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CERVICAL SPECIFIC PROTOCOL FOR 100 MENIERE

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Title: Slide 1 Author: MICHAEL T BURCON DC Last modified by: MICHAEL T BURCON DC Created Date: 9/22/2005 4:20:11 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: CERVICAL SPECIFIC PROTOCOL FOR 100 MENIERE


1
CERVICAL SPECIFIC PROTOCOL FOR 100 MENIERES
PATIENTS
  • THE 25th ANNIVERSARY OF THE
  • PROSPER MENIERE SOCIETY
  • The 12th International Symposium and Workshops on
    Inner Ear Medicine and Surgery

2
Prosper Meniere 1861
  • Director of the Paris Institute for Deaf-Mutes
  • First described the condition that was later
    named for him

3
Andrew Taylor Still, MD, Founder of Osteopathy
  • Watched three of his children die of spinal
    meningitis in the 1870s, after being treated by
    having their skin burned with hot irons and
    having leeches applied to their open wounds
  • Bloodletting was the most common medical
    treatment at that time

4
Wilhelm Conrad Roentgen
  • Took the first x-ray in October 1895 of his wife
    Frau Berthas hand
  • Awarded the first Nobel Prize in Physics 1901
  • Later, his wifes hand was amputated and soon
    after she died of cancer caused by his experiments

5
Harvey Lillard, September 18, 1895
  • Black male janitor presented with almost total
    deafness
  • Case history he was working in a stooped,
    cramped position when he felt something pop and
    heard a crack in his neck, immediately losing his
    hearing

6
D.D. Palmer, Magnetic Healer
  • Discovered a bump on the back of Mr. Lillards
    neck at level of C2 (Axis)
  • Performed the first chiropractic adjustment
  • Within ten minutes Mr. Lillards hearing was
    fully restored

7
BJ Palmer, DC
  • Son of DD Palmer
  • Took over Palmer Chiropractic College from his
    father
  • Started researching upper cervical specific
    chiropractic in 1931

8
William G Blair, DC
  • Started researching the atlanto-occipital joints
    in 1951
  • Started teaching his technique in 1961
  • The Blair technique is the only non-orthogonal
    upper cervical specific technique today

9
2 Superior Articulations of C1 (Atlas)
  • Before you can know the correct vertebral
    positions, you must first know all the existing
    asymmetries and malformations, William Blair.

10
Atlas Subluxation
  • Subluxated articular misalignments are analyzed
    as they displace the neural rings, thereby
    occluding the neural canal and compromising the
    cord space, Blair.

11
My Own Experience
  • Dr Perry Rush, instructor at Sherman College of
    Straight Chiropractic, introduced me to the Blair
    Technique in 1995, and gave me my first upper
    cervical specific adjustment.

12
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13
4 Blair Atlas Subluxation Listings
  • Anterior and Superior on the Right (ASR)
  • Anterior and Superior on the Left (ASL)
  • Posterior and Inferior on the Right (PIR)
  • Posterior and Inferior on the Left (PIL)

14
Blair X-Ray Analysis of Atlas
  • If the atlas tracts up or down on the left
    condyle, you will be able to see the misalignment
    being created and demonstrated on the right
    condyle.

15
Over lap (ASR) and the under lap (PIL) of C1 in
relation to Occiput.
16
Next we have atlas beneath the occiput. Atlas
tracts along the left condyle and will show the
creation of an anterior superior right (ASR)
subluxation first. It then follows through and
shows
17
PIL (Posterior inferior on the left)
18
Listings Determined by X-Ray
  • View lateral edges of the two articulations
    between Occiput and Atlas on Nasium and AP Open
    Mouth or Oblique Protracto Views
  • Overlapped Atlas determines Anterior and Superior
    listing on side of that articulation
  • Underlapped Atlas determines Posterior and
    Inferior Listing on opposite side of subluxated
    articulation

19
Before C1 PIL After C1 Juxta
20
Lateral Cervical of Menieres Patient
  • Note lack of normal cervical curve with kink
  • Note posterior atlas
  • The only cause of these two findings on an x-ray
    is whiplash

21
Dr. Karel Lewit, Czechoslovakian neurologist
Typed 120 Cases in 1961
  • Type I (a)- Menieres Disease with no neck pain
  • Type I (b)- Menieres Disease involving neck
    symptoms
  • Type II- Cervical Vertigo (dizziness after head
    movements)
  • Type III- Mixed Cases of Type I Type II

22
Lewits Proposed Causes of Dizziness
  • Inner ear disorders
  • Brain diseases
  • Blood supply interference to the inner ear
  • Direct nerve interference with balancing reflexes
  • Combination of the above causes

23
  • Chiropractors refrain from assuming that the
    site of a symptom is the site of its cause. When
    an injury occurs in one area, the normal balance
    is disrupted, the body makes compensations and
    structural patterns are altered. Due to the laws
    of gravity, a new state of dynamic equilibrium is
    created.

24
Other possible Morphologies of Atlas Subluxation
causing Menieres
  • Irritates the nucleus of CN VIII, the
    Vestibulocochlear
  • Irritates the nerve root of CN VIII
  • Diminished blood flow from the vertebral artery
  • Increased CSF pressure via the cochlear aqueduct
  • Pressure on auditory tube
  • Ears at different heights/angles due to kink in
    the neck

25
My First Menieres Patient 1998
  • 85 y.o. white female
  • Case history whiplash in 1940s, R sided
    Menieres since 1954, colostomy and mastectomy
  • Presented with vertigo, tinnitus, cervicalgia,
    LROM L arm, blindness L eye, numbness L thumb, R
    shoulder P!

26
The Merck Manual
  • Menieres disease is associated with
    endolymphatic hydrops
  • The cause is unknown
  • Treatment is empirical
  • Question? What causes the edema that causes the
    dilation of the membranous labyrinth?

27
Burcon Chiropractic Research
  • 2000- Upper Cervical Protocol for Three Menieres
    Patients,
  • Journal of Vertebral Subluxation Research
  • Burcon Chiropractic
  • 4362 Cascade Road, SE
  • Grand Rapids, MI 49546
  • (616) 575-9990
  • drmburcon_at_aol.com
  • www.BurconChiropractic.com

28
Upper Cervical Protocol for Ten Menieres
Patients
  • Presented at the 9th Annual Vertebral Subluxation
    Research Conference, Sherman College of Straight
    Chiropractic in 2001

29
Dynamic Chiropractor 2003
  • Parkinsons Disease, Menieres Syndrome,
    Trigeminal Neuralgia and Bells Palsy One
    Cause, One Correction

30
Upper Cervical Protocol forTen Menieres Patients
  • Same paper published in Upper Cervical
    Subluxation Complex, A Review of the Chiropractic
    and Medical Literature, by Kirk Ericksen.
    Lippincott, Williams Wilkens, 2004

31
Upper Cervical Protocol for 30 Menieres
Patients
  • 2005, Los Angeles, CA
  • Poster presentation
  • Exhibitor

32
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33
WZZM Channel 13
  • ABC affiliate in Grand Rapids, MI
  • Burcon Chiropractics Menieres research featured
    on the 6 and 11 Oclock News in 2005
  • Resulted in 60 new Menieres patients

34
Protocol for 100 Menieres Patients
  • Extensive case history that includes at least two
    episodes of vertigo lasting at least 20 minutes
    each
  • Sensorineural hearing loss confirmed by
    audiometry
  • Tinnitus and/or
  • Perception of aural fullness
  • Patient must provide letter from ENT specialist
    confirming diagnoses with copy of test results

35
Demographics
  • 54 Females
  • 46 Males
  • Youngest 9 y.o.
  • Oldest 93 y.o.
  • Mean age 53 y.o.

36
Cervical Syndromes
  • Derifield/Thompson Cervical Syndrome Test- Hold
    patients shoes with thumbs under the heel, while
    applying very mild cephalic pressure. Lift the
    legs one inch off from the table, keeping the
    shoes one inch apart. Compare the welts to
    estimate the leg length differential. Notate
    differential of short leg to closest 1/8 inch.
    Instruct patient to slowly turn their head to the
    right, then to the left. If the legs change
    length only while turning to the right, notate
    the amount of change as a right cervical syndrome
    (RCS). If the legs change length only while
    turning to the left, notate the amount of change
    as a left cervical syndrome (LCS). If the leg
    length changes while turning the head in both
    directions, notate the total amount of change as
    a bilateral cervical syndrome (BLCS). If there
    is no change in leg length when the head is
    turned, there is no cervical syndrome. Perform
    following tests to determine which upper cervical
    vertebrae is subluxated.

37
Orthoneuro Examination
  • Modified Modified Prill Cervical Leg Check
    Protocol
  • Interactive presentation at the 11th Annual
    Vertebral Subluxation Research Conference
  • Determines which cervical vertebra to adjust
  • Intraexaminer repeatability tested very good
  • Interexaminer repeatability tested excellent

38
Modified Blair X-Ray Protocol
  • All 100 consecutive Menieres patients tested
    positive for upper cervical subluxations
  • 3 Cervical x-rays taken and analyzed Lateral,
    A-P Open Mouth and Nasium
  • All 100 film studies showed evidence of upper
    cervical subluxation and whiplash, although
    cervical trauma was denied by over 50 of
    patients.

39
Level of Major Upper Cervical Subluxation
  • C1 (Atlas) in 96 out of 100 consecutive cases
  • C2 (Axis) in 4 out of 100 consecutive cases

40
Observation
  • When major symptom is vertigo with nausea, atlas
    is the major subluxation
  • When major symptom is tinnitus with ear fullness,
    axis is the major subluxation

41
Atlas Listings for 96 Menieres Patients
  • 0- Anterior and Superior on opposite side of bad
    ear
  • 1- Anterior and Superior on side of bad ear
  • 2- Posterior and Inferior on side of bad ear
  • 9- Posterior and Inferior bilaterally
  • 84- Posterior and Inferior on opposite side of
    bad ear

42
Most Significant Finding
  • The primary cause of unilateral Menieres disease
    is an atlas subluxation with a listing of
    posterior and inferior on the opposite side of
    the involved ear
  • This means that the atlanto-occipital
    articulation is subluxated on the side of the
    involved ear

43
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44
Improvement at 6 Weeks
45
Negative Side Effects
  • The only negative side effect noted was an
    increase in the frequency and magnitude of
    headaches in 3 patients, increasing in average
    from 2.3 to 5.7
  • Headaches improved with 30 patients, decreasing
    in average from 5 to 2
  • Headaches remained unchanged in 67, with the
    average staying at 3

46
Improvement at 3 Months 6 Years (80 out of 100
Patients Responded)
47
Other Improvements
48
Comments
  • I have felt safe enough to drive again.
  • Weaned off my meds with no Menieres symptoms!
  • I do not fall down anymore.
  • I do not snore anymore.
  • My wife says that I am easier to get along
    with.

49
Suggestion
  • Next time a patient presents with Menieres
    symptoms
  • And brain tumors and MS are ruled out by MRI
  • Refer patient to an upper cervical specific
    chiropractor
  • Before resorting to surgery
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