Many of us have struggled with occasional ringing in our ears following a night out at a concert, or perhaps struggled with inability to hear clearly following an ear infection or related ailment. However, constant tinnitus is something we often see in practice and certainly deserves attention due to the discomfort that it brings to the patient, and the impact it has on their quality of life. Heading to a chiropractor for ear-related ailments is something that is not often reported though, though given the frequency with which we see it, it is certainly something we need to address.
That is what makes this week’s case report quite interesting. Hypoacusis, otherwise known as low or unclear hearing, and tinnitus resolving concomitant with chiropractic care is a fascinating outcome – one that hasn’t appeared often in case report data at this point in time.
The case in question, published in the Asia Pacific Chiropractic Journal as part of the Australian Spinal Research Foundation’s inaugural case report project featured a 62-year-old female who presented for chiropractic care with a primary concern of severely reduced hearing and loud ringing in her ears following a weight overload.
She noted a history of bruxism (a sleep disorder with grinding of the teeth affecting the sleep cycle). This affected the start of sleep on a nightly basis, causing awakenings and poor sleep throughout the night. She also suffered from arterial hypertension. She has previously had her gallbladder surgically removed.
Audiometry readings were taken before the commencement of care to establish an objective baseline of her hearing. The initial readings revealed a significant difference in hearing between her ears, but both were reduced.
During the physical examination, subluxations at C3-C4 on the left side, T3-T4, and the left sacral base were identified. Her leg check was positive for cervical syndrome and algometry picked up on the suboccipital points. The patient was adjusted using Diversified Technique.
During the second review subluxations at C0-C1 were added to the initial findings. The patient received 4 sessions of chiropractic care, after which a re-evaluation was performed in order to establish whether or not improvements had been realised.
The re-evaluation revealed a 90% increase in her hearing on the left side. The patient also reported a significant reduction of the ringing in the ears, an improvement in the start of her sleep and overall sleep quality, as well as a decrease in the frequency of the times she wakes up at night.
Interestingly, upon examination it was noted that while the subluxations at C3-C4 and in the thoracic spine did not resolve, C0-C1 did. This may be noteworthy given the high level of innervation at the C0-C1 level, which may have implications with relations to the presenting hearing-related symptomatology.
This case highlights the involvement of the Autonomic Nervous System in relation to sleep disturbance. Interestingly, in the 2021 ASRF Case Report Project, improved sleep was noted in multiple cases (2,3) emphasising the need for further research to qualify and explain this connection in the chiropractic specific context with regard to improved sleep.
Previous studies have noted the effects of manipulative therapies relative to the autonomic nervous system have been noted. A randomised controlled trial investigated the effect of osteopathic manipulative treatment on vascular and autonomic measures. The study included 20 patients with heart failure, aged between 50 to 60 years of age. The treatment was found to be effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure. Vascular changes appear to precede the autonomic modulation. (4) It is important to note this study included only one session of therapy for each participant, not a multi-session course of care.
A systematic review published in 2019 suggested, overall, the low quality of evidence in the area of chiropractic and autonomic nervous system effects, preventing us from making any definitive conclusion when it comes to sleep and autonomic nervous system function. (5) The report stated,“Based on the current evidence there is uncertainty regarding the true effect estimates of SMT on ANS-mediated outcomes.”
With the conclusions we can draw from this, there is an absolute necessity for us to do the research necessary to evidence what we see clinically – that chiropractic does impact the autonomic nervous system and health of our patients.
The need for further research was also shown by A Randomised Controlled Trial evaluating the effect of a single spinal manipulation on ANS activity. It found there was no effect on cardiovascular autonomic activity. There was also no relationship between cardiovascular autonomic activity and PPT after the SM. HRV and systolic blood pressure variabilities were used and there has been some contention around the accuracy of this measure. (6) The conclusion: “Further experimental research should consider the use of several markers of autonomic activity and a more comprehensive pain assessment.”
For the time being, what we have is this study which shows sleep, hypoacusis and tinnitus all improving concomitant with chiropractic care. Further research is certainly required to explain and understand the linkages between chiropractic care and the improvement in the patient’s symptomatology. While the need for further research certainly remains — this is another life significantly impacted by the gift of chiropractic care – and that is good news to us indeed.
References:
- Alarcon EM, Postlethwaite R, McIvor C. Resolution of severe hypoacusia and first degree tinnitus concomitant with chiropractic care. A case report. Asia-Pac Chiropr J. 2022;2.5. URL apcj.net/papers-issue-2-5/#Emiliohypoacusia
- Steinberg B, Postlethwaite R, McIvor C. Decrease in allergies, nocturnal enuresis and sleep problems in a 3-year-old under chiropractic care: A case report. Asia-Pac Chiropr J. 2022;2.5. URL apcj.net/papers-issue-2-5/#SteinbergAllergies
- Leahy A, Postlethwaite R, McIvor C. Improvement in posture, sleep and energy in a 25 year old female under chiropractic care: A case report. Asia-Pac Chiropr J. 2022;2.5. URL apcj.net/papers-issue-2-5/#LeahyPostureSleep
- Amatuzzi F, Gervazoni Balbuena de Lima AC, Da Silva ML, Cipriano GFB, Catai AM, Cahalin LP, et al. Acute and Time-Course Effects of Osteopathic Manipulative Treatment on Vascular and Autonomic Function in Patients With Heart Failure: A Randomized Trial. Journal of Manipulative and Physiological Therapeutics. 2021. 44(6):455–66.
- Araujo FX, Ferreira GE, Angellos RF, Stieven FF, Plentz RDM, Silva MF. Autonomic Effects of Spinal Manipulative Therapy: Systematic Review of Randomized Controlled Trials. Journal of Manipulative and Physiological Therapeutics. 2019. 42(8):623–34.
- Picchiottino M, Honoré M, Leboeuf-Yde C, Gagey O, Cottin F, Hallman DM. The effect of a single spinal manipulation on cardiovascular autonomic activity and the relationship to pressure pain threshold: a randomized, cross-over, sham-controlled trial. Chiropractic & Manual Therapies. 2020. 28(1).
