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Secondary tinnitus as a symptom of instability of the upper cervical spine operative management,scratching sound in ear when lying down only,motor noise in right ear - New On 2016

Author: admin | 08.04.2014 | Category: Tinnitus Causes And Treatments

Between January 1996 and January 2000, we operated on the cervical spines of nearly 150 patients per year (on average) at FUssen Hospital, Germany. After becoming aware of the secondary symptom of tinnitus, which some of the patients found very unpleasant, we evaluated the statistics more specifically. During surgery on those in the latter patient group, special attention was paid to ensuring complete relief of any nerve structures that may have been involved. In this report, we have deliberately omitted all other symptoms that required surgery of the cervical spine.
Between January 1996 and January 2000, we operated on a total of 134 patients with secondary tinnitus. Sixty percent of the patients reported that the injection of 0.5 ml 1 % prilocaine hydrochloride (Xylonest) into the Cl-C2 joint with a long cannula under an image converter had an effect on their tinnitus. During the postoperative phase, 30% of the patients had recurrent tinnitus for a period of up to 4 weeks. The aim of an operation to correct an unstable craniocervical junction with torn or overstretched ligaments after an accident is to stabilize the area. The ideal physiological position of the upper cervical vertebrae is adjusted under the image converter, also taking into account the position of the head relative to the spine.
In the first few years after beginning surgical management of this patient group with unstable craniocervical junctions, we performed fusion with autologous bone at CO-C1-C2 and fixation with titanium wire cerclage. Intraoperative radiography and precise knowledge of the anatomical features of the region are mandatory for this type of fixation because a variable vertebral artery may pass laterally. Follow-up examinations of a large number of patients who had a relatively high percentage of failures (15) showed this method to be inadequate. Secondary tinnitus may develop owing to altered geometry of the cervical spine, especially the upper segments. In the treatment of tinnitus, this method certainly should be borne in mind, and patients should be asked about any symptoms suggestive of changes in the cervical spine. Suffering From Vertigo, Tinnitus, Hearing Loss, Meniere's Disease?Atlas Misalignment May Be The Common Denominator! Meniere’s disease is a disorder characterized by sudden, recurring attacks of disabling vertigo (a whirling sensation), hearing loss and tinnitus (ringing in the ears) and nausea and vomiting. There is an extensive amount of research that shows the relationship between inner ear disorders, (vertigo, tinnitus, Meniere's disease, etc.) and trauma. Secondary Tinnitus as a Symptom of Instability of the Upper Cervical Spine: Operative Management.
It very frequently manifests as a high-pitched whistle that disappears after operative correction and stabilization of the articular geometry. Statistical evaluation of the large number of patients who received treatment for their cervical spines at our hospital revealed that up to 80% of those with pathological changes in the upper cervical spine (C3 and above) had reported tinnitus as a secondary symptom. Mostly, they were patients with degenerative changes in the midcervical spine, but some also presented with prolapsed disks and solitary metastases. Our analysis showed that patients with degenerative changes in the lower cervical spine only rarely reported tinnitus as a secondary symptom, whereas the patient group with instability at the craniocervical junction had usually reported a unilateral or bilateral high-pitched whistle.
At the same time, the region was stabilized, with a very strong emphasis on physiological correction of the craniocervical junction geometry. Later, in describing the patients, we again concentrate on the tinnitus symptom and discuss the other symptoms separately.


As it has not been possible to date to restore torn alar ligaments to their original condition via a ventral approach or to replace a ruptured transverse ligament, the only access for any stabilization surgery on the craniocervical junction is by a dorsal approach.
The patient is positioned prone with the head slightly flexed and resting on a headrest (Fig. A hole is drilled through the posterior arch of C2 in the direction of the lateral mass of Cl and a screw is set into the hole under temporary compression with titanium screws. This method had the disadvantage that rotation of the head was not fully obliterated and that, ultimately, incorrect movements could not be ruled out completely. At the same time, attention must be paid to the C2 nerve root; if the screws pass medially, they create the danger of injuring the dura. The loss of correction of the geometry of the craniocervical junction after surgery caused very many relapse symptoms, even if they were not as severe as before the operation. If the tinnitus is caused by morphological changes in the upper cervical vertebrae, it disappears after surgical correction. If a connection exists between the medical history and symptoms of cervical degeneration, cervicocephalic symptoms, and tinnitus, we consider a more exacting functional examination obligatory to rule out tinnitus induced by changes in the cervical spine. This type of trauma could range from a mild bump on the head to a fall, a concussion, or even whiplash from a motor vehicle accident or sports injury. Grayson Blom is a Boise, Idaho native that works with a nationwide group of Doctors expertly trained and specializing in the Upper Cervical procedure. Prolapsed intervertebral disks, discoligamentous injury, and even metastases as low as level C3 can cause tinnitus, which also usually disappears after surgery.
In patients with dysfunction at C2-C3 or C3-C4, we also found tinnitus but of a different character.
After operative correction and rehabilitation, the tinnitus disappeared completely and permanently in all but two patients. One patient had a tumor at C2, one had a metastasis at C3, seven patients had disk prolapses at C3-C4, two had instability and angular kyphosis at C3-C4, one patient had a prolapsed C4-C5 disk, and one had instability at C2-C3.
However, the postoperative tinnitus responded very well to treatment (1) by infiltrating the paravertebral muscles that showed tremendous tension, (2) by chewing gum, which eases and relaxes the neck muscles, and (3) in part by prescribed muscle relaxants.
The symptoms did not disappear entirely, and losses of correction at surgery were frequent.
Thus, since November 1998, we have selected plate fixation (as described) as our standard method (see Fig. Tinnitus is a very annoying, tormenting secondary symptom for patients with instability of the upper cervical spine and exacerbates an already compromised patient's state of health, as it accompanies several other pathological changes that generally disappeared after surgery. Vertigo often is associated with nausea, vomiting, malaise, hearing loss, tinnitus (ear ringing), and a feeling of ear fullness or pressure. Inner ear disorders can appear immediately after trauma or could actually take months or years to develop. These included those with instability of the craniocervical junction due to torn or overstretched ligaments, patients with discoligamentous damage without neurological deficit, and many patients with degenerative discopathies, some with pronounced spinal stenosis. The dorsal approach was used for 121 patients undergoing stabilization surgery for instability at C0-C1-C2. Twenty-one patients reported that they suffered occasional tinnitus but that this was triggered immediately by stress. Subsequently, a titanium plate is bent to correspond to the angle at the craniocervical junction to allow the plate to be screwed to C0, C1, C2, and C3 (Fig.


Only the introduction of Magerl's transarticular screws, which are screwed through the arch of C2 into the lateral mass of C 1, brought considerably better results.
One disadvantage was that the bone grafts placed in this critical region between the occiput and Cl-C2 caused major problems. There are several different types of vertigo, including positional, post-traumatic and cervicogenic vertigo (dizziness caused by the neck). Osteolytic bone changes were very frequent, pseudarthroses were very common, the patients reported recurrent symptoms, and radiographs showed that the correction was lost, with the head generally tending toward dorsiflexion. The procedure no longer enables any movement at all at the craniocervical junction and furthermore does not permit any loss of the correction achieved in the sense of gradual dorsiflexion of the head. Tinnitus, which may be constant or intermittent, may be worse before, during, or after an attack of vertigo. Although these patients reported considerable improvement in their degenerative cervical syndrome and cervicooccipital symptoms, the tinnitus had remained unchanged. The titanium plate is fixed to the occiput with very short screws after careful drilling into the occipital bone. Only correcting the head position in ventral flexion with fixation brought pronounced improvements in the symptomatology. This was the case with slight shrinkage of the bone grafts at the craniocervical junction for fusion without the supporting titanium plates.
According to medical literature, vertigo can be caused by hyperactivity or irritation to the joints and nerves in the upper neck.
After exposure of the spinous processes, the paravertebral muscles are dissected and retracted. This method has been successful also in patients with repeat bone resection and revision surgery but without the possibility of grafting of new bone onto which the plates could be screwed. The nerves and joints in the upper neck assist in the coordination of the eye, head and body, spatial orientation and control of posture; therefore, any abnormality or interruption in these structures can produce vertigo. Long-term observation has not shown any instances of screw or plate loosening in this region. Moving the head with the surgical site open allows clear observation of how the individual ventral ligaments function and to what extent the movement between individual vertebrae is disharmonious. Furthermore, the region around the articular capsule of C1-C2 can be observed and assessed at operation.
By this means, we create a rigid complex incorporating C0-C1-C2 down to and including C3, which prohibits any faulty movements (Fig. After placement of a Redon drain, the cervical musculature is sutured back onto the spinous processes in the midline, which is followed by wound closure in layers and wound dressing. I received my first upper cervical correction and within a 15-minute period, I regained my hearing.




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Comments to “Secondary tinnitus as a symptom of instability of the upper cervical spine operative management”

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