Last week, Hearing International explored the suspicious nature of the world of Chiropractic, its scope of practice, and the discipline’s claims that it cures hearing loss with a “Crack of the Back” or as some call it, Spinal Manipulation Therapy (Miller, 2012). Although good Chiropractors are extremely helpful for certain adjustments for back pain, a review of Chiropractic literature suggests that the discipline in general feels that it can cure anything from bed wetting and ear infections, to sensorineural hearing impairment for children and adults by simple manipulation of the spine. This week we review the chiropractic treatment for a problem Chiropractors call Vertebragenic Hearing Disorders, sometimes referred to as Cervicogenic Hearing Loss and Otitis Media.
First, the real question is what exactly is a vertebragenic/cervicogenic hearing disorder? Its name suggests that this problem has something to do with the Vertebral Artery and its supply of blood to the auditory system. There is also some indication that there is a reduction of blood suppy to the audio/vestibular mechanism due to the position of the spine and its reduction of blood supply to audition.
Chiropractic and Hearing Loss
On the Chiropractic side, Hulse (1994), an ENT at Heidelberg University (Germany), published one of the classic studies that is cited in support of the existence and verification of veterbrogenic hearing loss as well as the use of chiropractic manipulation for its cure. Hulse (1994) reviewed the medical findings of 259 patients with well-defined functional deficits of the upper cervical spine and symptoms of cervical vertigo and found that subjective hearing disorders occurred in 15%. Audiometric threshold shifts of 5-25 dB, most often in lower frequencies, were observed in 40% of subjects, and results of click-evoked otoacoustic emissions (OAE) were negative, in spite of approximately normal hearing.
Findings in 62 of these patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. There is no discussion of the type of spinal theraputic manipulations conducted, nor are there before and after results to conclude whether or not these techniques were successful. Since OAEs had just recently been discovered at the time, it would be interesting to know the methods, equipment, and examiner expertise for the OAE measurements conducted as well as the environment, headphones and other variables in which the audiometry was conducted. However, these are not discussed in this paper.
If the audiometry was conducted outside of a sound-treated environment, that may explain the low-frequency hearing loss. Ives (2012) writes that not only do spinal manipulations of the vertebral apparatus not cure hearing impairment, they are actually dangerous and may even cause death, under some circumstances. Ives further indicates that that there are virtually no vertebral artery disorders that can be cured by chiropractic adjustment.
Secondly, there are chiropractors who attempt to treat otitis media An example of this type of treatment is offered by Saunders (2004). A 3 1/2-year-old boy presented to a chiropractic clinic with a 10-month history of continuous discharge accompanied by a distinctive smell emanating from both ears. Upon a routine 3-year check-up for his hearing, 4 months prior to consultation, a slight hearing deficit had been identified. The author does not say how much, nor the type of impairment, but we can surmise that it was a bilateral conductive impairment. This case was being reviewed for consideration of myringotomy and tympanostomic tube insertion, within a 2-month period.
Saunders (2004) reports that cervical and thoracic segmental dysequilibrium was found upon static motion palpation that suggested the presence of a “chiropractic vertebral subluxation complex” at these levels (a What!?). The patient was treated four times by means of “cervical paediatric adjusting” (whatever this is). Activator technique was applied to the thoracic region. Discharge from the ears disappeared immediately after the first visit. “An improvement in hearing was identified at a hearing test 3 months after cessation of chiropractic care.” (Could it be that the ear infection cleared up on its own?)
Consequently, according to Saunders, the myringotomy and tympanostomic tube insertion were considered inappropriate. The patient now uses oil drops to prevent cerumen accumulation. “At 6 years old, he has had no further recurrence of OME and no speech or hearing problems are apparent.” (Whew! Could people really believe that a spinal adjustment could cure otitis media?)
Heasley (2006), taking to heart the dubious Di Duro (1996) literature that we discussed here last week, states that “I believe it’s a left-brain deficit.” Heasley seems to be offering an explanation for why chiropractic treatment is most often used for hearing loss in the right ear by adding that, “The left side of your brain runs speech and word recognition. If that part starts to become a little sleepy, then you’ll lose more hearing in your right ear.” (Where have these people been for the past few years?) Di Duro’s theory seems to be based on findings from chiropractic neurology which is usually flawed, according to our sources, Ives, 2012.
When bad chiropractic or other research is published, it creates credibility for the procedures supported by the article, spawning speculation as to how to clinically apply a possibly worthless procedure.
Be with us next week for a special presentation of experience with Spinal Maniulation Therapy.
Di Duro, J., (2006). Improvement in hearing after Chiropractice care: A case series. Chiropractic & Osteopathy, 14:2. Retrieved February 14, 2012: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395318/
Heasley, J. (2006). Can you hear me know? Psychology Today. Retrieved February 21, 2012: http://www.psychologytoday.com/articles/200608/can-you-hear-me-now
Hulse, M., (1994). Cervicogenic hearing loss. HNO, 42 (10), pp 604-13. Retrieved February 22, 2012: http://www.ncbi.nlm.nih.gov/pubmed/8002367
Ives, T. (2012). Personal Communication. February 22, 2012.
Miller, M. (2012). Personal Communication. February, 20, 2012
Saunders, L., (2004). Chiropractic treatment of otitis media with effusion. Clinical Chiropractic, 7(4), pp 158-173. Retrieved February 22, 2012: http://www.sciencedirect.com/science/article/pii/S1479235404000203