Water in my ear? Fullness sensation? Ringing in my ear? Why?

Signs and Symptoms: Sudden onset of fullness in the left ear and ringing in the left ear (tinnitus)

Type of Trauma: She was hit by the basketball in her face when she was in her teenage period, and had multiple falls over many years in her 30~40s.

Adjustments: Gentle manual adjustment based on the 3D x-ray image findings. No cracking or twisting involved.

Outcome: 95% regression of the fullness and tinnitus and her hearing test (Audiograms) did show the improvement.

A female in her early 40s visited Silverdale Chiropractic for her Meniere's disease affecting her left ear. She had been experiencing a fullness sensation and constant ringing in her left ear. Diagnosed by her ENT specialist, she had been taking medication for the past few months without significant improvement, based on audiogram results before and after treatment. Seeking alternative options, she also had a history of multiple traumas to her neck and face from active sports in her teenage years, as well as several falls in adulthood.

The patient had already undergone an MRI of the brain to investigate her symptoms. However, Cone Beam Computed Tomography (CBCT) was ordered for further investigation. After reviewing both scans, numerous findings and potential causes for her symptoms were discovered.

The patient's MRI scan (brain) revealed several findings that are relevant to the upper cervical chiropractic approach. Firstly, there was a low-lying tonsil, indicating cerebellar tonsillar ectopia, which is commonly associated with Chiari Malformation. Additionally, the patient's left vertebral artery appeared notably diminished compared to the right side, even though the left vertebral artery is typically the dominant and larger side in most individuals. These findings were considered in the context of her symptoms and the potential involvement of the upper cervical spine in contributing to her condition.

The dens of C2 is showing retroflexion, which is another potential finding associated with Chiari malformation. This retroflexion, along with the low-lying tonsils visible in the scan, may suggest a Chiari-like malformation. However, it is important to note that the clivo-axial angle remains within normal limits, and there is no evidence of basilar invagination by the dens, which would typically confirm a Chiari malformation.

What could be mimicking the Chiari malformation in this case is the hypoplastic occipital condyle and the flat condyle characteristic of the lateral mass of C1. This structural anomaly could lead to instability or misalignment (displacement) at the craniocervical junction, which could contribute to the symptoms and findings observed. This type of structural instability is significant in that it could compromise normal neurovascular function, potentially leading to symptoms like those seen in Meniere’s disease and other related conditions.

Note the atlanto-occipital joint axis angle is beyond the normal range (125~127).

For this case, it appears that the mild displacement/misalignment of the atlas (C1) on the occiput was causing tension on the left vertebral artery, which in turn affected the intracranial vertebral artery. This mechanical compression on the brainstem likely contributed to the neurological signs and deficits, including the symptoms of Meniere's disease such as ear fullness and tinnitus.

Upon imaging, it was noted that the C1 (atlas) was displaced in a forward and upward direction, with half of the posterior aspect of the C1 lateral mass not properly contacting the occipital condyle. This type of misalignment requires a specific technique known as torque, which can only be effectively applied manually.

A manual adjustment using this torque technique helped to relieve the patient’s left ear fullness and tinnitus. The patient’s audiogram before the upper cervical correction showed a noticeable decrease in hearing at higher frequencies, but after a few weeks of treatment, the hearing levels returned to normal. The patient experienced close to 100% symptom relief, and her symptoms have not returned since the treatment was completed in early 2020.

The patient returned in mid-2021 for an unrelated issue (elbow pain), but she remained symptom-free from the initial complaint, which further highlights the lasting benefits of the upper cervical correction.

Disclaimer: Although this case was successful, it is important to note that these results may not be typical for all individuals with similar presentations. Each patient’s response to treatment can vary. Further research is necessary to better understand the true relationship between this intervention and its effectiveness for treating Meniere's disease or similar conditions.