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Nowadays, the neurosensorial disorders, which appreciably diminuate the quality of the life, are in a continuous increase all over the world. Table 1 presents the main causes responsible for this phenomenon, as well as the extent to which they influence the increase of each type of neurosensorial disorders.
In Germany during 1992, we had to deal with about 200,000 cases of whiplash injuries due to traffic accidents.
Basically, the following types of post-traumatic syndromes due to whiplash injuries can be differentiated, as there does not exist one single disease pattern (Table 2).
Tinnitus occupy a special place between the complaints of the patients suffering from the Late Whiplash Injury Syndrome (LWIS). Tinnitus is an acoustical phenomenon which is perceived without having an extrinsic source of sound. Already in 1994, Claussen has reported the results of a study, which compared the data from 206 cases of late whiplash injury syndrome, who were in medical attention only for treatment purposes, with those from 41 neurootological expertise cases after whiplash injury.
In the present work we oncentrated our attention upon those cases of LWIS who were labeled and treated by numerous other doctors and representants of insurance companies as so-called "trifle-cases". In the third subsample were included those cases who suffered from the so-called Hypersensitive Ear Syndrome (HES) (Claussen 1985). The audiometrical results then were underpinned through analyses of the acoustical pathway. The subdivision of the main sample from the point of view of the above described criteria is presented in Table 6.
Table 7 shows that in all the samples other sensorial disturbances are considerably present.
Table 8 combines the data concerning the hearing disturbances with those concerning the tinnitus. When analyzing the qualitative characteristics of the ear sensations, the highest incidence of the complaints is found in the sample of patients with maskable tinnitus (Table 9). Two of the 91 patients were notable to make a personal estimation concerning the evolution of their disease. The results of these complex and sensorial investigations showed that in nearly all the patients tinnitus was not an isolated phenomenon, being mostly associated to other multi sensorial neurootological functional disturbances. As all the cases come to us with a very rich medical, hospital, litigation, and expertise documentation accumulated in the peri od of time following the accident, however, including also pre-accidental patient information, we get comple e information about the evolution of the disease, the inte mediary symptoms and the preexisting medical result and diagnosis. The problem of tinnitus as a consequence of whiplash injury is intensively discussed in the neurootological literature since 1928. In 1928 tinnitus is ment oned by Barré and Lieou as being the most frequent sym tom in the patients with cervi cospinal injury.
In most of the patients investigated by these authors, tinnitus appears as a result of the so-called "degenerative cervico-spinal injury syndrome".
Shulman, who is considered as one of the pioneers and an exceptional specialist in the field of the tinnitus research, shows in his book about the modern diagnosis and therapy of tinnitus, that the severe, disabling tinnitus is usuallly associated with anxiety psychosis.
The observation of Shulman, that in most of the tinnitus cases, there coexists a high tone sensorineural hearing loss, is valid for the patients investigated by us, too.
Fürther on, Shulman shows that about 20% of the patients with severe tinnitus also have vertigo complaints. Based upon the numerous observations from all over the world, concerning the late complications of the whiplash injury, we can affirm that even the simple, non-contact whiplash injury can be the cause of long lasting, cronic polisensorial disturbances. Drugs may mask symptoms or make the situation worse by dulling the pain and further taxing the muscles. Thermal shock (extreme hot, cold, sauna) can be harmful to circulation, but heat can act as painkiller on the nerve endings. DO: Walking, warm up, stretch (Eastern forms of exercise), high intensity walking, biking, for 5 minutes all out and 3 minutes slow, and power lifting (machines are best).
SUBOCCIPITAL MUSCLES:sinus problems, asthma, agitated depression, allergies, herpes, headaches, shingles, and PMS. Top view of model of compiled atlas and axis (left), as it was found in computed tomography (right): Chronic torticollis of 10-yaer-old child. Whiplash injury or the whiplash trauma consists of a strain of the left posterior digastric muscle, so that it remains permanently extended, leaves its original position at the outer end of the posterior arch of the atlas and nests itself further inwardly on the lower transverse cervical muscle (Musculus obliquus capitis inferior). If the condition persisted for a long time, an imbalance between left and right muscles is generated: The left upper cervical muscles are as if in a plaster bed and stunted, the right ones cramp. I have the feeling that the head is lighter that the head rotates easier and as thouph it was generally getting a little better.
A month later, the mother came the laconic but very specific message that her daughter is 'healthy'. I feel just great, I can not see my shoulders any more, they are very far behind where they, usually they were quite at the front. The patient reported a relief from pain in the upper part of the spine, and that the resolution of shoulder protrusion had been permanent.
Presumably, the whiplash injury in the youth (bicycle accident), which had even required surgery of the nasal septum, had led to hearing loss on a long term, because the blood flow ratios were reduced due to the extreme skewed angle of the upper cervicals (latent basilar ischemia). Interpretation: The loud noise shortly after therapy indicated that the weakened upper cervical muscles could not hold the required lymph and blood flow initially.
Ten months ago tinnitus, vestibular failure on the left side and afterwards on the right side, then almost deaf on the right side, afterwards on the left side. The wrestling matches had probably contributed to a very oblique position of the upper cervicals, the left posterior digastric muscle was repeatedly and continually strained and shifted inwardly, so that motion-dependent blood-supply reduction through the vertebral arteries had very much increased.
At the day of treatment, again quite severe headaches as well as head&neck-pain, since then no more headache, but pain in the neck area.
Some of the most frequent sensorineural disorders are the visual disorders, the hearing loss, the tinnitus and the vertigo. The present work presents a certain neurosensorial disorder related to the head, namely the tinnitus of traumatic etiology.

The consequences of the trauma can appear immediatel y after the accident, but most frequently, the traumatic incident is followed by a period of more or less clinical silence and the symptoms become evident only after hours, days or months. The orthopedic as well as the radiological findings mostly are unsatisfactory with respect to the neurosensorial disturbances.
Of a special interest for the present work are the disturbances described as the "cervico-encephalic syndrome." This group also frequently follows a whiplash injury. In all the cases, the neurootological disorders were late complications of a whiplash injury. As Table 5 shows, these patients had complaints of the LWIS for a long time, and were repeatedly investigated by many different medical specialists prior of coming to us. The percentage distribution of the most important non-acoustical subjective symptoms in the above described samples of patients is presented in Table 7. The clinical experience showed that in the case of the LWIS, symptoms like otalgia or pressure in the ear may accompany tinnitus.
Many patients reported the presence of several complaints and disturbances which we considered as being complications of the tinnitus (Table 11). The vestibulo-ocular and retino-ocular reactions are investigated by the method of polygraphic electronystagmography and the vestibulo-spinal reaction by cranio-corpo-graphy with simultaneous computer analysis.
Because of the medical expertise questioning, a clear differentitation between the disturbances brought about the accident and thos already pre-existing or having other causes must be done for each of the cases. Decher reports in 1966, that 41% of 500 patients with a history of cervico-spinal injury complain of tinnitus. In many cases the disturbances are also caused by vascular problems in the posterior cranial fossa, due to a narrowing of the vertebral artery in the cervical region. Because of their permanent presence, the ear noises often become intolerable and are seriously disturbing the daily personal life. We also frequently find this stato-acoustical combination in our tinnitus patients with a cervico-encephalic syndrome, due to a whiplash injury.
As it was shown above, tinnitus plays a special role in the complex mosaic of these multisensorial neurootological functional disturbances.
This impairs nerve function and circulation, which explains why veins are visible on the skin surface. Metabolic diseases result from hypothalamus and pituitary glands, which regulate hormones: diabetes, chronic fatigue syndrome, weight problems, osteoporosis, autism, epilepsy, hyperactivity, and schizophrenia. The involvement of both muscles (digastric and upper cervical muscle) causes increased tension on the upper cervicals and places the atlas obliquely with respect to the axis. This state of the art is perpetuated down the entire back: In that way, neck stiffness and paraesthesia in the arms can be produced, because the brachial plexus in the interscalene hiatus is pressurized.
Now it feels 'like a TENS unit' in the upper cervical spine, in the lower cervical region 'stabbing pain' -> pain, opiates patch, Lyrica, formerly Amytriptillin.
She reportedly felt the increased blood flow to the neck region as warming and very pleasant. I have no pain in the upper shoulder area any more, which is such a cool, liberating feeling. 2 days ago, at night, sudden left-sided ear noise (hum) for a few hours, then right-sided noise intermittently.
The fact that the symptoms disappeared, points to the symmetric and gradually strengthening upper cervical muscles. Tinnitus, loss of balance, sudden hearing loss, deafness are likely signs that basilar ischemia had been too strong. Since the 17th year of age (2001) worsening of symptoms, especially nausea, gradual increase of burning eyes, inability to read long texts, dizziness, sleep disturbances (maximally 4 hours sleep, then several hours awake, second sleep again urgently needed).Tinnitus (loud beep) with certain head movements. While rotating, the head bobbed several times in a significant way, especially while turning to the right. Rather, a lot of patience and upper cervical therapeutic care is necessary until the physiological conditions have normalized. Since 4 years, increasing neck pain, then, in addition, headache, usually bilateral, often lasting three days, increasingly under stress, then a few days without pain. The incidence and variety of the head and neck injuries due to traffic accidents have extremely increased in recent years. Statistically, about 80% of the cases with whiplash injuries due to traffic accidents recover within a few months. Therefore many of these patients are under suspicion of malingering, or their disturbances are considered as being of a psychic type. They develop as the result of the years long lasting cronification degenerative processes of the lesions induced by the trauma incident.
Likewise, in none of these cases a cerebral commotion or a cerebral concussion could be established after the accident.
Therefore, the audiological investigations by the tinnitus masking method mostly cannot determine the presence of the tinnitus' at the moment of the examination.
Their presence can be due to traumatical changes induced during the accident in the maxillary sinuses, as well as in the temporomandibular joints.
Thereby taken into consideration only hearing losses of perception type, assessed by the bone conduction testing. The vestibulo-vegetative reactions are permanently monitored by a simultaneous EKG-registration.
In our study, the multisensorial neurootological disturbances were caused in nearly all the patients, by the whiplash injury (Table 16).
The degree of the psychical impairment is directly depending on the intensity of the tinnitus.
By means of the modern functional neurootological network analysis we can contribute much to clarify and to verify the disabling complaints which appear in the late whiplash injury syndrome. A stretch and hold exercise (yoga) will temporarily lengthen the tendon, while shortening the muscle.

Autoimmune diseases are primarily caused by the malfunction of the hypothalamus: MS, rheumatoid arthritis, lupus. In accidents with head involvement, the left atlas process is positionned extremely dorsally compared to the axis (see figure). The twisting- and blood-perfusion possibilities to suffer on a long term basis under the strain of the left posterior digastric muscle are far from being ennumerated. Thus, the rearrangement of the left posterior digastric muscle had been  the major therapeutic measure.
Yes, the whole spine is under way, especially the sacroiliac joint, and I hope that in the next few months I would find relief, but otherwise I'm fine. Nevertheless, she was confident and hoped that the painful situations would regress over time. This symptom did recede in the course of the day and then there was a steady decline in symptoms. Quite probably, more often than expected, long-term effects of whiplash injuries express in form of hearing loss, but the cause-effect relationship remains unfortunately speculative. Permanent damage to the hearing and equliibrium systems can occur under these circumstances. Known: ventouse birth, left elbow fracture due to falling from the balcony of 3 m height at the age of six. By using seat belts, shoulder harnesses and head rests the amount of direct wounds and fractures are reduced in modern motor vehicles. Problems of evidence also arise in compensation claims calling for an additional neurootological medical expertise.
By means of the modern functional neurootological network analysis we can nowadays contribute much to clarify and to verify the disabling complaints of the late whiplash injury syndrome. These cases were classified and treated as "trifle-and minor-traumas" by all the doctors and experts who have seen them prior to him.
This is very important on one side for the medical expertise and on the other hand for the correct diagnostic and therapeutical evaluation of these patients.
The muscle eventually develops an abnormal, sustained contraction known as a hypertonic spasm, which is really a malfunction of the nervous system. In the atlantoaxial joint, a rotation of the head to the left of approximately 20 ° is apparent.
For that reason, the young woman in the cited paper held her head so badly turned to the left after the accident. Upper-cervical asymmetry caused deafness could probably be avoided, if the connection of whiplash and basilar ischemia was well known.
After the digastric muscle rearrangement took place, an increase of rotation (left 80 °, re 70 °) tooke place.
However, the energy impact upon a person, sitting in a car involved in a traffic accident of the surprise-rear-end-collision type, is absorbed in the head and neck through an abrupt hyperextension and hyperflexion movement, which also is called the whiplash injury mechanism. Once more it reflects the uncertainty of the doctors as it concerns the neurosensorial disturbances, and appeared as late complications of the whiplash injury. For this Dutch team, the neurootological investigations are of an exceptional importance for a correct judgement of the patients with whiplash injury, as namely they can reveal the long lasting degenerative and cronification processes following the trauma. The position of the atlas offset to the back is probably caused by pression of the sprained left posterior digastric muscle exerted via the oblique upper cervical muscles. In addition, due to the tension exerted on the transverse cervical muscles (Musculi obliquii capitis superior et inferior) and the resulting oblique position of the atlas with respect to the axis, a continuous stretching of the left and right vertebral arteries is also created. These abrupt movements of the head and neck may have several morpho-functional consequences upon the cervical region, as well as upon the nervous and sensorial structures of the head. The characteristics of the ear noises were specifically investigated through the tinnitus masking method. Their studies and conclusions are based upon the numerous pathological electronystagmographical findings, and also the corresponding pathological audiological results. You might not feel pain because the muscle may go into a kind of shock (flight or fight) and produce endorphins, nature’s painkillers. Expansion and extension of a soft tube reduces throughput: Henceforth, the position of the head - viewing up or down - or rotations - the jerk - cause basilar hypoperfusion. The latter consists of a variety of symptoms that may be perceived but with difficulty as a unity, if one was unaware of upper cervical asymmetry.
The state of the acoustical pathways was investigated by means of the acoustically evoked brain stem potentials as well as the acoustically evoked late (cortical) potentials.
The faster and the more extreme the head is moved, the more likely is dizziness to occur due to vertebral artery stretching and contiguous perfusion disorder.
The aforementionned symptom diversity obtains a common denominator and treatability: The upper cervical muscles, teared on a long term basis by whiplash on the left side, need some time after the rearrangement of the left posterior digastric muscle to achieve the msucle tone that will restore blood flow through the vertebral arteries in the long term.
Not least, tinnitus, sudden hearing loss, and vertigo, but probably also persistent insomnia are partly based on the upper cervical asymmetry caused by vertebral-artery blood-supply reduction (basilar ischemia). The harmonization of muscle tone between left and right ensues automatically, but can and should be activated and promoted by vibratory stimulation. Jaw cracking on the left while moving sideways and while biting, no jaw pain, had been a wrestler.
While looking upwards, disagreable feeling, pain release.The serious accident at the age of 21 years initially seemed not to have any long-term consequences. In prevailing upper cervical asymmetry, it is likely that extension has a blood-circulation reducing effect, whereas flexion increases blood circulation.

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