Ear pain, neck pain, headache, difficulty swallowing, reduced hearing and arm weakness are not usually thought of as a single problem. They are usually thought of as several problems, and frequently referred out to several different specialists. A new case report in the Asia-Pacific Chiropractic Journal argues that in some practice members they are one problem, one that sits at the craniocervical junction, and that the profession has a name for it which traditional medicine has quietly stopped using.
While the case report is new, and covers a single individual and their management under chiropractic care, there is a wider trend in chiropractic literature, and it’s one that begs the question – do we need to ‘unretire’ this term?
Rapid Resolution of Craniocervical Syndrome using Sacro-Occipital Technique, by Max P Bento, describes a 28-year-old man who carried this cluster of symptoms for two years, was investigated by his GP and by ENT without a diagnosis, and reported his symptoms resolving over five weeks of chiropractic care.
The patient was a 28-year-old man with a two-year history of worsening fullness and pain in the right ear. Alongside it, he reported neck pain, intense occipital headaches brought on by exertion (such as jogging), difficulty swallowing, and weakness and poor fine motor control in the left arm. He had been cleared of middle and inner ear pathology on MRI, and antibiotics had not helped. He recalled a significant head injury in childhood (a skull fracture with contusion) and reported that his symptoms had worsened after a massage while he was on holiday and had not improved.
Examination findings included generalised weakness in the left upper limb that did not follow a myotomal pattern (a skeletal muscle group coming from a single nerve root), bilateral single-leg balance deficit, reduced straight leg raise bilaterally at 45°, reduced tongue strength on the right, hypersensitivity to light touch over the right side of the face and neck, and a cough reflex provoked by palpation of the right mastoid fossa. Sacro-Occipital Technique analysis placed him in Category 3 which is usually treated with adjustments and blocking. Craniopathic assessment identified an external listing of the right temporal bone, and spinographic assessment a posterior-right-inferior listing of the axis.
It was a thorough examination, given the severity of his symptoms, but the findings were certainly noteworthy. Almost every element of this presentation points to the same anatomical neighbourhood: the upper cervical spine, the temporal bone, and the cranial nerves and vessels that pass between them.
The course of care
The patient entered a course of chiropractic care that was delivered over roughly five weeks. It combined upper cervical correction of the C2 listing with SOT category blocking, sacral base procedures, and cranial work addressing the right temporal bone.
The reported improvement in this case was not immediate. At the second visit, the patient reported no change at all. By the third, the arm symptoms and the swallowing difficulty had gone, and the mastoid tenderness and cough reflex had disappeared. At this visit, the headache, neck pain and ear fullness still persisted. By the fourth, however, the ear and head symptoms had resolved, leaving only intermittent neck pain. At the final visit, he reported no arm, ear, throat or head symptoms, and neck pain that was reduced but still intermittently present.
This was a substantial improvement in a relatively short course of care after two years of no change. That element of this case report is significant. So too is this: long-term, entrenched symptoms can’t always be expected to resolve on the first session. In fact, research by Holt et al turned up a novel finding that there were peaks in the effectiveness of chiropractic care at about four and eight weeks.
Still, this one resolved quickly, and it appears to reinforce (at least in this one case) the chiropractic concept that everything is connected, and that caring for the nervous system is caring for the body as a whole.
The diagnosis that went missing
The most interesting part of the paper is its argument about classification.
Bento traces the idea that upper cervical dysfunction can produce symptoms well beyond the neck back through the founding literature of both chiropractic and osteopathy: DD Palmer in 1906, John Martin Littlejohn in 1903, and BJ Palmer’s later work on the physiological consequences of upper cervical correction. He then points to a parallel development in mainstream medicine: German-language clinicians describing Zervikalsyndrom, or cervical syndrome, in the 1950s, and linking upper cervical dysfunction to altered vertebral artery flow, mechanical irritation of neural tissue and disturbed sensory input. The symptom picture they described — headache, facial pain, balance disturbance, tinnitus, arm weakness, autonomic signs — maps closely onto the case above.
That construct made it into ICD-10 as cervicocranial syndrome. Bento’s argument is that ICD-11 has since dismantled it into narrower diagnoses such as cervicogenic headache and cervicogenic dizziness, and that the fragmentation loses something: the more unusual cervicogenic presentations — otalgia, aural fullness, hearing change, swallowing difficulty — no longer have an obvious diagnostic home. A patient presenting with all of them at once, as this one did, may be split across specialties and never assembled back into a single picture.
Whether that is the correct reading of the classification change is a question for coders and clinicians rather than for us to settle here. But the clinical observation underneath it is one many chiropractors will recognise: practice members arrive having been investigated thoroughly, organ by organ, and told that nothing is wrong.
A search of the Index to Chiropractic Literature suggests Bento’s case sits within a modest but genuine body of related work, and reading it alongside the case report is interesting indeed.
The closest comparison is Australian. A case appearing in the Chiropractic Journal of Australia in 2002, followed a 43-year-old woman with neck pain and complex ear symptoms (severe otalgia, hearing difficulty, tinnitus and dizziness) over seven years of chiropractic care. Their observation is more nuanced than a straightforward resolution: symptoms consistently reduced after adjustments with relief lasting up to two months, but the underlying condition deteriorated overall across the observation period, consistent with the natural history of Ménière’s syndrome. What they found most notable was the pattern: neck pain exacerbations frequently preceded exacerbations of the ear symptoms, and both relieved after adjustment, with hearing fluctuating in approximate synchrony with changes in upper cervical alignment.
Topics in Integrative Health Care in 2014 reported a 46-year-old woman with neck pain, tinnitus and low-frequency hearing loss, unimproved after eight months of medical care, whose symptoms improved markedly after three chiropractic adjustments and whose post-treatment audiogram was normal.
Another piece published in Chiropractic & Manual Therapies in 2011 covered thirteen investigations of manual therapy for cervicogenic dizziness, including five randomised controlled trials. Their conclusion was that there is moderate evidence supporting spinal mobilisation and manipulation for cervicogenic dizziness, with the important qualification that the methodological quality of the included studies was generally poor to moderate (which merely indicates that more high-quality studies are needed to back up the findings). Some studies also reported improvements in postural stability, joint position sense, range of motion and vertebrobasilar blood flow velocity.
The broadest dataset comes from a multinational survey published in the Journal of Manipulative and Physiological Therapeutics in 2005, in which 385 chiropractors collected data on 5,607 practice members across seven countries. Reported improvement in non-musculoskeletal symptoms (including hearing and tinnitus) was a minority phenomenon, appearing in 2% to 10% of all patients and 3% to 27% of those who had such problems to begin with. Notably for this discussion, care directed at the upper cervical spine was among the few variables associated with reporting such a change (odds ratio 1.4), though the explanatory value of all identified variables together was small. The authors’ recommendation was that future work concentrate on specific diagnostic subgroups, tinnitus among them.
What this means for chiropractic
For chiropractors, the practical value here is a reminder to take the whole cluster seriously. A practice member who mentions ear fullness, a swallowing difficulty and an arm that does not work properly, alongside their neck pain, may be describing one problem rather than four unrelated ones, and the upper cervical spine is a reasonable place to begin looking. The vertebral subluxation is understood at this Foundation as a diminished state of being comprising reduced coherence, altered biomechanical function, altered neurological function and altered adaptability. A presentation like this one, in which several systems appear to lose function together and recover together, is a fair description of that concept in clinical form.
For students and researchers, the more useful observation is about method. The chiropractic literature on cervicogenic aural and craniofacial symptoms is dominated by case reports, and the ones that carry the most weight are the ones that measured something (an audiogram, a validated questionnaire, a repeated alignment measure).
For practice members, the summary is this: if you have persistent ear, throat, head and neck symptoms that have been investigated without a diagnosis, a careful chiropractic assessment of your upper cervical spine may be worth having.
The pattern this paper describes has been observed, in one form or another, for well over a century and across several professions. It hasn’t been studied as carefully as it deserves as yet. That is a gap the profession can close, and case reports like this one are how the argument for doing so gets made.
References
Bento MP. Rapid Resolution of Craniocervical Syndrome using Sacro-Occipital Technique: A case report describing the resolution of persistent Otalgia, Cervicalgia, Cephalgia, Dysphagia, Hypoacusis, and Upper Limb paresis using Chiropractic care. Asia-Pacific Chiropractic Journal. 2026;7.2. Available at: https://www.apcj.site/BentoCraniocervical.pdf
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