Case 6. 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.

Female in her early 40 visited Silverdale Chiropractic for her Meniere's disease affecting her left ear. She is suffering from the fullness sensation on her left ear and constant ringing in her left ear. She was diagnosed by her ENT specialist that she has a Meniere's disease and was taking the medication for the past few months. Unfortunately she was not responding much (from the audiograms before and after the medication) and was seeking an alternative options. She has history of multiple trauma on her neck and face from her active sports involvement in her teenage and multiple falls from them in her adulthood.

The patient already had the MRI for her brain to investigate the signs and symptoms.

Cone Beam Computed Tomography was ordered for further investigation. Combining the two scans, lots of findings and possible cause was discovered.

Patient's MRI scan (Brain) revealed number of findings that are relevant to the upper cervical chiropractic approach. Firstly, there was a low lying tonsil which means a cerebellar tonsillar ectopia. It is commonly found to the people who has a Chiari Malformation. Patient's left vertebral artery was notably diminished compared to the right one. Usually it is the left side is the dominant and larger side.

Note the dens of C2 is showing a retroflexion. Retroflexion is a also a finding from the Chiari malformation. You can observe the low lying tonsil on this view even more clear.

However the clivo-axial angle is within normal limit and there is no basilar invagination by the dens.

What could be mimicking the Chiari malformation this similar?

I believe it is the hypoplastic occipital condyle and the flat condyle characteristic of the lateral mass of C1, resulting the structural instability (subluxation) of the craniocervical junction.

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

For this case, I believe it is the subluxation of the atlas on occiput resulting tension on the left vertebral artery, caused a abnormal intracranial vertebral artery hence resulting mechanical compression on the brainstem, resulting the neurological signs and deficit.

Patient's C1 (atlas) was subluxated in a forward and upward manner. Note the half of the posterior aspect of C1 lateral mass is not contacting the occipital condyle. This type of subluxation require a specific line of correction called a torque and only by hands that can be made.

Manual adjustment involving the torque helped the patient's fullness of her left ear and the tinnitus in her left ear. Her initial audiogram before the upper cervical correction showed a clear decreased hearing at the higher frequency and after few weeks of correction, the decreased frequency became normative. Her symptoms disappeared close to 100% and still not returned till now. The correction was made from late 2019 to early 2020. Patient re-visited for different issue (elbow pain) in mid 2021 but even then, she was still symptom free from the initial complaint.

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