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What is Vestibular Neuritis?

Posted in Head Pain Disorders on Sep 05, 2019

Can upper cervical adjustments help vestibular neuritis?

How long ago were you diagnosed with vestibular neuritis? … Because if it was more than a month ago, there’s probably more going on than meets the eye.

I once took care of a person, who said they had already been to three specialists for vestibular neuritis that had been going on for about 2 years. The first said it was vestibular neuritis. The second said it was Meniere’s disease … but wasn’t sure. The third said they didn’t know, but that it wasn’t vestibular neuritis or Meniere’s disease.

If you can relate to this story - going to vestibular neuritis specialists - but feeling like you’re only going in circles, I want to offer you some valuable information that may help you if you have been dealing with dizziness or vertigo.

More importantly, I want to share with you a unique approach to healthcare that focuses, of all places, on the alignment of the top two bones in the neck - the atlas (C1) and the axis (C2) - how they affect your nervous system, and how the right kind of treatment may be able to help with vestibular neuritis.

If you have been dealing with vestibular neuritis or any other dizziness or vertigo condition long enough, I can appreciate your frustration not being able to find answers. In this article, I hope I will be able to offer you a new direction: one that may help you get your life back so that you can enjoy doing the things that you enjoy most.

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How to “read" common vestibular neuritis symptoms

Vestibular neuritis is also known as “labyrinthitis.”

True vestibular neuritis is due to inflammation of the vestibular nerve or the vestibular apparatus, which is the organ in your inner ear that is responsible for sending balance information to your brain.

HERE IS WHY I DON’T LIKE HE DIAGNOSIS OF VESTIBULAR NEURITIS.

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It’s because most of the time, vestibular neuritis is diagnosed without doing any tests. You wake up one morning with acute vertigo, rush to the doctor or the emergency room … but many times, unless you’re having other symptoms you don’t end up having any tests done.

You are simply told that you have a virus and that it’s caused swelling of your inner ear, which is the reason you have vertigo. Then you are prescribed a couple of anti-inflammatories and diuretics to help reduce the swelling, and told the the condition should fix itself in the new few days.

Now, maybe you did have a few tests like a brain CT or MRI to rule out other dangerous kinds of conditions. One way or another, here’s the thing: UNLESS YOU WERE SPECIFICALLY TESTED FOR A VIRUS (WHICH ONLY SHOWS UP ON A BLOOD TEST) OR UNLESS YOUR MRI SCAN CLEARLY SHOWED SWELLING IN OUR INNER EAR, YOU CANNOT MAKE A DIAGNOSIS OF VESTIBULAR NEURITIS!

In other words, the name “vestibular neuritis” might be a complete misnomer. Moreover, if the condition does indeed last longer than a few days, it is very unlikely that a virus is the only problem.

 

 

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What is the cause of vestibular neuritis

So what else could be going on to cause vestibular neuritis? Perhaps more appropriately, what else could be the cause of your sudden vertigo?

There are a couple of other possibilities including conditions known as Meniere’s disease and benign paroxysmal positional vertigo (BPPV), which is attributed to inner ear crystal malpositions, and endolymphatic hydrops, which is attributed to fluid accumulation of the inner ear. You may also experience a few of the other symptoms including the following:

  • vertigo changes when you move your head
  • tinnitus or ringing in your ears
  • fullness or pressure in your ears,
  • pressure in your head,
  • transient deafness, 
  • or other things like brain fog, difficulties concentration or remembering things.

All of these symptoms ultimately involve dysfunction of your nervous system. In other words, something is affecting your brain’s ability to maintain its sense of balance. Now the thing about it is that the problem may be affecting the inner ear, but that does not always mean that is where the problem is coming from in the first place! 

If so, you can take all the stematil, cerc, diuretics or anti-inflammatories that you want, but it won’t resolve the underlying problem. So instead, let’s come back around and see what other causes there may be, emphasising the role of the upper neck in vestibular neuritis.

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Acute vertigo can be triggered by a few possibilities:

  1. Altered blood flow to the vestibular nerve. The major source of blood to the inner ear comes from the pair of vertebral arteries, which enter the skull after passing directly through the C1 and C2 vertebrae. Potentially, misalignments of the upper vertebrae can affect blood flow
  2. Altered sympathetic control to the vertebral arteries. All blood vessels in the body are controlled by a division of your autonomic nervous system called sympathetics nerves. These nerves control blood vessel dilation or constriction. Of note, their activity cannot be see on any CT or MRI scans. The hub of these nerves that control blood flow to the face, neck, head, brain and inner ear are located directly in front of the C1 and C2 vertebra. Traction or irritation of these nerves that this site may have the potential of disrupting their activity further up the chain in the inner ear, also potentially producing the symptoms of vestibular neuritis.  
  3. Inner ear fluid accumulation. This is more what causes an endolymphatic hyropds, but can still produce vertigo if fluid levels in the inner ear get backed up. The thing about it is that the muscle that regulates the opening of the valve for the inner ear (Eustachian tube) are heavily influenced by what happens withe the alignment of the C2 vertebra. In brief, the sensory relay centre of the spinal cord at C2 contains the information about the tensor veil palatine muscle, If this muscle is in spasm, it will contract the Eustachian tube, lead to the backup of fluid in the ear canal and potentially produce vertigo.

Indeed, there can still be so much more going on. Nevertheless, I wanted to illustrate that the three examples above have nothing to do with a virus, but can all still produce acute vertigo and the symptoms of vestibular neuritis.

If so, what do you need to do?

 

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What to do about vestibular neuritis problems

If you have never experienced vertigo before, yes, I agree with many GPs to give things a day or so to see if the issue will resolve on its own. Your body is designed to be strong. If there is a viral infection, it should be strong enough to heal from the problem.

However, if you have been dealing with “vestibular neuritis” for more than just a couple of days - or if you have been dealing with on-and-off bouts of vertigo for weeks, months or even years (!), that is a hallmark that there is something else going on.

One of the first things to do is have a brain MRI or CT scan to rule out the pathologies that I mentioned back in the beginning of this article. However, when the scan comes back as being “normal” that does NOT mean that everything is normal … nor does it mean that you should just treat the issue with medication, diet, etc.

Because if there is a problem now, you can mask the symptoms BUT IT WILL ONLY COME BACK STRONGER IN THE FUTURE.

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THE KEY TO SUCCESS IS IDENTIFYING WHAT THE CAUSE OF VESTIBULAR NEURITIS IS.

And no assessment of vestibular neuritis would be complete without also looking at the structure and alignment of your neck. Here is the unique form of healthcare that we provide at Atlas Health called Blair Upper Cervical Care.

Our North Lakes chiropractic office is the only clinic in Brisbane offering this unique form of healthcare. Now, you may have just noticed I used the word “chiropractic.” However, this is NOT what you may think of with a general Brisbane chiropractor. 

Foremost, there is no spinal manipulation. The Blair upper cervical approach is a method developed in the USA that includes post-doctorate study and advanced certification. At the time of this writing, we are the only Advanced Certified Blair chiropractor Brisbane.

I will explain a bit more about the approach in a little bit, but let me add that typically upper cervical chiropractors see the kind of cases where you have gone to XYZ practitioner or specialist, not found any relief there … but then MANY of those cases do experience relief once we get the upper neck properly aligned.

 

 

Most common reasons adults have vestibular neuritis problems

So what can cause vestibular neuritis in adults? As I mentioned before, unless there is a pathognomonic test that identifies a certain virus living in your inner ear, I am not entirely convinced that is the problem.

So let’s look instead what can cause a misalignment of your upper neck: the C1 vertebra (atlas) or C2 vertebra (axis). It is a physical injury. Not always the kind that causes bleeding, broken bones or even bruising.

It’s the kind of injury that knocks you around hard - maybe even where you feel jolted for a couple of days ago - but then when the pain goes away after a week and you convinced yourself that you healed up fine because you “feel fine.”

However, that does not always mean that everything IS fine. Let me explain. The total movement of the C1 and C2 vertebrae is approximately 1cm in any one direction. If an injury exceeds 1cm (1005), that’s called a dislocation and requires immediate medical attention. If an injury is less than a millimetre, (<10%) your body is usually able to resolve the issue on its own.

However, if the injury misaligned things by 2-4mm (20-40% which is exceptionally common), your body is not always able to pull these misalignment back into place. The result is that the injury will get stuck in this position. Now, you brain will work to compensate for this misalignment which is the reason you don’t immediately feel pain!! In fact, only 1/3 types of nerves in your upper neck contain pain sensory. 2/3 do NOT, which is how so may of these vestibular neuritis problems can creep up over a long time without any neck pain.

So if you multiply this 20-40% decease in function over a long period of time - voila! - it can appear seemingly out of nowhere when it finally gets triggered. And because it seems to appear so suddenly, it’s easy to look for an acute cause (such as a virus) when the reality is that the issue may have been developing for a much longer period of time.

 

 

Most common reasons children have vestibular neuritis problems

Even children are not immune from vestibular neuritis. Admittedly, vertigo is way less common in children. (They are far more likely to develop inner ear infections, which is still associated with labyrinthitis but usually doesn’t involve the same degree of vertigo).

The real reason that I raise the possibility of vestibular neuritis in children is because it is in childhood that so many of the injuries occur that cause misalignments of the C1 or C2 vertebrae.

There is an old expression: as the twig is bent, so grows the tree. So consider all the potential ways that kids suffer micro injuries that may affect eh structure and development of their bodies thereafter:

  • Skating, skateboarding, surfing and skiing
  • Dancing, gymnastics and jungle gyms
  • Bike riding, motorbike riding and horse riding
  • Kicking, running, slipping, sliding, tackling, falling and fumbling

Then add some of the bigger ones in there like car accidents or birth injuries and you have potentially set the stage for developing vertigo later in life.

Then, as you grow up and experience vestibular neuritis, you are told that the symptoms are the result of a virus or “getting older” … when the real culprit may be an atlas injury that happened so long ago!

I know this is a very different perspective from what you’ve probably heard or been told about vestibular neuritis. Maybe I’m completely wrong! But let me ask you: HAS THE APPROACH YOU’VE TRIED THUS FAR FOR VESTIBULAR NEURITIS WORKED FOR YOU?

If the answer is “no,” I would simply ask you to open your mind to this possibility, which the more you think about it, the more it will make sense.

 

Diagnostic for vestibular neuritis problems

So how can we tell if you have a problem with your upper neck that can be related to vestibular neuritis? That is the relatively easy part. I want to mention one other important thing before that though about why you’ve never heard this connection between the upper neck and vestibular neuritis before.

It’s because it is a non-linear connection.

With western medicine, the entire system is based on one of linear cause-and-effect. That is, we treat symptom “A” with drug “B.”  Although this strategy is effective when it comes to treating symptoms, it does not address the cause. And when it comes to identifying cause, the way that the body works is NON LINEAR.

For example, a symptom such as vertigo (“A”) can be caused by a number of different things, not just a virus or even a neck misalignment … and so we have to figure out which among the possibilities is most likely.

Moreover, a condition such an a misalignment in your upper neck (“B”) can not only cause vertigo, but so many other things that affect your nervous system health: migraines, headaches, organs, brain, etc. The result is that many medical and even other healthcare practitioners don’t consider the full array of possibilities that may truly be involved with vestibular neuritis.

So in our North Lakes chiropractor office, of course we will be looking to see if you have a condition of your upper neck that is affecting your nervous system and may be related to your vestibule neuritis … BUT WE ALSO LOOK FOR OTHER FACTORS THAT COULD ALSO BE RELATED

I hope that scenic detour makes sense.

As far as the tests that we perform to identify if you have a problem with the alignment of your atlas and upper neck, we start with a series of physical and neurological tests that look at your body as a whole.

One of the common things that we find in nearly 100% of people who experience dizziness or vertigo is called a “torso twist,” which is an abnormal finding with your posture that reflects what is happening with your brainstem and spinal cordWe also find the resolution of this twist is often the key to achieve ing relief from dizziness or vertigo.

We also don’t leave things to chance when it comes to treating your neck. So we have our own specialised 3D x-ray equipment on site that allows us to take images that show things about the alignment of your atlas and axis that aren’t visible even on CT or MRI scans.

The result is that we are able to diagnose, and ultimately treat things that no one has been able to see with you before!

 

 

Upper cervical chiropractic treatment for vestibular neuritis problems

Even though the symptoms of vestibular neuritis can come on very quickly, if the cause is an underlying issue with the alignment of your neck that has been developing over a long time, it is rare that it’s a single session where everything is fixed.

That would be the ideal … but also not a realistic expectation.

The procedure that we follow is that we make a series of specific corrections to the alignment of your neck using no more force that what you need to feel your pulse. … And ideally as few treatments as possible! Not only is the style of chiropractic different from other North Lakes chiropractors, but we also do NOT treat you on every visit! We find that this is the actual key to getting the best possible, longest lasting results: i.e., getting your own body to take care of itself again.

And we find that many of our clients who follow this approach finally experience relief from vertigo even when they’ve tried so many other approaches before. 

In fact, they often remark, “I should have done this first”. 

Wherever you are in your search for answers - whether you have only just been diagnosed with vestibular neuritis OR if you have been struggling with vertigo for a long time - we hope that you have found value and hope in this article. If so, I’d like to encourage you then to take the next logical step, which would be simply to reach our to us.

You can contact our North Lakes chiropractic office at 07 3188 9329 - or you can send us a email through this webpage - and we will get in touch with you if you’d simply like to have a chat to discuss your condition and if there is anything we can do to help you.

Our Brisbane chiropractor clinic provides upper cervical care for people suffering a wide variety of vestibular conditions, and we would be happy to assist you in any capacity that we can.

So if you have been dealing with vestibular neuritis for a long time, and you are ready to do something different about it, I hope that you don’t forget to take care of your neck too! It’s your lifeline to wellbeing.

 

 

References

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Boyd-Clark LC, Briggs CA, Galea MP. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine (Phila Pa 1976). 2002 Apr 1;27(7):694-701. https://www.ncbi.nlm.nih.gov/pubmed/11923661

Burcon MT. Health Outcomes Following Cervical Specific Protocol in 300 Patients with Meniere’s Followed Over Six Years. Journal of Upper Cervical Chiropractic Research ~ June 2, 2016 ~ Pages 13-23. https://www.vertebralsubluxationresearch.com/2016/06/02/health-outcomes-following-cervical-specific-protocol-in-300-patients-with-menieres-followed-over-six-years/

Grgić V. [Cervicogenic proprioceptive vertigo: etiopathogenesis, clinical manifestations, diagnosis and therapy with special emphasis on manual therapy]. [Article in Croatian] Lijec Vjesn. 2006 Sep-Oct;128(9-10):288-95. https://www.ncbi.nlm.nih.gov/pubmed/17128668

Hegemann SCA, Wenzel A. Diagnosis and Treatment of Vestibular Neuritis/Neuronitis or Peripheral Vestibulopathy (PVP)? Open Questions and Possible Answers. Otol Neurotol. 2017 Jun;38(5):626-631. doi: 10.1097/MAO.0000000000001396. https://www.ncbi.nlm.nih.gov/pubmed/28346294

Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol Indfa, 2001;49(4):355-9. https://www.ncbi.nlm.nih.gov/pubmed/11799407

Ndetan H, Hawk C, Sekhon VK, Chiusano M. The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data. J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42. doi: 10.1177/2156587215604974. Epub 2015 Sep 11. https://www.ncbi.nlm.nih.gov/pubmed/26362851

Peng B. Cervical Vertigo: Historical Reviews and Advances. World Neurosurg. 2018 Jan;109:347-350. doi: 10.1016/j.wneu.2017.10.063. Epub 2017 Oct 20. https://www.ncbi.nlm.nih.gov/pubmed/29061460

[Acute vestibular syndrome in emergency departments : Clinical differentiation of peripheral and central vestibulopathy]. [Article in German] HNO. 2019 Aug 22. doi: 10.1007/s00106-019-0721-8. [Epub ahead of print] Pudszuhn A, Heinzelmann A, Schönfeld U, et alhttps://www.ncbi.nlm.nih.gov/pubmed/31440773

Ravn JH, Fuglsang R, Højland C, Hauvik M. The effect of the sympathetic nervous system on proprioception of the neck. Aalborg University. Project supervised by Deborah Falla and Shellie Boudreau. 2009. Date of submission: 1/5/2010. http://vbn.aau.dk/files/19025476/Projekt_3.0_F_RDIG.pdf

Yang L, Chen J, Yang C, et al. Cervical Intervertebral Disc Degeneration Contributes to Dizziness: A Clinical and Immunohistochemical Study. World Neurosurg. 2018 Nov;119:e686-e693. doi: 10.1016/j.wneu.2018.07.243. Epub 2018 Aug 6. https://www.ncbi.nlm.nih.gov/pubmed/30092465

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