Cervical Trauma and Tinnitus.

VeStibUIOCOchlear symptoms after cervical trauma remain a matter of controversy. This controversy is due to the difficulty in interpreting vague symptoms, the lack of objective findings, and the unpredictable time span between trauma and onset of symptoms. Cervicogenic vestibulocochlear symptoms include vertigo, hearing loss, and tinnitus and frequently are used in the same context, suggesting a common mechanism. Experience with treatment, however, shows that symptoms respond quite differently and, generally, tinnitus is the least responsive. Since 1978, we have been observing mydriasis in patients with vestibulocochlear symptoms. However, only recently a systematic investigation of this observation showed that mydriasis is associated with a functional disorder of the upper cervical spine and that it suggests sympathetic dysfunction. An analysis of 140 consecutive patients has shown that mydriasis frequently is found in Cl-C2 facet joint disorders. In 81.5%, mydriasis is associated with ear symptoms. In our patients, whiplash injuries are represented in 58.3%. We have become aware through the observation of mydriasis in CI-C2 facet joint disorders that the anterior cervical sympathetic plexus encompassing the superior cervical ganglion and the internal carotid artery nerve plays an important part in trauma patients, in contrast to the posterior cervical sympathetic plexus surrounding the vertebral artery (which has received all the attention in the past). These observations inspired us to carry out a pilot study to investigate the influence of the anterior cervical sympathetic plexus on tinnitus in patients with a history of whiplash injuries.