Skip to main content

Selected ENT symptoms in functional disorders of the upper cervical spine and temporomandibular joints

Ausgewählte HNO-Symptome bei funktionellen Störungen der oberen Halswirbelsäule und der Kiefergelenke

Abstract

This paper discusses otorhinolaryngological symptoms associated with functional disorders of the upper cervical spine. Hints aimed to avoid misdiagnoses of cross-organ otorhinolaryngological symptoms as phobic or psychogenic disorders are presented. Clinically relevant neuroanatomical convergence of the upper cervical spine (occiput to C3) is fundamental for the interpretation of functional otorhinolaryngological symptoms. Based thereon, evidence for the most common cervical differential diagnoses of dizziness, tinnitus, dysphagia, and craniomandibular dysfunction is presented separately. The corresponding therapeutic options and their contraindications are discussed in the concluding chapter. The importance of interdisciplinary cooperation in related fields is emphasized.

Zusammenfassung

Der vorliegende Artikel beschäftigt sich mit denjenigen Symptombildern aus dem HNO-ärztlichen Behandlungsgebiet, die auf funktionelle Störungen der oberen Halswirbelsäule zurückgeführt werden können. Es werden Hinweise gegeben, wann Vorsicht geboten ist, organübergreifende HNO-Symptome vorschnell als phobisch oder psychogen einzustufen. Als Grundlage für funktionelle Symptome im HNO-Bereich werden einleitend die klinisch relevanten neuroanatomischen Konvergenzen der oberen Halswirbelsäule (Okziput bis C3) aufgezeigt. Darauf aufbauend werden separat empirische und evidenzbasierte Charakteristika der wichtigsten zervikalen Differenzialdiagnosen von Schwindel, Tinnitus, Schluckstörungen und kraniomandibulärer Dysfunktion dargestellt. Die zugehörigen Therapieoptionen und deren Kontraindikationen werden im abschließenden Kapitel abgehandelt. Hervorgehoben wird die Bedeutung der interdisziplinären Zusammenarbeit der angrenzenden Fachgebiete.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Neuhuber WL (2005) Funktionelle Neuroanatomie des kraniozervikalen Übergangs. In: Hülse N, Wolff (eds) Die obere Halswirbelsäule. Springer, Heidelberg, pp 56–69

    Google Scholar 

  2. Voss H (1971) Tabulation of the absolute and relative muscular spindle numbers in human skeletal musculature. Anat Anz 129:562–572

    CAS  PubMed  Google Scholar 

  3. Neuhuber WL (2005) M. longissimus als Vermittler zwischen kraniozervikalem Übergang und Becken. Manuelle Medizin 43:395–399

    Article  Google Scholar 

  4. Müller A, Böhni U (2014) Praktische Neurologie der oberen HWS. In: Böhni L, Locher (eds) Manuelle Medizin 1. Thieme, Stuttgart, pp 394–398

    Google Scholar 

  5. Neuhuber WL (2004) Hirnstamm. In: Benninghoff-Breckhahn (ed) Anatomie, vol 2. Elsevier, München, pp 326–386

    Google Scholar 

  6. Pfaller K, Arvidsson J (1988) Central distribution of trigeminal and upper cervical primary afferents in the rat studied by anterograde transport of horseradish peroxidase conjugated to wheat germ agglutinin. J Comp Neurol 268:91–108

    CAS  Article  Google Scholar 

  7. Shore SE, Vass Z, Wys NL et al (2000) Trigeminal ganglion innervates the auditory brainstem. J Comp Neurol 419:271–285

    CAS  Article  Google Scholar 

  8. Brandt T, Huppert D (2016) A new type of cervical vertigo: Head motion-induced spells in acute neck pain. Baillieres Clin Neurol 86:974–975

    Google Scholar 

  9. Hülse M, Hölzl M (2000) Vestibulospinal reactions in cervicogenic disequilibrium. Cervicogenic imbalance. HNO 48:295–301

    Article  Google Scholar 

  10. Mai J, Paxinos G (2011) The human nervous system. Elsevier, Amsterdam

    Google Scholar 

  11. Bronstein AM (2016) Multisensory integration in balance control. Handb Clin Neurol 137:57–66

    CAS  Article  Google Scholar 

  12. Bronstein AM (1999) The interaction of otolith and proprioceptive information in the perception of verticality. The effects of labyrinthine and CNS disease. Ann N Y Acad Sci 871:324–333

    CAS  Article  Google Scholar 

  13. Cutfield NJ, Scott G, Waldman AD et al (2014) Visual and proprioceptive interaction in patients with bilateral vestibular loss. Neuroimage Clin 4:274–282

    Article  Google Scholar 

  14. Lappat A, Dorn LJ, Hölzl M (2016) The vestibular craniovertebral joints. HNO 64:320–327

    CAS  Article  Google Scholar 

  15. Brandt T, Buchele W, Arnold F (1977) Arthrokinetic nystagmus and ego-motion sensation. Exp Brain Res 30:331–338

    CAS  PubMed  Google Scholar 

  16. Lucertini M, De Angelis C, Martelli M et al (2011) Subjective visual vertical in erect/supine subjects and under microgravity: effects of lower body negative pressure. Eur Arch Otorhinolaryngol 268:1067–1075

    Article  Google Scholar 

  17. Marano E, Marcelli V, Di Stasio E et al (2005) Trigeminal stimulation elicits a peripheral vestibular imbalance in migraine patients. Headache 45:325–331

    Article  Google Scholar 

  18. Sadeghi SG, Minor LB, Cullen KE (2012) Neural correlates of sensory substitution in vestibular pathways following complete vestibular loss. J Neurosci 32:14685–14695

    CAS  Article  Google Scholar 

  19. Matyssek C (2010) Funktionell-anatomische Analyse der kurzen, tiefen Nackenmuskulatur des Neugeborenen im Vergleich zum Erwachsenen. Medizinische Fakultät der Universität, Köln

    Google Scholar 

  20. Maurer C, Mergner T, Becker W et al (1998) Eye-head coordination in labyrinthine-defective humans. Exp Brain Res 122:260–274

    CAS  Article  Google Scholar 

  21. Campos JL, Butler JS, Bulthoff HH (2014) Contributions of visual and proprioceptive information to travelled distance estimation during changing sensory congruencies. Exp Brain Res 232:3277–3289

    Article  Google Scholar 

  22. Lang J, Ishikawa K, Hatakeyama K et al (2013) 3D body segment oscillation and gait analysis for vestibular disorders. Auris Nasus Larynx 40:18–24

    Article  Google Scholar 

  23. Grossman GE, Leigh RJ (1990) Instability of gaze during locomotion in patients with deficient vestibular function. Ann Neurol 27:528–532

    CAS  Article  Google Scholar 

  24. Pozzo T, Berthoz A, Vitte E et al (1991) Head stabilization during locomotion. Perturbations induced by vestibular disorders. Acta Otolaryngol Suppl 481:322–327

    CAS  Article  Google Scholar 

  25. Decher H (1969) Die zervikalen Syndrome in der Hals-Nasen-Ohren-Heilkunde. Thieme, Stuttgart

    Google Scholar 

  26. Biesinger E (1997) Das C2/C3-Syndrom – Der Einfluß zervikaler Afferenzen auf HNO-Ärztliche Krankheitsbilder. Manuelle Medizin 35:12–19

    Google Scholar 

  27. Reisshauer A, Mathiske-Schmidt K, Kuchler I et al (2006) Functional disturbances of the cervical spine in tinnitus. HNO 54:125–131

    CAS  Article  Google Scholar 

  28. Shore SE (2005) Multisensory integration in the dorsal cochlear nucleus: unit responses to acoustic and trigeminal ganglion stimulation. Eur J Neurosci 21:3334–3348

    CAS  Article  Google Scholar 

  29. Zhou J, Shore S (2004) Projections from the trigeminal nuclear complex to the cochlear nuclei: a retrograde and anterograde tracing study in the guinea pig. J Neurosci Res 78:901–907

    CAS  Article  Google Scholar 

  30. Ralli M, Greco A, Turchetta R et al (2017) Somatosensory tinnitus: current evidence and future perspectives. J Int Med Res 45:933–947

    Article  Google Scholar 

  31. Singbartl F, Ernst A (2009) Hör- und Gleichgewichtsstörungen nach HWS-Weichteildistorsion. In: Graf M, Grill C, Wedig HD (eds) Beschleunigungsverletzung der Halswirbelsäule. Springer, Heidelberg

    Google Scholar 

  32. Biesinger E, Reisshauer A, Mazurek B (2008) Die Rolle der Halswirbelsäule und des Kiefergelenks bei Tinnitus. Der sog. somatosensorische Tinnitus (SST). HNO 56(7):673–677

    CAS  Article  Google Scholar 

  33. Neuhuber WL, Zenker W (1989) Central distribution of cervical primary afferents in the rat, with emphasis on proprioceptive projections to vestibular, perihypoglossal, and upper thoracic spinal nuclei. J Comp Neurol 280:231–253

    CAS  Article  Google Scholar 

  34. Gritsenko K, Caldwell W, Shaparin N et al (2014) Resolution of long standing tinnitus following radiofrequency ablation of C2–C3 medial branches—a case report. Pain Physician 17:E95–E98

    PubMed  Google Scholar 

  35. https://www.youtube.com/watch?v=iux_uiums-m. Zugegriffen: 9. Feb 2018.

  36. Arens C, Herrmann IF, Rohrbach S et al (2015) Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology—Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children. GMS Curr Top Otorhinolaryngol Head Neck Surg 14:Doc2

    PubMed  PubMed Central  Google Scholar 

  37. Seifert K (1995) Hals. OtoRhinoLaryngologie in Klinik und Praxis, vol 3. Thieme, Stuttgart

    Google Scholar 

  38. Hülse M (1991) Cervical dysphonia. Folia Phoniatr (Basel) 43:181–196

    Article  Google Scholar 

  39. Hülse M (1991) Functional dysphonia following cervical spine injuries. Laryngorhinootologie 70:599–603

    Article  Google Scholar 

  40. Losert-Bruggner B, Hülse M, Hülse R (2017) Fibromyalgia in patients with chronic CCD and CMD—a retrospective study of 555 patients. Cranio:1–9. https://doi.org/10.1080/08869634.2017.1334376

    Article  PubMed  Google Scholar 

  41. Hülse M, Neuhuber WL, Wolff HD (2005) Die obere Halswirbelsäule-Pathophysiologie und Klinik. Springer, Heidelberg

    Book  Google Scholar 

  42. De Felicio CM, Melchior Mde O, Ferreira CL et al (2008) Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy. Cranio 26:118–125

    Article  Google Scholar 

  43. Lam DK, Lawrence HP, Tenenbaum HC (2001) Aural symptoms in temporomandibular disorder patients attending a craniofacial pain unit. J Orofac Pain 15:146–157

    CAS  PubMed  Google Scholar 

  44. Pereira TC, Brasolotto AG, Conti PC et al (2009) Temporomandibular disorders, voice and oral quality of life in women. J Appl Oral Sci 17(Suppl):50–56

    Article  Google Scholar 

  45. Rener-Sitar K, John MT, Pusalavidyasagar SS et al (2016) Sleep quality in temporomandibular disorder cases. Sleep Med 25:105–112

    Article  Google Scholar 

  46. Schmitter M, Kares-Vrincianu A, Kares H et al (2015) Sleep-associated aspects of myofascial pain in the orofacial area among Temporomandibular Disorder patients and controls. Sleep Med 16:1056–1061

    Article  Google Scholar 

  47. Ohrbach R, Dworkin SF (2016) The evolution of TMD diagnosis: past, present, future. J Dent Res 95:1093–1101

    CAS  Article  Google Scholar 

  48. Schiffman E, Ohrbach R, Truelove E et al (2014) Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J Oral Facial Pain Headache 28:6–27

    Article  Google Scholar 

  49. Arens C, Scholz FG, Kropf S et al (2017) Reduction of post-surgical pain by Manual Medicine following tonsillectomy in adults. Laryngorhinootologie 96:831. https://doi.org/10.1055/s-0043-119885

    Article  PubMed  Google Scholar 

  50. Böhni U (2015) Biomechanische und kinematische Grundlagen. In: Böhni L, Locher (eds) Manuelle Medizin. Thieme, Stuttgart, pp 21–43

    Google Scholar 

  51. Greenman P (2000) Lehrbuch der Osteopathischen Medizin – Grundlagen und Konzepte, Techniken und Methoden, klinische Integration und Korrelation. Thieme, Stuttgart

    Google Scholar 

  52. Hülse M, Hölzl M (2004) The efficiency of spinal manipulation in otorhinolaryngology. A retrospective long-term study. HNO 52:227–234

    Article  Google Scholar 

  53. Gautschi R (2015) Triggerpunkt-Therapie. In: Böhni L, Locher (eds) Manuelle Medizin. Thieme, Stuttgart, pp 296–302

    Google Scholar 

  54. Neumann HD (1999) Manuelle Medizin – Eine Einführung in Theorie, Diagnostik und Therapie. Springer, Heidelberg

    Google Scholar 

  55. Bischoff HP, Moll H (2007) Kurzgefasstes Lehrbuch der Manuellen Medizin. In: Chirodiagnostische und chirotherapeutische Technik. Spitta, Balingen

    Google Scholar 

  56. Besnard JM (2017) Red flags und yellow flags. In: Mayer J, Standen C (eds) Lehrbuch Osteopathische Medizin. Elsevier, Amsterdam, pp 287–291

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Hölzl.

Ethics declarations

Conflict of interest

M. Hölzl, R. Behrmann, E. Biesinger, W. von Heymann, R. Hülse, U.R. Goessler, and C. Arens declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

The supplement containing this article is not sponsored by industry.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hölzl, M., Behrmann, R., Biesinger, E. et al. Selected ENT symptoms in functional disorders of the upper cervical spine and temporomandibular joints. HNO 67, 1–9 (2019). https://doi.org/10.1007/s00106-019-0610-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-019-0610-1

Keywords

  • Vertigo
  • Tinnitus
  • Deglution disorders
  • Craniomandibular disorders
  • Musculoskeletal manipulations

Schlüsselwörter

  • Schwindel
  • Tinnitus
  • Schluckstörung
  • Kraniomandibuläre Störungen
  • Manuelle Therapie