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Korean J Otorhinolaryngol-Head Neck Surg 2015;58(3):177-81 / pISSN 2092-5859 / eISSN 2092-6529

Otology

http://dx.doi.org/10.3342/kjorl-hns.2015.58.3.177

The Diagnosis and Treatment of the Cervical Vertigo

Joo Young Kim, Wee Hwang Kim, Jang Soo Lee, Hyun Myung Oh,
Dae Woong Kim, and Dong Jin Choi
Department of Otolaryngology-Head and Neck Surgery, Kwangju Christian Hospital, Gwangju, Korea

Background and ObjectivesZZVertigo is an illusion of environmental movement due to var-

Received June 13, 2014

Revised
September 3, 2014
Accepted September 8, 2014
Address for correspondence
Dong Jin Choi, MD
Department of OtolaryngologyHead and Neck Surgery,
Kwangju Christian Hospital,
37 Yangnim-ro, Nam-gu,
Gwangju 503-715, Korea
Tel +82-62-650-5095
Fax +82-62-650-5090
E-mail brok-kim@hanmail.net

ious causes, thus it is hard for medical doctors to determine the exact kind of dizziness in the
final diagnosis. Recently, cervical vertigo was reported from several vertigo cases. Cervical vertigo is defined as sensation of rotation, resulting from an alteration of the neck proprioceptive
afferents of the upper cervical spine. The aim of our study is to document the clinical features
and the treatment outcomes in vertigo patients with myofascial pain syndrome (MPS).
Subjects and MethodZZA total of 488 patients, excluding 18 patients who received other diagnosis, were examined to investigate the reasons for dizziness. We evaluated 34 patients, who
were diagnosed with cervical vertigo by questionnaire after MPS treatments. Clinical evaluations for cervical vertigo were performed on all subjects, and vestibular function tests were also
performed in patients with vertigo symptoms. All patients received a total of 4 treatments including trigger point injection, physical therapy or medication, and then followed up, respectively. The symptom changes of dizziness, patient satisfaction and cervical pain were checked
before and treatment 1, 2, 4 times by Visual Analogue Scale (VAS) score.
ResultsZZThere were significant improvement in the VAS score of dizziness, patient satisfaction and cervical pain after treatment for MPS.
ConclusionZZTreatment for MPS could improve dizziness in cervical vertigo with MPS patients, but further study is needed to clearly confirm the cervical vertigo with MPS for improvKorean J Otorhinolaryngol-Head Neck Surg 2015;58(3):177-81
ing patients quality of life.
Key WordsZZMyofacial pain syndromeTrigger pointVertigo.

. ,

. 20

.1)

(cervical vertigo) ,

, ,

.2)

Brandt Bronstein3) ,

(somatic nerve)

, ,

Copyright 2015 Korean Society of Otorhinolaryngology-Head and Neck Surgery 177

Korean J Otorhinolaryngol-Head Neck Surg 2015;58(3):177-81

(myofascial pain syndrome, MPS)

.

MPS

Temporalis muscle

Sternocleidomastoid muscle

Cervical paraspinal muscle

Levator scapulae muscle

, 2013 3 1 2014 2 28

Upper trapezius muscle

542( 256,
286) .
36 506

Fig. 1. Dermographic distribution of five muscles arounding the

head, neck, and shoulders that were checked for myofascial trigger
points.

, 18

488 ( 245, 243)

(temporalis muscle), (sternocleidomastoid muscle), (cervical paraspinatus

,
, , ,

muscle), (levator scapular muscle), (upper

trapezius muscle) (Fig. 1),
, .7)

, ,
, , ,

. ,

34

, , Dix-Hallpike , Romberg

(TPI) 1

, tandem gait , ,

2 4 .

, , , ,

(Lenox, 60 mg, Ildong Pharm, Seoul, Korea; 1

3) (Mulex, 50 mg, Chodang Pharm, Seoul,

Korea; 1 3) 2

Brandt Bronstein3) ,

0.5% 5%

, , ,

Travell Simon4) (taut band)

(tender spot)

1, 2, 4

, (trig-

Visual Analogue Scale(VAS)

ger pont injection, TPI)

. 0

, 10

.5,6)

178

Cervical Vertigo Kim JY, et al.

. VAS

. 10
0

. VAS

268

, 0, 10

(54.9%), 98(20.1%), 58(11.9%),

34(7.0%), 5(1.0%),
3(0.6%), 22(4.5%)
.

SPSS 17.0

121, 47, 43,

(SPSS Inc., Chicago, IL, USA) Fishers exact

15, 3, 1,

test , , ,

13 .

unpaired t-test .

147, 51, 19,

16, 2, 2,

Wilcoxon signed rank test .

9 ,

95% (p-value0.05)

(p0.05, by Fishers exact

test). , 4,

Table 1. The distribution of final diagnosis in dizziness 488 cases

Disease

3 (Table 1).

Cases (male:female)

BPPV

268 (147:121)*

54.9

VN

098 (51:47)*

20.1

34( 19, 15

Menieres disease

058 (15:43)*

11.9

). 42.7 42.5, 43.4

Cervical vertigo

034 (19:15)*

07.0

CVA

005 (2:3)*

01.0

. .

Infectious disease

003 (2:1)*

00.6

Others

022 (9:13)*

04.5

*p0.05, by Fishers exact test. BPPV: benign paroxysmal positional vertigo, VN: vestibular neuritis, CVA: cerebrovascular
accident

23.55.6(: 22.34.2, : 24.16.1),

15.54.7(: 14.95.4, : 15.93.1).
2.71.1(: 2.61.4, : 2.91.9)
.
(p0.05, by unpaired t-test)(Table 2).

Table 2. Characteristics of cervical vertigo group

Variables
Sex (M:F)

Cervical vertigo group

19:15

Age (M:F)

42.7 (42.5:43.4)*

Symptom duration (days)

(M:F)

23.55.6 (22.34.2:24.16.1)*

Duration of treatment (days)

(M:F)

15.54.7 (14.95.4:15.93.1)*

Number of trigger points (M:F)

02.71.1 (2.61.4:2.91.9)*

,
1
,
.

*p0.05, by unpaired t-test. M: male, F: female

1
. 1

Table 3. The comparison between pretreatment VAS score and posttreatment VAS score checked at 1, 2, and 4 times after treatment
for vertigo, patients satisfaction and cervical pain (meanSD)
Variables

VAS score
Vertigo

Patients satisfaction

Pretreatment

8.461.30*

1.480.94*

Cervical pain
7.841.51*

Posttreatment (1st)

3.530.95*

7.511.51*

4.511.65*

Posttreatment (2nd)

2.960.84*

8.140.48*

3.150.95*

Posttreatment (4th)

1.941.15*

8.950.45*

2.861.12*

*p0.05, by Wilcoxon signed rank test. VAS: Visual Analogue Scale, SD: standard deviation

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Korean J Otorhinolaryngol-Head Neck Surg 2015;58(3):177-81

Table 4. Distribution of trigger points in neck and shoulder muscles
for patients with cervical vertigo with MPS
Muscle

Cervical vertigo group (%)

.11)

.

Temporalis

03.4

Sternocleidomastoid

08.5

Cervical paraspinatus

33.4

Upper trapezius

41.1

Levater scapular

13.6

.12)
,

MPS: myofascial pain syndrome

,
(30~45%).4,13)

(p0.05, by Wilcoxon signed rank test)(Table 3).

5~40% .14)

41.1%.

33.4%. , ,

, ,

13.6%, 8.5%, 3.4%(Table 4).

, (
41.1%, 33.4%)

. Bracher 11)

.
, ,

8,9)

.7)

. ,

, Brandt-Bronstein

(TPI),

, , ,

, 1 4 , 1, 2

, , ,

, 4

, ,

.
10)

Ryan Cope

, ,

, 3

180

Cervical Vertigo Kim JY, et al.

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