Vertigo, also called dizziness, accounts for about 6 million clinic visits in the U.S. every year, and 17–42% of these patients eventually are diagnosed with benign paroxysmal positional vertigo (BPPV). Two treatments have been found helpful for BPPV: the canalith repositioning procedure (CRP) or Epley maneuver, and the liberatory or Semont maneuver 1. The following is a case study that discusses another possible treatment for BPPV.
A 37-year-old female with acute the front teeth. benign vertigo was referred to this office by her allopathic physician to determine the need for interdisciplinary care. The patient had 2-3 months of constant vertigo, diagnosed as BPPV. She had been treated with the Epley Maneuver and various medications, but her symptoms were unresponsive. Her vertigo would last the whole day, with peaks and valleys related to intensity. This affected her ability to function at home, drive her car and even walk “out of the door” of her home.
Patient presented with a sacro occipital technique category two (sacroiliac joint hypermobility syndrome)2, right temporal bone with external rotation, and significant malocclusion with clenching and anterior interferences. Her malocclusion was affected by the stress of the anterior interferences, particularly on the right side, and the repetitive stress on occlusion appeared to create right temporomandibular (TMJ) stress summating at the right temporal fossa. It was theorized this possibly contributed to the patient’s vertigo presentation 3.
Category two protocols for the pelvis were applied 2 and an intraoral cranial adjustment to the temporal bone, maxilla, sphenoid, and zygoma were performed 4. Reduction of palpatory pain in and around the TMJ along with joint translation was used to help guide treatment. Cotreatment with a dentist was used to help stabilize and maintain the chiropractic cranial and TMJ corrections.
By the 7th-office visit (3-4 weeks of care) the patient’s vertigo had resolved. In addition her TMJ translation and opening had improved significantly with right TMJ and related tissue pain eliminated. The anterior interferences were treated with a nighttime dental appliance that allowed the patient to have bilateral posterior teeth contact and reduced contact to the front teeth.
Occlusion and condylar position is purported to be affected by or affect cranial bone distortion patterns 5. When there is malocclusion affecting the cranial suture and local periosteal tissue, it is theorized that with some patients — possibly the internal periosteal dura, CSF circulation, and related cortical region might be affected 6-8.
On the other hand re-living the stressors of restricted cranial motion and malocclusion could lead to improved function just by reducing global stress to the CNS due to reduced pain and related myofascial tension 5.
In this case report the patient’s response to care was quite dramatic. She was unresponsive to prior care and her quality of life was profoundly affected. It is difficult to extrapolate from this one case and apply this to the general population however the patient’s rapid response to care suggests that further investigation into this method of care for patients presenting with vertigo be considered.
Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, Chalian AA, Desmond AL, Earll JM, Fife TD, Fuller DC, Judge JO, Mann NR, Rosenfeld RM, Schurina LT, Steiner RW, Whitney SL, Haidan J, American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008 Nov;139(5 Suppl 4):S47-81.
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Steigerwald DP, Verne SV, Young D. A of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus. Cranio. 1996 Jan;14(1):46-54.
Monk R, Blum CL. SOT Cranial Level Two Manual: TMJ Technique. Sacro Occipital Technique Organization – USA: Sparta, NC, USA. 2004.
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Retzlaff EW, Mitchell FL jr, Upledger J, Biggert T. Nerve fibers and endings in cranial sutures – research report. J Am Osteopath Assoc. 1978;77(6):474-5.
Pick, MG. A Preliminary Single Case Magnetic Resonance Imaging Investigation into Maxillary Frontal-Parietal Manipulation and its Short-Term Effect upon the Intercranial Structures of an Adult Human Brain. J Manip Physio Therap. Mar-Apr 1994; 17(3): 168-73.
Jones L, Retzlaff E, Mitchell FL Jr., Upledger J, Walsh J. Significance of nerve fibers interconnecting cranial suture vasculature, the superior sagittal sinus, and the third ventricle. J Am Osteopath Assoc. 1982;82:113.