenic Endolymphatic Hydrops” and Other Vestibular and Cervicogenic Vertigo as “Spectrum of Same Disease”: A Novel Concept. Indian Journal of Otolaryngology and Head & Neck Surgery. 2021 Jun;73(2):174-9. [Google Scholar]
3 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326.  [Google Scholar]

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• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.