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HOME » PROLOTHERAPY NEWS » NECK CENTER » NECK PAIN CHRONIC SINUSITIS AND EUSTACHIAN TUBE DYSFUNCTION

Neck Pain Chronic

Sinusitis and Eustachian
Tube Dysfunction

Ross Hauser, MD

I am going to begin this article with a case history seen at our center and then we will discuss the research
that shows a connection between cervical spine instability and neck pain leading to your problems of
chronic sinusitis and various other conditions you may su9er from including Eustachian tube dysfunction.

As I have stated many times in the articles on our website, people we see rarely su9er from one problem or
condition by itself. Tinnitus, vertigo, imbalance, dizziness, and hearing loss are common symptoms of
cervical spine instability caused by weak or damaged cervical spine ligaments and are often symptoms of
those who are diagnosed with POTS (postural orthostatic hypotension), cardiovascular dizziness,
vestibular neuritis, migraines, benign postural positional vertigo, persistent postural perceptual
dizziness, or Meniere’s disease, and can have common pathophysiology: Cervicovagopathy. Cervico – a
structural problem in the neck that is causing “vago” vagus nerve “pathy” or disease or illness.
Cervicovagopathy is then the neck’s altered or broken structure causing compression or disease on the
vagus nerve and then on to produce a myriad of symptoms related to dizziness.

Article summary

■ Eustachian Tube Dysfunction. When this condition occurs, symptoms such as dizziness, imbalance,
lightheadedness, vertigo and tinnitus can result.
■ A 25-year-old college student with chronic sinusitis and Eustachian tube dysfunction.
■ Nothing helped his Eustachian tube dysfunction, worse, over the next six months, the
symptoms themselves were getting worse.
■ A clue about Eustachian tube dysfunction from a deviated uvula.
■ What a deviated uvula can mean in patients with “neurologic-type” symptoms.

■ When it comes to strange symptoms, doctors often report cases that “stumped” them. This is where
we call in the specialists, the medical research papers.
■ Low vagal tone or vagus nerve injury. A connection to the trigeminal nerve will also be made.
■ The cervical spine and “cervicogenic otoocular syndrome.”
■ A clue suggesting vagus nerve compression is the problem: Some people with a functional disorder of
the upper cervical spine have problems related to vision.
■ Clicking in the ears, eustachian tube dysfunction, and chronic sinusitis. They are all connected.

The main mechanisms by which cervical instability causes dizziness are:

■ Tension on the cervical spinal cord and or brain stem

■ Neck Proprioception dysfunction (The movements of your head and neck do not match).
■ Vagus nerve injury vagopathy
■ Atlas malalignment
■ Intracranial hypertension vestibular neuritis blockage of cerebral Suid vertebral carotid artery
occlusion dysautonomia internal jugular venous compression vertebral subluxation.

Eustachian Tube Dysfunction. When this condition occurs, symptoms such as

dizziness, imbalance, lightheadedness, vertigo and tinnitus can result.

A 25-year-old college student with chronic sinusitis and Eustachian tube

dysfunction

A 25-year-old college student became a patient at Caring Medical. He su9ered from a myriad of symptoms
including chronic sinusitis. As with many 25-year-old men he engaged in sports, some high contact sports.
He also worked out, trained, and ran. He also told us about the many high-speed impacts he had with other
players during games. He reported a number of hits to the head. As his symptoms progressed his activity
levels fell to a now “couch potato,” status.

He is a nose breather

After one particular game where he was involved in a high-impact collision, our patient started to get
popping sounds and a sensation of grinding in his neck. After the collision, he felt as if his nose was all
plugged up. This presented a problem for him as he stated he was always a nose breather. As this
symptom worsened, he stated he would spend 15-30 minutes every morning blowing his nose and using
other decongest aids and techniques so he could breathe out of it.

Even when he was successful at this, this would only allow him to breathe out of his nose for a few minutes,
then it would get stopped up again. He described it as having a really bad cold or Su all the time. With the
stopped-up nose came ear fullness, hearing loss, tinnitus, and dizziness. His ears popped constantly,
like balloons. He noticed the symptoms were worse when he looked down at his phone or the ground.

He saw many doctors, including ENTs, allergists, primary care physicians, emergency room physicians, a
gastroenterologist, a cardiologist, and neurologists. They all said he had allergies and prescribed di9erent
types and variant strength decongestants, steroids, antihistamines, and other drugs to no prevail. He was
also prescribed anti-anxiety medications.

■ The problem with his Eustachian tube did not seem to be one of primary inSammation being the
cause, and as you probably know [rst hand if you have been treated for Eustachian tube dysfunction,
it is all about inSammation. If the Eustachian tube is inSamed it cannot open properly. If it cannot
open properly hearing problems, ear fullness, and tinnitus set in. This person had been through
many courses of anti-inSammatories and other treatments without resolution of his issues.

Nothing helped his Eustachian tube dysfunction, worse, over the next six
months, the symptoms themselves were getting worse.

A clue from a deviated uvula

Why then were his anti-inSammatories not e9ective? Why were his anti-histamines not e9ective?

Again, as we typically see, this patient had various conditions and symptoms. Already mentioned above
were trips to a gastroenterologist to track down digestive problems, a cardiologist to rule out heart
problems, and neurologists to determine if neurological de[cits and problems were at play here. As these
other possible causes were being ruled out, what could be left? For some people, it is cervical spine
instability and compressive problems in the neck. Nerve impingement can be going on.

When this person came into our center, it was after a screening process to determine if cervical spine
instability could be realistically thought of as a cause of his problems. Once we suspected cervical spine
instability as the underlying cause of his problems, we asked about other cervical instability symptoms
including headaches, visual changes, neck/head, and scalp pain, he noted he had all of them. In fact, his
neck was causing him a lot of pain and discomfort, enough so that he had sought out chiropractic care. Of
which he did say that he did [nd relief, but only on a temporary basis.

A possible clue: A deviated uvula. What is this?

Upon his initial examination, we noted that he had a deviated uvula sitting to the left of where it should be.
This typically signals right side vagus nerve injury and low vagal tone which correlated with his right side
tinnitus from Eustachian tube dysfunction being worse than left. His digital motion x-ray showed a loss of
the cervical curve (he had a military curve), forward atlas (atlas anterior subluxation), and signi[cant C1-C2
(atlantoaxial) instability.

What does all this mean?

Let’s stop the case history here so we can go deeper into the problems discovered during our examination
and have a better understanding of what is happening. We will also have some specialists come in, in the
form of research papers that will help you understand what we saw in this patient’s [rst examination.

We mentioned:

1. A deviated uvula
2. Low vagal tone or vagus nerve injury. A connection to the trigeminal will also be made.
3. A loss of the natural cervical spine curve.
Now let’s explore what is happening here starting with the deviated uvula.

A deviated uvula: In this video, Dr. Hauser explains what a deviated uvula can
mean in patients with “neurologic-type” symptoms.

There are various clues that the vagus nerve is involved in the di9erent and complex neurological, cardiac,
and gastrointestinal problems some people have. One of the simplest ways to send us down the path of
vagus nerve function is to simply look down the throat of the patient and see if the uvula (the small [nger-
like tissue that hangs at the back of the soft palate) deviates to one side, we call that a deviated uvula and a
deviated uvula is one of the biggest clues that the vagus nerve is not functioning correctly.

Deviated uvula and vagus nerve degeneration - Say AHHHH!

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We know, you may be saying to yourself, “I had all these tests, my doctors can’t And anything, how can
looking down my throat tell me something the tests did not?”

■ Many patients we see have, have ear pain, ear fullness, or sensitivity to sound.
■ Some of these people have a long medical history that may include visits to the ENT and other
specialists and doctors. Some may get a diagnosis of Meniere’s disease.
■ In many of these patients, their problems of tinnitus, Meniere’s disease, dizziness, ear fullness,
decreased hearing, or sensitivity to sound may be traced to problems of cervical spine/neck
instability.
■ Cervical spine instability can cause impingement or pressure on the various cranial nerves including
the vagus nerve.
■ Many times this factor is not even looked for as many doctors are not aware that this could be the
problem.
■ For many people, their long medical history of unresolved neurological type problems may have their
roots in cranial nerve impingement in the cervical spine.

When it comes to strange symptoms, doctors often report cases that “stumped”
them. This is where we call in the specialists, the medical research papers.

When it comes to strange symptoms, doctors often report cases that “stumped” them. By reporting these
cases it is hoped that this will help those health care providers after they see these cases and maybe [gure
out something bene[cial for future patients who may have similar symptoms.

What we will focus on here is a report of a uvula deviation and how this may be a way to screen
unresponsive or dibcult to treat or understand neurological and digestive-type symptoms.

Here is a case reported in the Journal of Child Neurology. (1) It is about a 7-year-old boy who displayed
symptoms very similar to our patient. Here is that story:

■ A 7-year-old boy was seen by doctors because of a sudden change to nasal speech, dysarthria
(muscle malfunction when talking) for words with explosive consonants in speech, and nasal
regurgitation of Suids.
■ The symptoms arose over 1 week following a capricious (sudden and unaccountable) episode of
acute asthmatic bronchitis.
■ Physical and neurologic examinations were normal except for a left deviation of the uvula,
accompanied by a “curtain” movement of the posterior pharyngeal wall against the opposite
side, and a left deviation of the protruded tongue.

EXPLANATORY NOTE: Look at what is happening here. The boy had a deviation of the uvula and a “curtain”
movement of the posterior pharyngeal wall (the back of the throat). The curtain movement is an
involuntary movement of the soft palate at the back of the throat. The muscles of the palate move up and
down like a curtain rising and falling. This problem is also associated with clicking in the ears. Clicking in the
ears is a symptom of Eustachian tube dysfunction.

■ No vascular, traumatic, infectious, neoplastic, or neurologic causes could be identiQed. No

therapy was administered. Full recovery occurred 4 months later. The diagnosis was idiopathic (we
do not know why he had it or why it went away on its own) vagal and right hypoglossal nerve palsy
(Bell’s palsy).

So what these doctors pointed out was there was a case of asthmatic bronchitis, which turned into other
symptoms, it a9ected the vagus and hypoglossal nerves.

This case is presented to show the interplay between an infection, in this case, asthmatic bronchitis and
vagus nerve malfunction. How one can a9ect the other.

Low vagal tone or vagus nerve injury. A connection to the trigeminal nerve will
also be made.

An important aspect of vagus nerve function is its role in the regulation of middle ear pressure by opening
the auditory tube or Eustachian tube. The Eustachian tube connects the middle ear cavity with the
nasopharynx. Normal opening of the Eustachian tube equalizes atmospheric pressure in the middle ear
and clears mucus from the middle ear into the nasopharynx. The Eustachian tube needs to be open during
normal swallowing, as just that noise could damage the sensitive nerve endings and structures in the inner
ear. The vagus nerve innervates the levator veli palatini one of the key muscles that open the Eustachian
tube. The other muscle that opens the Eustachian tube is the tensor veli palatine innervated by the
trigeminal nerve. If the Eustachian tube on one side of the head were unable to open and close properly
then secretions would build up in the middle ear, causing a pressure gradient between the middle ear,
atmosphere, and the other middle ear cavity. When the pressure inside one middle ear cavity is di9erent
than the other side it can cause many symptoms including dizziness, hearing loss, ear discomfort, ear
fullness, pressure in the ears (as if submerged in water), as well as pain in the ears.

The cervical spine and “cervicogenic otoocular syndrome.”

Next, we are going to visit the opinion of a paper presented in The International Tinnitus Journal. (2) Here the
researchers sought to make a connection between cervical spine disorders and hearing problems that
would eventually result in tinnitus and Ménière’s disease. Here are the summary learning points:

■ The researchers observed 420 patients who had fullness in the ear, episodic vertigo, Suctuating
hearing, and tinnitus over a four-year period.
■ They noted 182 patients showed normal hearing levels, a mild Eustachian tube dysfunction, normal
SP/AP ratios (summating potential/action potential as a means to measure hearing disorders),
mydriasis (pupil dilation) on the side of the a9ected ear, and a functional disorder of the upper
cervical spine.
■ These patients responded to conservative management, particularly physiotherapy.
■ Additionally, 51 patients showed normal hearing levels, a mild Eustachian tube dysfunction, an
elevated SP/AP ratio suggesting endolymphatic hydrops, mydriasis on the side of the a9ected ear,
and a functional disorder of the upper cervical spine.
■ Note: Endolymphatic hydrops is a disorder of the middle ear caused by vestibular system
dysfunction.
■ The vestibular system is the body’s sensory system that regulates balance and spatial
orientation (the understanding of where you are in your environment).
■ It sits in the inner ear and works by adjusting Suid levels that act as the balance
mechanism.
■ We set our awareness of our place in space by using the ground as the constant place of
orientation. We can keep our balance when we walk because we understand the ground
is the constant and our vestibular system makes constant involuntary adjustments to
“keep things steady,” to prevent motion from creating dizziness or sway.

■ The patients of the study were given a diagnosis of cervicogenic otoocular syndrome.
■ Within this group, 43 patients did not respond to preceding conservative management, and 3
patients developed Ménière’s disease within 12 months.
■ Also within this group, 8 patients responded to physiotherapy only, with a return of the SP/AP
ratio to normal levels.
■ A total of 187 patients had a sensorineural hearing loss, an elevated SP/AP ratio, mydriasis on
the side of the a9ected ear, a functional disorder of the upper cervical spine.
■ Of the patients, 186 had mild Eustachian tube dysfunction and had been diagnosed with
Ménière’s disease.

■ Patients with COO syndrome invariably responded to the insertion of a middle-ear ventilation tube,
with the return of the SP/AP ratio to normal levels and relief of symptoms. Patients with Ménière’s
disease had a mixed response. The cervicogenic otoocular syndrome is suspected to be a forerunner
of Ménière’s disease.

What is being suggested here? Simply that a functional disorder of the upper cervical spine can
cause hearing problems.

A brief discussion of Meniere’s disease

I want to brieSy touch on Meniere’s disease here. For more extensive research on this problem, please see
my articles: Meniere’s Disease and Fluid build up in the ears – Chronic cerebrospinal venous
insuWciency and Ear pain, ear fullness, sound sensitivity, tinnitus, Meniere’s Disease and hearing
problems caused by neck instability.

Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo – a sensation
of a spinning motion – along with Suctuating hearing loss, ringing in the ear (tinnitus), and sometimes a
feeling of fullness or pressure in the ear. In many patients, low-frequency hearing loss is seen. Meniere’s
disease comprises symptoms related to the Eustachian tube, the upper cervical spine, the
temporomandibular joints, and the autonomic nervous system. The cervical spine, temporomandibular
joint, and Eustachian tube all are connected through the autonomic nervous system as well as peripheral
nerves such as the trigeminal nerve. All of these symptoms can easily appear if some condition were
causing Suid to accumulate in the inner ear because of Eustachian tube dysfunction.

A clue suggesting vagus nerve compression is the problem: Some people with a
functional disorder of the upper cervical spine have problems related to vision

The people in the above study noted a problem of mydriasis (pupil dilation) on the side of the a9ected ear.

When the Vagus nerve is injured by compression caused by instability at C1-C2, this can cause
vasospasms (narrowing of the arteries and reduction of blood Sow). If these vasospasms impact the
ophthalmic artery, the artery that supplies blood to the eye and eye area including the orbit – this can
lead to some of the symptoms are patients describe to us such as darkening, black spots, or
grayness in the vision of one eye.

In this image, vision problems caused by cervical spine instability are connected to Diminished ocular blood =ow,
Exaggerated pupillary hippus dilating, hampered accommodation or human ocular accommodation mechanism
or accommodation re=ex, Increased intraocular pressure, or elevated intraocular pressure, Limited pupillary
constriction, Optic nerve damage. 

Clicking in the ears, eustachian tube dysfunction, and chronic sinusitis. They are
all connected.

There can be many reasons you have clicking in your ears, there can be many reasons you have chronic
sinusitis. There can be many reasons you have both. This article presents one possible answer to why you
may have not responded to treatment. That answer is a connection to cervical spine instability and neck
pain.

In your research of chronic sinusitis and eustachian tube dysfunction symptoms, you learned that
eustachian tube dysfunction is when the eustachian tube that connects the throat to the ears gets clogged.
When this happens you can have ear fullness, ear pain, and hearing dibculties associated with a clogged
eustachian tube. You learned that this is more frequent in people with sinusitis, allergies, who smoke, and
people who are obese.

■ Eustachian Tube Dysfunction

■ The eustachian tube is the canal that connects the inner ear and the upper throat. It regulates
the pressure within the inner ear.
■ Eustachian Tube Dysfunction can occur when the muscles of the eustachian tube, the tensor
veli palatini, the levator veli palatini, the salpingopharyngeus, and the tensor tympani, do not
perform their job of opening and closing the tube. This can cause Suid build-up in one ear as
opposed to the other. This can cause problems of inner ear fullness, ear pain, and loss of sense
of balance. Cervical spine instability can cause muscle disruption.

What are we seeing in this image?

Proper Eustachian Tube function vs. dysfunction. In this illustration, the proper opening of the Eustachian
Tube is shown to require the action of the tensor veli palatini and the levator veli palatini muscles
innervated by the vagus and trigeminal nerves. When these muscles do not operate normally, Suid builds
up in the middle ear potentially causing the problems of ear discomfort, ear fullness, pressure, pain,
dizziness, and even partial or complete hearing loss.

There are four muscles associated with the eustachian tube: the levator veli palatini, salpingopharyngeus,
tensor tympani, and tensor veli palatini. The [rst two muscles are innervated by the vagus nerve and the
latter 2 by the trigeminal nerve. When a person swallows, contraction of the tensor veli palatini and levator
veli palatini causes the eustachian tube to open. LUCI can a9ect both the vagus and trigeminal nerves, as
the trigeminocervical nucleus goes down to the C2 level in the spinal cord.

When sound waves are unable to be conducted because of Suid in the middle ear from Eustachian tube
dysfunction, the mechanical vibrations from sound are not transmitted to the cochlear perilymph and
endolymph. As the Suid builds up, this blockage can get worse, and the person can develop worsening ear
pain. Cranial nerve VIII, the vestibulocochlear nerve, can also be a9ected, a9ecting the balance sensory
system, as evidenced by abnormal posture, balance, and/or vestibulo-ocular reSex symptoms arising,
including tinnitus, vertigo, and imbalance.  Sound waves are conducted via the external ear and the
external auditory canal to the tympanic membrane, which is thereby set in vibration like the diaphragm of a
microphone. These mechanical vibrations are then transmitted by way of the ossicles of the middle ear to
the cochlear perilymph and endolymph. All the disturbances that can arise along the sound conduction
pathway are mechanical in nature and are collectively termed conductive hearing loss.

Why surgery will help many, why surgery may not help some

As we will see in the research below, patients with chronic rhinosinusitis and/or septal deviation who
su9ered from Eustachian tube dysfunction showed signi[cant improvement after surgery. The reasons for
this success in surgery is that changes in the sinuses that enabled proper drainage also helped drain out
the eustachian tubes. First let’s look at the surgery research.

An October 2022 paper in the journal European archives of otorhinolaryngology (5) examined changes in
symptoms of septoplasty Eustachian tube dysfunction after nasal surgery. A total of 359 patients were
included in the study.

■ The patients were divided into 3 groups according to the type of surgery:
■ group A, septoplasty (a surgery to correct or straighten a deviated nasal septum (76 patients).
The prevalence of Eustachian tube dysfunction was 28.9% in this group.
■ group B, endoscopic sinus surgery (to open the drainage pathways of the sinuses) alone (209
patients); The prevalence of Eustachian tube dysfunction was 28.9% in this group.
■ group C, septoplasty + endoscopic sinus surgery (74 patients). The prevalence of Eustachian
tube dysfunction was 31.1 % in this group.

Conclusion: Patients with Chronic rhinosinusitis and/or septal deviation su9ered from Eustachian tube
dysfunction, and showed signi[cant improvement after surgery. In addition, Eustachian tube dysfunction
symptoms were shown to be a9ected by nasal obstruction as well as chronic rhinosinusitis symptoms.

Endoscopic sinus surgery Or Eustachian tube balloon dilation

In July 2022, researchers at the Department of Otolaryngology-Head and Neck Surgery, Medical University
of South Carolina published in the International forum of allergy & rhinology (6) their systematic review and
meta-analysis of  Eustachian tube dysfunction in chronic rhinosinusitis with comparison to primary
Eustachian tube dysfunction. Here is what they said:

“Otologic symptoms consistent with Eustachian tube dysfunction (ETD) are common in patients with
chronic rhinosinusitis, but can also occur independently of chronic rhinosinusitis as primary
Eustachian tube dysfunction. It is unclear if chronic rhinosinusitis + Eustachian tube dysfunction is
similar to primary Eustachian tube dysfunction or how treatment outcomes compare.”

In other words Eustachian tube dysfunction symptoms do not need the condition of chronic rhinosinusitis
to appear. Eustachian tube dysfunction can be a primary diagnosis. What the researchers were looking for
is if it is necessary to treat chronic rhinosinusitis + Eustachian tube dysfunction di9erently than primary
Eustachian tube dysfunction with endoscopic sinus surgery. What they found was Eustachian tube
dysfunction occurs in approximately half of patients with chronic rhinosinusitis. Outcomes of chronic
rhinosinusitis + Eustachian tube dysfunction treated with endoscopic sinus surgery alone are similar to
those of patients with primary Eustachian tube dysfunction treated with Eustachian tube balloon dilation.

5.4% experience worsening of symptoms

A July 2022 paper (7) did not however that Eustachian tube dysfunction symptoms can be e9ectively
alleviated in most patients within 3 months following endoscopic sinus surgery. However, 5.4% of patients
reported worsening of their symptoms at the 1-year follow-up.

Rhinosinusitis / Sinusitis – is this a drainage problem caused by herniated discs?

Above I suggested the connection between cervical spinal instability and a patient’s Eustachian tube
dysfunction and sinusitis. The surgical research above con[rms this connection. Let’s look at the sinusitis
part of his problem and also connect that to cervical spine instability.

First, let’s look at a case study in the Journal of Manual and Manipulative Therapy. (3) It looks at possible sinus
headaches and the development of rhinosinusitis and a connection to neck pain.

Here are the summary learning points:

■ Headaches can be associated with rhinosinusitis and may present a diagnostic challenge because of
symptomatic overlap with other recurring headaches.
■ Neck pain has received extensive attention in migraine, tension-type, and cervicogenic headaches but
not as a comorbid feature of headache in those with rhinosinusitis.
■ This study investigated the occurrence of neck pain and cervical musculoskeletal dysfunction in
individuals with self-reported sinus headaches.
■ Patients in this study (who had an average duration of symptoms of 8.5 YEARS) were asked to
assess their Cervical range of motion (ROM), had a cervical segmental examination, muscle
endurance, and pressure-pain threshold tests.
■ Findings or tests and examinations: “Neck pain and cervical musculoskeletal dysfunction are
common among persons with sinus headaches and may be a comorbid feature or contributing
factor to headaches attributed to rhinosinusitis. Further research is needed to understand
these associations.”

In the research of your symptoms, you have probably uncovered various connections between your neck
pain and your problems with a chronic sinus infection, sinusitis, and rhinosinusitis. Here you learned that
much like problems with Eustachian tube dysfunction, an inability of the Eustachian tube to drain, you may
have a problem with sinus drainage.

Malalignment of C1-C2 can impact sinus drainage

We have many articles and research studies that point out the possible problems misalignment of the C1-
C2 or Atlantoaxial instability can cause. As I have also pointed out, the clue to a patient’s problems may
lie in the fact that they su9er from many symptoms simultaneously and not from one or two isolated
symptoms.

In the story of the patient that we are covering in this article, we see that he had many symptoms. People
we see with Atlantoaxial instability can also su9er from drainage problems of the sinus and associated
nasal congestion, headaches, hearing problems and ear infections, vision problems, balance, vertigo,
dizziness, and nausea among many symptoms. Often they su9er all at once.

When the cervical spine is involved in chronic ear or sinus infections, we suspect that the patient is having a
drainage problem. The ear and sinus are not draining. One reason that they are not draining can be a
bulging or herniated disc impinging on the cervical nerves in the C1-C2 region.

The start of the chase for the root cause of the problem. The connection
between the vagus nerve and the trigeminal nerve and sinus drainage

The vagus nerve, as illustrated below, travels through the cervical spine. It travels especially close to the C1,
C2, C3 vertebrae. Cervical spine instability in these regions can cause herniation or pinching of the vagus
nerve, which can lead to a disruption of normal nerve communication between the vagus nerve and the
trigeminal nerve and trigeminal ganglion. This disruption or herniation of the nerve can cause among the
many symptoms of cluster headaches.

What are we seeing in this image?

The vagus nerve, as illustrated here, travels through the cervical spine. It travels especially close to the C1,
C2, C3 vertebrae. Cervical spine instability in these regions can cause herniation or pinching of the vagus
nerve, which can lead to a disruption of normal nerve communication between the vagus nerve and the
trigeminal nerve and trigeminal ganglia. This disruption or herniation of the nerve can cause among the
many symptoms of cluster headaches.

In the context of this article, we will simply explore how cervical spine instability impacts the trigeminal
nerve and how this impact can prevent your sinus from draining. A more complex understanding of the
trigeminal nerve is found here: The evidence for Trigeminal Neuralgia non-surgical treatments.

The head and neck, as all parts of the body, live in complex relations. Compression of the cranial nerves
including the vagus nerve and the trigeminal nerve can cause among many symptoms, a problem of sinus
drainage.

Our bodies have a left side trigeminal nerve and a right side trigeminal nerve. The trigeminal nerve
separates into three branches. The ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves.

In regard to the sinus:

■ The ophthalmic nerve (V1) serves the eye and parts of the nasal cavity. Damage or dysfunction of this
nerve can impact sinus function and vision. This is why people have these symptoms concurrently.
This could include sinusitis. Sinusitis can occur when the nerve messages are getting distorted and
signals for proper drainage of the sinus are not getting through. Note that a dysfunction of this
branch can cause pupil dilation as cited above as well as many other vision problems. Pupil dilation is
a tell-tale sign of cervical instability that can be causing sinusitis.
■ The maxillary nerve (V2) also serves parts of the nasal cavity and sinus as well as portions of the
mouth. This is why sinus congestion and sinusitis can be reported by patients along with problems of
the palate as noted in a study above. A deviated uvula can be a tell-tale sign of palate dysfunction and
as stated above a clue of cervical instability causing sinusitis and Eustachian tube dysfunction.
■ The Vagus nerve serves the sinuses, the back of the throat (pharynx), and the larynx.

3. Restoring the natural curve of the spine and strengthening cervical spine
ligaments – a possible treatment for Chronic Sinusitis and Eustachian Tube
Dysfunction

Many patients we see when they come in for their [rst visit for issues of chronic pain and neurological
symptoms, come in with an understanding that something is wrong with the curve of their neck and spine.
This they learned through the many years of seeking treatments. This is why they also understand that the
curvature of the spine is a complex problem

In the story of our patient in this article, we noted that he had a military curve. A loss of the natural cervical
spine curve.

The curvatures of the neck

 What are we seeing in this image?

In our practice, we see problems of cervical spine instability caused by damaged or weakened cervical spine
ligaments. With ligament weakness or laxity, the cervical vertebrae move out of place and progress into
problems of chronic pain and neurological symptoms by distorting the natural curve of the spine. This
illustration demonstrates the progression from Lordotic to Military to Kyphotic to “S” shape curve.

Repairing the ligaments and curve for a long-term Xx

The goal of our treatment is to repair and strengthen the cervical ligaments and get your head back in
alignment with the shoulders in a normal posture.

What are we seeing in this image?

In this illustration, we see the before and after of neck curve corrections. Ligament laxity or looseness or
damage, whether the cause is from trauma, genetic as in cases of Ehlers-Danlos syndrome, ultimately
causes a kyphotic force on the cervical spine, stretching the posterior ligament complex of the neck. As can
be seen in the x-rays of this image, patients with a whiplash injury, Joint Hypermobility Syndrome, and
Ehlers-Danlos syndrome can have their cervical curve restored with Prolotherapy Injections and the use of
head and chest weights.

Treating Cervical Instability-Induced Chronic Sinusitis and Eustachian Tube

Dysfunction with Cervical Curve Correction and Prolotherapy

Let’s now return to what happened to our patient. At the onset of this article I described that when this
person came into our center, it was after a screening process to determine if cervical spine instability could
be realistically thought of as a cause of his problems of chronic sinusitis and Eustachian tube dysfunction.

Once it was determined that his problems were coming from his neck we started Prolotherapy treatment
and cervical spine curve correction.

■ The patient had a remarkable recovery as after four Prolotherapy and cervical curve correction
treatments his chronic sinusitis was 90% gone, as well as noted signi[cant improvements in his other
symptoms. He was able to 100% breathe out of his nose again and the horrible sounds in his ears,
ear fullness, hearing impairment, tinnitus were almost entirely alleviated.
■ Follow-up x-rays, digital motion x-rays showed signi[cant improvement in his neck curve and cervical
stability.
■ After some time, he had some tightness return in his neck. He went to a chiropractor and thought he
was just going to get a massage or some other gentle technique. Instead, he received a high-velocity
manipulation at the C1-C2 area. The chiropractor did rapid rotational movement and after that, he
had a return of 30% of his overall symptoms but 50% of his chronic sinusitis, ear fullness (blocked
Eustachian tube), hearing impairment and tinnitus returned.
■ He required three more Prolotherapy visits to alleviate these new symptoms.

Brief summary.

The sinuses of the head and face/nose are interesting in that they involve several cranial nerves (especially
cranial nerve [ve (trigeminal) and 10 (vagus/parasympathetic) and the superior cervical sympathetic
ganglion. In this particular patient, his loss of the cervical curve and anterior subluxation of the atlas would
stretch neck structures such as the vagus nerve (whose primary ganglion (nodose)) sits right in front of it
and on top of the cervical sympathetic ganglion which is in front of C2. The forward head carriage he had,
evidenced by anterior subluxation of C1 (a common [nding that they go together) again could inhibit vagus
and/or cervical superior sympathetic ganglion Sow, but note it could also just throw o9 the normal balance
that occurs with the autonomic nervous
the system, which occurred in his case.

Let’s also take a moment to specify that not all patients have results like these. There is nothing typical
about these problems and treatments. The cases we see are very complex and that is why we carefully
screen patients for their appropriate candidacy.

Treating cervical ligaments with Prolotherapy  – published research from Caring

Medical

Prolotherapy is an injection technique that stimulates the repair of unstable, torn or damaged
ligaments. When the cervical ligaments are unstable, they allow for excessive movement of the vertebrae,
which can stress tendons, atrophy muscles, pinch on nerves, such as the vagus nerve,  and cause other
symptoms associated with cervical instability including problems of digestion among others.

In 2014, we published a comprehensive review of the problems related to weakened damaged cervical
neck ligaments in The Open Orthopaedics Journal. (4) We are honored that this research has been used in at
least 6 other medical research papers by di9erent authors exploring our treatments and [ndings and cited,
according to Google Scholar, in more than 40 articles.

In our clinical and research observations, we have documented that Prolotherapy can o9er answers for
su9erers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures
of the neck eliminates the instability and the sympathetic symptoms without many of the short-term and
long-term risks of cervical fusion. We concluded that in many cases of chronic neck pain, the cause may be
underlying joint instability and capsular ligament laxity. Furthermore, we contend that the use
of comprehensive Prolotherapy appears to be an e9ective treatment for chronic neck pain and cervical
instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well
as ebcacious in relieving chronic neck pain and its associated symptoms.

In this video, DMX displays Prolotherapy before and after treatments

■ In this video, we are using a Digital Motion X-Ray (DMX) to illustrate a complete resolution of a
pinched nerve in the neck and accompanying symptoms of cervical radiculopathy.
■ A before digital motion x-ray at 0:11
■ At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
■ At 0:34 DXM three months later after this patient had received two Prolotherapy treatments
■ At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure
on the nerve
■ At 1:00 another DMX two months later and after this patient had received four Prolotherapy
treatments
■ At 1:14 the previously completely closed neural foramina are now opening normally during motion

Pinched nerve treated with Prolotherapy: Before and after Digital Motion X-ray
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Summary and contact us. Can we help you? How do I know if I’m a good
candidate?

We hope you found this article informative and it helped answer many of the questions you may have
surrounding Chronic Sinusitis and Eustachian Tube Dysfunction in your complicated neck pain case. Just
like you, we want to make sure you are a good [t for our clinic prior to accepting your case. While our
mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a
multi-step process so our team can really get to know you and your case to ensure that it sounds like you
are a good [t for the unique testing and treatments that we o9er here.

Please visit the Hauser Neck Center Patient Candidate Form

References

1 Zannolli R, Acquaviva A, D’Ambrosio A, Pucci L, Balestri P, Morgese G. Vagal and hypoglossal Bell’s palsy.
Journal of child neurology. 2000 Feb;15(2):130-2. [Google Scholar]
2 Franz B, Altidis P, Altidis B, Collis-Brown G. The cervicogenic otoocular syndrome: a suspected forerunner
of Ménière’s disease. International Tinnitus Journal. 1999;5(2):125-30. [Google Scholar]
3 Petersen SM, Jull GA, Learman KE. Self-reported sinus headaches are associated with neck pain and
cervical musculoskeletal dysfunction: a preliminary observational case control study. Journal of Manual &
Manipulative Therapy. 2019 Aug 8;27(4):245-52. [Google Scholar]
4 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular
ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
5 Lee IH, Kim DH, Kim SW, Kim SW. Changes in symptoms of Eustachian tube dysfunction after nasal
surgery. European Archives of Oto-Rhino-Laryngology. 2022 Mar 29:1-7. [Google Scholar]
6 Chen T, Shih MC, Edwards TS, Nguyen SA, Meyer TA, Soler ZM, Schlosser RJ. Eustachian tube dysfunction
(ETD) in chronic rhinosinusitis with comparison to primary ETD: A systematic review and meta-analysis.
InInternational Forum of Allergy & Rhinology 2022 Jul (Vol. 12, No. 7, pp. 942-951). [Google Scholar]
7 Chen WC, Yang KL, Lin WC, Fang KC, Wu CN, Luo SD. Clinical outcomes of Eustachian tube dysfunction in
chronic rhinosinusitis following endoscopic sinus surgery. Journal of the Chinese Medical Association. 2022
Jul 1;85(7):782-7. [Google Scholar]

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