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14.03.2014
Sensorineural hearing loss is the most common type of hearing loss, occurring in 23% of population older than 65 years of age. Infections, such as meningitis, are a common cause of hearing loss in children where it occurs in approximately 20% of those with streptococcus pneumoniae meningitis (Heckenberg et al 2011). Noise induced hearing loss is a permanent hearing impairment resulting from prolonged exposure to high levels of noise. Children who are born prematurely or contract certain infections in utero are at a higher risk of hearing loss (Hille et al 2007, Roizen 2003).
While very unusual, acoustic neuromas or metastatic cancer (particularly breast) can be a source of hearing loss. Sudden hearing loss (SHL) is defined as greater than 30 dB hearing reduction, over at least three contiguous frequencies, occurring over 72 hours or less.
Sensory presbyacusis is caused by loss of sensory elements in the basal (high-frequency) end of the cochlea with preservation of neurons. Cochlear conductive presbyacusis is caused by thickening of the basilar membrane caused by deposition of basophilic substance. Because presbycusis occurs in some individuals as they age but not in others, genetic or environmental factors must also play a role in its development (Liu & Yan 2007).
In conductive hearing loss, the second most common form of hearing loss, sound is not transmitted into the inner ear. Images marked as copyright Northwestern University were developed with the support of a National Institutes of Health (NIH) grant to Northwestern University Dept.
The American Hearing Research Foundation is a non-profit foundation that funds research into hearing loss and balance disorders related to the inner ear and is also committed to educating the public about these health issues. According to O’Reilly, risk factors include: young age, functional immaturity of the Eustachian tube, group child care, season of the year, lack of breastfeeding, the presence of adenoid tissue, environmental smoke exposure, pacifier use, allergy, sibling order, craniofacial abnormalities, genetic predisposition, and ethnicity. Up to 60% of children who have AOM will have persistent MEE 14 days after the bacteria have been eradicated.
AOM is the most frequently diagnosed condition in children and the most common reason for antibiotic therapy. Complications of OM may include: tympanic membrane perforation, tympanosclerosis, otorrhea, or cholesteatoma. Williamson concluded that “Oral antibiotics, antihistamines plus oral decongestants, or mucolytics may be of no benefit in OME and can cause adverse effects”, “Ventilation tubes may improve short-term outcomes, but the clinical effect size is small” and “Ventilation tubes improve hearing for the first two years, but have no longer-term benefit, and may not improve cognition of language.” [13] Tympanostomytube insertion is the most frequently performed operation in children in the US. The great concern when a child has recurrent OME or chronic MEE is that the child’s language development may be compromised due to hearing loss. If the hearing loss is less than normal, it becomes necessary to determine if the hearing loss is sensorineural (due to loss of function in the cochlea, 8th cranial nerve, or brain), or conductive (due to interruption of sound in its travel from the external ear canal, through the malleus, incus, and stapes of the middle ear, and into the cochlea). His initial audiogram was performed at a separate facility 9 days before starting chiropractic treatment, at the age of 6 years, 7 months (Figure 3). Treatment consisted of 6 chiropractic manipulations utilizing Gonstead and Diversified high-velocity low amplitude techniques modified to use fingertip contacts and lower force for pediatric application.
The patient had no ear pain or drainage and his hearing subjectively seemed improved at the end of the treatment, and the parents chose to cancel the surgery.
The prevalence for otitis media decreases after 6 years of age, which is the approximate age of cranial vault maturity [18] (Although the subject of this paper had persistent symptoms after reaching the age of 6). The likelihood of spontaneous remission of conductive hearing loss in a case like this one is small.
While this represents only a single case, the suggestion it brings of normalization of auditory physiology by chiropractic manipulation is tantalizing.
Conservative therapy such as chiropractic care with referral for audiology monitoring may offer children with otitis media and hearing loss a possible benefit of recovery from their condition without the concern of antibiotic side effects, antibiotic resistance, or risks of surgery and associated anesthesia. Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. Air pollution and emergency department visits for otitis media: a case-crossover study in Edmonton, Canada.
The health care burden and societal impact of acute otitis media in seven European countries: results of an Internet survey.
Effects of prenatal exposure to dioxin-like compounds on allergies and infections during infancy.
Host factors and early therapeutic response in acute otitis media: Does symptomatic response correlate with bacterial outcome? Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors.
Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study.
Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. A prospective study of the effect of gastroesophageal reflux disease treatment on children with otitis media.


Improvements in hearing, speech, development and behavior following chiropractic in a 4 year old male. Improved hearing and resolution of otitis media with effusion following chiropractic care to reduce vertebral subluxation. Asthma is a condition of the lungs that occurs within the general population regardless of the work done by the sufferer. Irritant-induced – where there is a one off exposure to an irritant (eg hydrochloric acid, chlorine, acetic acid, ammonia fumes or gluteraldehyde) that would cause wheezing and shortness of breath in anyone who inhaled them. The employer’s statutory duties are set out in the Control of Substances, Hazardous to Health (COSHH) Regulations.
If you have been diagnosed as suffering from Asthma as a result of your work you may have a claim. I’d like to thank Simpsons Solicitors very much for their help in gaining a successful outcome to my case. I would like to take this opportunity to thank you, for dealing with this matter so swiftly and effectively…I can now close that chapter in my life and move on.
Simpsons Solicitors were extremely helpful in every way, patient, listening to my concerns and questions. I would just like to say that I am very pleased with the service that your firm provided to me, and also the speed of the final outcome.
The service I received was absolutely first class, from beginning to end and it is really difficult to see how it can be improved. Whether you have been involved in an accident at work, contracted an occupational illness, had a slip, trip or fall, or are involved in a dispute at work, Simpsons Solicitors team of Personal Injury Solicitors are here to help. The outer ear includes the auricle, the external auditory canal, and the lateral surface of the tympanic membrane (TM). Postmeningitic hearing loss can be due to lesions of the cochlea, brainstem and higher auditory pathways, but usually is related to suppurative labyrinthitis (cochlear damage).
One in 10 Americans has a hearing loss that affects his or her ability to understand normal speech. Much research has focused on the detection of genetic causes of hearing loss, and many of them can now be diagnosed at an early age (Blanchard et al 2012, Dror & Avraham 2009, Kochhar et al 2007, Kokotas et al 2007, Robin et al 2005, Xing et al 2007). Risk factors that correlate with hearing loss in premature infants include hypoxia, mechanical ventilation, hyperbilirubinemia, very low birth weight, and the use of ototoxic medications. It occurs most frequently in the 30- to 60-year age group and affects males and females equally.
These patients have symmetrical, high-frequency sensorineural hearing loss (as shown in Figure 3). Medical conditions that are common in the elderly, such as diabetes and stroke, may also increase the risk of hearing loss with aging (Bainbridge et al 2010, Helzner et al 2005, Maia & Campos 2005, Schreiber et al 2010). Causes include a buildup of ear wax, a foreign body in the ear canal, otosclerosis, tympanosclerosis (as shown in Figure 4), external or middle ear infections (otitis externa or media), allergy with serous otitis media, trauma to the ossicular chain such as temporal bone fracture, tumors of the middle ear, erosion of the ossicular chain (cholesteatoma) and perforation of the tympanic membrane. Prior treatment included several rounds of antibiotics starting at 14 months and myringotomy at age 3. After 6 chiropractic adjustments, the child was asymptomatic, and remained free of otitis media symptoms on long-term follow-up.
This may suggest a role for chiropractic care the management of otitis media with conductive hearing loss. Of children with a red or yellow tympanic membrane and distention and absence of visible landmarks on otoscopy, 91% will have a bacterial infection of the middle ear. The presence of effusion is generally believed to be due to a pressure gradient formed by the microvascular resorption of nitrogen from the middle ear in the absence of a patent Eustachian tube.
A Cochrane review concluded tympanostomy tubes for hearing loss associated with otitis media with effusion were mainly beneficial in the first 6 months after insertion, although the benefits were small and diminished over time. They also reported concern about hearing loss as measured by audiometry ordered by an ENT specialist. The test showed an obvious air-bone gap, with conductive hearing loss greater on the left than on the right. Segments adjusted were based on static and motion palpation of the entire spine, and no attempt was made to correlate the segments adjusted with the segmental innervation of the middle ear or Eustachian tubes. Right tympanic membrane (TM) showed fluid and was immobile on insufflation, but was glossy. The right TM was mobile with no fluid and some dullness; the left TM was dull with increased fluid but was mobile.
A review of the effectiveness of manual therapies on otitis media found the evidence to be inconclusive. This, along with craniofacial abnormality as a risk factor and the fact that myringotomy with tympanostomy tube insertion affords symptomatic relief, suggests that a dysfunctional eustachian tube plays a large role in OM. This is implied by a controlled trial of ear tubes (grommets), involving 55 children between 4 and 10 years of age, which found that within 6 months after insertion, the grommet ear and the control ear had the same average degree of hearing loss: 16 decibels.


Additionally, it may represent a new method for monitoring the results of CMT in children with MEE or recurrent OME.
Simpsons were clear in their advice, set out what was happening well and made sure I knew what was going on at every step of the claim. Kept informed at each stage and followed up by correspondence which was appreciated and beneficial. The middle ear includes the medial surface of the TM, the ossicular chain, the eustachian tube, and the tympanic segment of the facial nerve. These conditions are relatively common in premature infants, and the majority do not go on to develop hearing deficits. Hearing loss in adults surviving pneumococcal meningitis is associated with otitis and pneumococcal serotype. Race and sex differences in age-related hearing loss: the Health, Aging and Body Composition Study. Nineteen months after commencement of treatment, a repeat audiogram was performed, showing normal hearing in both ears. This results in decreased pressure (and often a retracted tympanic membrane), causing extracellular fluid to exude into the middle ear cavity. The AAP-AAFP recommends antibiotic therapy for younger children or those with recurrent AOM. A loss only in air conduction would be diagnostic of conductive hearing loss, while combined bone and air conduction loss would be diagnostic of sensorineural hearing loss (Figure 1).
CMT was C1 right supine rotatory, C5 left supine rotatory, T7 prone double-contact diversified, and Applied Kinesiology cranial. When the child was age 8 years, 2 months, a repeat audiogram was performed at the same separate audiology facility (19 months after his initial audiogram and 18 months after completing chiropractic treatment). The adult eustachian tube is larger, contains more elastin and traverses 45 degrees from the temporal bone to the nasopharynx, compared to the child’s smaller eustachian tube with less elastin that traverses 10 degrees. The inner ear includes the auditory-vestibular nerve, the cochlea and the vestibular system (semicircular canals).
The National Institute of Health reports that about 15 percent of Americans aged 20 to 69 have high frequency hearing loss related to occupational or leisure activities. If the loss is minor, then avoidance of noise and ototoxic medications may be an appropriate treatment.
In common usage, the word is used as synonymous with “ear infection,” even by many physicians, but the condition which most chiropractors confront in pediatric patients, persistent middle ear effusion (MEE) involves no culturable pathogenic bacteria in 75% of patients. He was initially treated with repeated courses of antibiotics, and then by insertion of myringotomy tubes at age 3. Results showed the patient’s air-bone gap had closed completely, and the hearing in both ears was within normal limits (Figure 4). Also, Froehle states “Eustachian tube function depends upon appropriate contraction of the tensor veli palatine muscle, which in turn depends upon proper function of the mandibular branch of cranial nerve V, which in turn is dependent upon proper alignment and movement of the occiput and upper cervical vertebrae as the nucleus of the spinal trigeminal tract extends down to the level of the upper cervical segments”. Trauma is more likely to affect hearing in patients who suffer a temporal bone fracture or are older in age (Bergemalm, 2003). Because of occupational risk of noise induced hearing loss, there are government standards regulating allowable noise exposure. Attempting such examinations makes the performance of spinal manipulation more difficult due to vocalization and active resistance on the part of the patient. People working before the mid 1960s may have been exposed to higher levels of noise where there were no laws mandating use of devices to protect hearing.
Occasionally, persons with acquired deafness can be treated surgically with a surgically implanted device, a cochlear implant.
Prior to seeking chiropractic care, he had recently completed a course of antibiotics for an episode of AOM. The RCT was found to be of “high” quality and found significantly fewer surgical procedures compared to usual medical care. Therefore, this case report has potentially two different mechanisms of success: establishing the cranial nerve V flow at the level of the upper cervical vertebra and improvement of the child’s lymphatic drainage. The availability of independent, non-medical practitioners in the audiology profession may present an opportunity to obtain reliable, objective criteria, on a pre- and post-treatment basis, for treatment effectiveness. History included several risk factors for otitis media, including short duration of breastfeeding, parental smoking, and early day care.



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