Do Lower Cervical Disc Herniations Cause Vertigo and Tinnitus?

Yıl 2025, Cilt: 12 Sayı: 1, 50 - 64

Deniz Uğur Cengiz , Ramazan Paşahan , Sanem Can Çolak , İsmail Demir , Ferhat Arslan

Öz

Objectives: To evaluate the effects of lower cervical disc herniation on the cochleovestibular system.
Materials and Methods: 40 patients with lower cervical disc herniation and 40 healthy individuals were included in the study. A patient demographic data form, Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), Cervical Evoked Myogenic Potentials (c-VEMP) Test, and Pure Tone Audiometry (PTA) Test were applied to all participants. Tinnitus severity and frequency were evaluated in participants with tinnitus.
Results: Of the patients diagnosed with lower cervical disc herniation, 23 (57.5%) had dizziness, and 19 (47.5%) had tinnitus. The tinnitus of the patients was found at a frequency of 6000 Hz and an intensity of 55 dB. A statistically significant difference was found between the groups both in terms of c-VEMP wave presence and in P1 latency and P1-N1 amplitude values (p<0.05).
Conclusion: A positive correlation was found between lower cervical disc herniation and audiovestibular findings. The audiological evaluation of these patients, together with neurosurgical examination, is clinically important for the follow-up of the process.

Anahtar Kelimeler

lower cervical disc herniation, vertigo, tinnitus, vestibular evoked myogenic potentials, balance

Etik Beyan

İnönü University’s Health Sciences Institute Non-Interventional Clinical Research Ethics Committee (Decision number: 2021/2208)

Kaynakça

• Aksoy, S., Firat, Y. & Alpar, R. (2007). The tinnitus handicap inventory: a study of validity and reliability. International Tinnitus Journal, 13(2), 94-98.
• Alpar, C. (2016). Spor Sağlık ve Eğitim Bilimlerinden Örneklerle Uygulamalı İstatistik ve Geçerlik Güvenirlik. [Applied Statistics and Validity Reliability with Examples from Sports, Health and Educational Sciences]. Detay Publishing.
• Al-Ryalat, N.T., Saleh, S.A., Mahafza, W.S., Samara, O.A., Ryalat, A.T. & Al-Hadidy A.M. (2017). Myelopathy associated with age-related cervical disc herniation: a retrospective review of magnetic resonance images. Annals of Saudi Medicine, 37(2): 130–137. doi: 10.5144/0256-4947.2017.130.
• Bankoul, S., Goto, T., Yates, B. & Wilson, V.J. (1995). Cervical primary afferent input to vestibulospinal neurons projecting to the cervical dorsal horn: an anterograde and retrograde tracing study in the cat. The Journal of Comparative Neurology, 353(4): 529-538. doi: 10.1002/cne.903530405.
• Binder, A. (2007). The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysica, 43(1): 79-89.
• Brandt, K.D. (2010). Diagnosis and nonsurgical management of osteoarthritis Professional Communications, New York.
• Brandt, T. & Bronstein, A. (2001) Cervical vertigo. Journal of Neurology Neurosurgery and Psychiatry, 71: 8-12. doi:10.1136/jnnp.71.1.8.
• Budway, R.J. & Senter, H.J. (1993). Cervical disc rupture causing vertebrobasilar insufficiency. Neurosurgery, 33 (4): 745-747. doi: 10.1227/00006123-199310000-00029.
• Canbal, M., Cebeci, S., Duyan, G.Ç., Kurtaran, H. & Arslan, İ. (2016). Baş dönmesi engellilik envanterinin türkçe geçerlilik ve güvenilirlik çalışması. [Turkish validity and reliability study of the dizziness disability inventory]. Turkish Journal of Family Medicine and Primary Care, 10: 1. doi:10.5455/tjfmpc.198514
• Colebatch, J.G., Halmagyi, G.M. & Skuse, N.F. (1994). Myogenic potentials generated by a click-evoked vestibulocollic reflex. Journal of Neurology Neurosurgery and Psychiatry, 57(2): 190-197. doi: 10.1136/jnnp.57.2.190
• Colledge, N.R., Barr-Hamilton, R.M., Lewis, S.J., Sellar, R.J. & Wilson, J.A. (1996). Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 313(7060): 788-792. doi: 10.1136/bmj.313.7060.788.
• Dıraçoğlu, D., Cihan, C., İşsever, H. & Aydın, R. (2009). Servikal radikülopatili hastalarda postüral performans. [Postural performance in patients with cervical radiculopathy]. Turkish Journal of Physical Medicine and Rehabilitation, 55: 4.
• Ernst, C.W., Stadnik, T.W., Peeters, E., Breucq, C. & Osteaux, M.J.C. (2005). Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers. European Journal of Radiology, 55(3): 409-414. doi: 10.1016/j.ejrad.2004.11.003.
• Faul, F., Erdfelder, E., Buchner, A. & Lang, A.G. (2009). Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4): 1149-1160. doi: 10.3758/BRM.41.4.1149.
• Fife, T. (2010). Overview of anatomy and physiology of the vestibular system, [Vertigo and Imbalance: Clinical Neurophysiologyof the Vestibular System] Elsevier. p. 5-17.
• Galm, R., Rittmeister, M. & Schmitt, E. (1998). Vertigo in patients with cervical spine dysfunction. European Spine Journal, 7(1): 55-58. doi: 10.1007/s005860050028.
• Hain, T.C. (2015). Cervicogenic causes of vertigo. Current Opinion in Neurology, 28(1): 69-73. doi: 10.1097/WCO.0000000000000161.
• Hong, L. & Kawaguchi, Y. (2011). Anterior cervical discectomy and fusion to treat cervical spondylosis with sympathetic symptoms. Journal of Spinal Disorders & Techniques, 24(1):11-14. doi: 10.1097/BSD.0b013e3181dd80f5.
• Hülse, M. & Hölzl, M. (2000). Vestibulospinal reactions in cervicogenic disequilibrium. Cervicogenic Imbalance. HNO, 48(4): 295-301. doi: 10.1007/s001060050569.
• Jastreboff, P. (1998). Tinnitus and hyperacusis. Otolaryngology Head & Neck Surgery, 3rd edn, pp 3198-3222. Mosby.
• Kaech, D. & Kalvach, P. (1995). Disc herniation, stenosis and instability of the cervical spine. Rivista di Neuroradiologia, 8(1): 111-119. doi:10.1177/19714009950080S113
• Karlberg, M., Persson, L. & Magnusson, M. (1995). Impaired postural control in patients with cervico-brachial pain. Acta Oto-Laryngologica, 520: 440-442. doi: 10.3109/00016489509125293.
• Karnath, H.O. (1994). Subjective body orientation in neglect and the interactive contribution of neck muscle proprioception and vestibular stimulation. Brain. 117(5): 1001-1012. doi: 10.1093/brain/117.5.1001.
• Kastanioudakis, I., Saravakos, P., Zigouris, A. Ragos, V., Reichel, O. & Ziavra, N. (2017). Anterior cervical disc fusion does not affect the presence of cervical vestibular-evoked myogenic potential. The Journal of International Advanced Otology, 13(3): 368-373. doi: 10.5152/iao.2017.3659.
• Kayıkçı, M.E.K. (2000). Tinnituslu Hastalarda Otoakustik Emisyon Cevaplarının Araştırılması. [Investigation of Otoacoustic Emission Responses in Patients with Tinnitus]. (Tez Numarası: 99081) [Yüksek lisans tezi, Hacettepe Üniversitesi]. Yükseköğretim Kurulu Ulusal Tez Merkezi.
• Kemaloğlu, Y.K., Tutar, H., Yılmaz, O. & Turhan, S. (2013). Tinnitus. Türkiye Klinikleri J ENT, 6 (1).
• Koyuncu, M., Celik, O., Lüleci, C., Inan, E. & Oztürk, A. (1995). Doppler sonography of vertebral arteries in patients with tinnitus. Auris Nasus Larynx, 22(1):24-28. doi: 10.1016/s0385-8146(12)80178-7.
• Koning, H.M. (2020a). Upper cervical nerves can induce tinnitus. The International Tinnitus Journal, 24(1): 26-30. doi: 10.5935/0946-5448.20200005.
• Koning, H.M. (2020b). Cervical nerve projections to the auditory pathway in tinnitus. The International Tinnitus Journal, 24(2): 70-74. doi: 10.5935/0946-5448.20200011
• Koning, H.M. & Ter Meulen, B.C. (2019). Pulsed radiofrequency of C2 dorsal root ganglion in patients with tinnitus. The International Tinnitus Journal, 23(2): 91-96. doi: 10.5935/0946-5448.20190016.
• Li, J., Jiang, D.J., Wang, X.W., Yuan, W., Liang, L. & Wang, Z.C. (2012). Mid-term outcomes of anterior cervical fusion for cervical spondylosis with sympathetic symptoms. Journal of Spinal Disorders & Techniques, 29(6):255-260. doi: 10.1097/BSD.0b013e31827b4cec.
• Neuhuber, W. & Bankoul, S. (1994). Besonderheiten der Innervation des Kopf-Hals-Übergangs. Der Orthopäde, 23(4): 256-261.
• Oosterveld, W.J., Kortschot, H.W., Kingma, G.G., de Jong, H.A. & Saatci, M.R. (1991). Electronystagmographic findings following cervical whiplash injuries. Acta Oto-Laryngologica, 111(2): 201-205. doi: 10.3109/00016489109137375
• Richardson, S.M., Mobasheri, A., Freemont, A.J. & Hoyland, J.A. (2007). Intervertebral disc biology, degeneration and novel tissue engineering and regenerative medicine therapies. Histology and Histopathology. 22(9): 1033-1041. https://doi.org/10.14670/HH-22.1033.
• Sharrak, S. & Khalili, Y.A. (2022). Cervical disc herniation. Available: https://www.ncbi.nlm.nih.gov/books/NBK546618/. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
• Shirley, D, Cherchi, M. & Hain, T. (2015). Triceps acoustically evoked myogenic potentials in patients with spinal cord lesions. Journal of Neurology & Neurophysiology, 6:288. doi: 10.4172/2155-9562.1000288
• Skovron, M. (1998). Epidemiology of Whiplash., in Whiplash Injuries: Current Concepts in Preventions, Diagnosis, and Treatment of the Cervical Whiplash Syndrome. Lippincott-Raven: Philadelphia. pp 61-67.
• Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy, 13(1): 2-11. doi: 10.1016/j.math.2007.06.003.
• Wolff, H.D. (2013). Neurophysiologische Aspekte der manuellen Medizin. [Neurophysiological aspects of manual medicine.] Springer-Verlag.
• Yacovino, D.A. & Hain, T.C. (2013). Clinical characteristics of cervicogenic-related dizziness and vertigo. Seminars in Neurology. 33(3): 244-255. doi: 10.1055/s-0033-1354592.