Ear pain, ear fullness, sound sensitivity, Tinnitus, Meniere’s Disease and hearing problems caused by 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.

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.

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?

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. Please see my article: Neck pain Chronic Sinusitis and Eustachian Tube Dysfunction.

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:

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.

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.

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


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:

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

We hope you found this article informative and it helped answer many of the questions you may have surrounding Ear pain, ear fullness, sound sensitivity, tinnitus, Meniere’s Disease, and hearing problems. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form

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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