Ross Hauser, MD | Hauser Neck Center

Persistent dizziness can make ordinary activities difficult. Some people feel the room spinning. Others describe rocking, swaying, lightheadedness, difficulty remaining upright, or a world that seems to bounce when they walk. Hearing changes, tinnitus, neck pain, fatigue, or difficulty concentrating may add to the confusion.

By the time someone is looking for more information, they may already have received several diagnoses or tried medication, dietary changes, repositioning maneuvers, or balance therapy. An incomplete response can be frustrating, especially when the explanation for continuing symptoms remains unclear.

At Caring Medical, our clinical interest includes the possible contribution of cervical structure in selected patients with persistent dizziness and accompanying neck symptoms. We also recognize that inner-ear, neurologic, visual, autonomic, and cervical problems can overlap. Persistent symptoms deserve a clear explanation of what has been identified and what remains uncertain.

This article accompanies Dr. Hauser’s detailed discussion of vestibular disorders and the cervical spine. We explain how these systems interact, what diagnostic tests can show, and how the research informs treatment choices.

1. Understanding dizziness, vertigo, and related symptoms

“Dizziness” describes several different experiences:

• Vertigo: an illusion that you or your surroundings are moving, including spinning, rocking, or swaying.
• Lightheadedness: a feeling of faintness or being about to pass out.
• Unsteadiness: difficulty maintaining balance when standing or walking.
• Oscillopsia: the impression that stationary objects bounce or move, often during head movement or walking.

The timing and triggers help clarify the problem. Brief attacks when rolling in bed differ from continuous dizziness, symptoms on standing, or dizziness triggered by loud sound. A diagnosis should consider that pattern together with examination findings. Emergency-care guidelines emphasize timing, triggers, and appropriate bedside assessment rather than relying on a symptom label alone. (1)

Symptoms that need urgent evaluation

Seek emergency care for sudden dizziness accompanied by new weakness, numbness, double vision, difficulty speaking, inability to stand or walk, or a severe new headache or neck pain. Sudden severe continuous dizziness can require urgent assessment even without these additional symptoms. Stroke and arterial dissection are among the conditions that must be considered. (2)

Sudden hearing loss also requires prompt medical evaluation. Waiting to see whether a neck treatment helps can delay time-sensitive care. (3)

2. Vestibulopathy and Vestibular hypofunction 

Following whiplash, concussion, or another head and neck injury, symptoms may involve more than one system. Possible diagnoses include BPPV, vestibular nerve injury, migraine, perilymphatic fistula, or post-traumatic inner-ear fluid disorders. These terms describe different suspected abnormalities; a history of trauma does not make them interchangeable.

Vestibulopathy means a disorder involving the balance system. Vestibular hypofunction means reduced vestibular function. Neither term identifies the cause by itself.

The practical question is whether the diagnosis matches the symptom pattern and testing. Neck pain accompanying an established vestibular disorder may represent an additional problem, a response to avoiding head movement, or a possible contributor to symptoms.

Does everyone with unexplained dizziness need a temporal bone CT?

High-resolution temporal bone CT can identify certain bony abnormalities around the inner ear. It is particularly relevant when canal dehiscence is suspected. The scan must agree with characteristic symptoms and physiological tests. An apparent opening on CT does not establish that it explains the dizziness. (4)

Routine imaging is discouraged when examination establishes typical BPPV and there are no additional atypical findings. Different clinical questions may call for different investigations. (5)

3. How the inner ears, eyes, and neck coordinate balance

Balance is an ongoing process. When you walk, turn your head, or lean to one side, the brain combines information from the eyes, inner ears, and sensory receptors throughout the body. It then adjusts posture, muscle activity, and weight distribution.

Each inner ear contains three semicircular canals that detect rotational movement. Fluid movement stimulates specialized sensory cells. The nearby utricle and saccule detect linear acceleration and orientation relative to gravity.

The vestibular branch of the vestibulocochlear nerve, or cranial nerve VIII, carries balance information toward the brainstem. Its cochlear branch carries hearing information. The brainstem and cerebellum help integrate these signals and coordinate responses.

Proprioception: knowing where your head is relative to your body

Proprioception is the sense of body position and movement. It allows you to recognize where your finger is pointing without looking. Receptors in muscles, tendons, joint capsules, ligaments, and other tissues contribute to this information.

The small, deep upper-neck muscles contain a rich supply of muscle spindles, which detect changes in muscle length. Researchers propose that altered sensory information from a painful or injured neck could conflict with vestibular and visual information and contribute to unsteadiness. A 2025 perspective discusses this sensory-mismatch model, while emphasizing the absence of a specific diagnostic test and the continuing uncertainty about cervical dizziness. (6)

The vestibulo-ocular reflex and bouncing vision

The vestibulo-ocular reflex, or VOR, moves the eyes opposite to head movement so that a target remains steady on the retina. When you turn your head right while looking at a fixed object, your eyes move left to maintain focus.

Inadequate VOR function can produce blurred vision or oscillopsia during movement. Bilateral vestibular loss may also cause unsteadiness that is worse in darkness or on uneven ground. These symptoms require assessment of vestibular function; they do not identify a cervical cause on their own. (7)

Patients may describe words blurring when they move their head, objects bouncing during walking, or discomfort watching moving scenes. These are useful descriptions of the experience, even when further testing is needed to establish its cause.

4. The neck–dizziness connection: our perspective and the evidence

We consider the cervical spine particularly relevant when dizziness accompanies persistent neck pain, restricted motion, a history of neck injury, or symptoms that change reproducibly with neck position. The atlas, or C1 vertebra, supports the skull and works with surrounding joints, muscles, and ligaments to permit controlled movement. Ligament injury can be relevant to excessive movement in an individual patient.

Our foundational review discusses capsular ligament laxity, cervical instability, and possible associated symptoms, including dizziness. It provides anatomical and clinical background for this perspective. It is a narrative review rather than a controlled trial demonstrating that cervical instability causes vestibular disease. (8)

Our article on post-traumatic cervical instability develops this discussion after injury.

Why the diagnosis remains debated

The Bárány Society’s position paper found insufficient evidence for a mechanistic link between neck pathology and true vertigo. It highlighted migraine and BPPV as common alternative explanations and did not propose clinical diagnostic criteria for cervical dizziness. This is an important qualification when interpreting symptoms provoked by head movement: many vestibular disorders become worse when the head moves. (9)

A possible cervical contribution therefore requires more than the coexistence of neck pain and dizziness. Our cervical dizziness article discusses the clinical questions in greater depth.

Forward head posture, fatigue, and neck noises

Prolonged downward viewing or holding the head forward can increase the demands on neck muscles and supporting tissues. Discomfort, guarding, and fatigue may follow. Posture alone does not demonstrate permanently stretched ligaments or cervical instability.

Clicking, popping, and grinding can accompany neck symptoms. These sounds are useful to mention, but they do not prove instability or establish where dizziness originates. Likewise, temporary relief after an adjustment does not identify a specific damaged ligament or demonstrate restored blood flow.

5. Venous drainage, cerebrospinal fluid, and nearby nerves

The internal jugular veins are important pathways for blood leaving the brain. Cerebrospinal fluid, or CSF, surrounds the brain and spinal cord and circulates through connected spaces. Venous drainage, CSF circulation, and tissue-clearance processes interact, but they are distinct processes.

Our 2024 hypothesis-and-theory paper proposes that ligamentous cervical instability and altered alignment could affect nearby neurovascular structures, including jugular drainage. This is the published framework behind Dr. Hauser’s discussion of cervical structure and fluid flow. It does not establish that cervical posture causes every vestibular disorder. (10)

Significant venous obstruction can be clinically relevant in selected circumstances. The effect depends on anatomy, collateral drainage pathways, position, and the severity of the obstruction. A narrowed vein on imaging does not establish that CSF is accumulating, that the brainstem is compressed, or that waste products explain the entire symptom pattern.

The “highway” and “river” analogies in the video illustrate a proposed relationship between connected systems. They cannot determine pressure or functional impairment in an individual patient.

Cervicovagopathy and autonomic symptoms

Our 2025 cervicovagopathy paper explores a proposed relationship between cervical structural abnormalities and vagus nerve dysfunction. It includes retrospective observations from 234 patients with otherwise unexplained symptoms. These data support investigation of cervical–autonomic associations, but are not controlled evidence that a neck abnormality caused POTS or another autonomic disorder. (11)

A smaller vagus nerve cross-sectional area on ultrasound does not by itself prove degeneration, functional nerve damage, or the location of compression. Lightheadedness with standing, palpitations, altered sweating, or digestive symptoms also requires consideration of autonomic and other medical explanations.

6. When dizziness accompanies many other symptoms

Some patients report dizziness together with headache, nausea, fatigue, brain fog, anxiety, sleep problems, neck pain, or muscle tension. Others describe swallowing difficulties, constipation, palpitations, or sound sensitivity. The combination deserves attention without assuming that one anatomical finding explains everything.

Our 2026 study of 84 consecutive patients with hypermobile Ehlers–Danlos syndrome documented frequent multisystem symptoms alongside cervical and neurovascular abnormalities. The published symptom table recorded 20 or more symptoms in 70 of 84 patients, or 83.3%. It was a retrospective study from a selected neck-center population, without a matched control group or treatment comparison. Its findings are hypothesis-generating and do not establish how common these abnormalities are in all people with hEDS. (12)

The symptom frequencies relevant to this discussion were:

These percentages describe this clinic cohort, not the general hEDS population or the likelihood that a symptom has a cervical cause. (12)

A separate 2026 retrospective, cross-sectional study examined 227 young adults with chronic brain-based symptoms. Neck pain, brain fog, concentration difficulty, and headache were common alongside cervical structural and neurovascular findings. The associations cannot establish cause, symptom origin, or the effectiveness of treating the neck. (13)

An isolated inner-ear disorder would not ordinarily explain the entire combination of constipation, swallowing difficulties, and palpitations. However, several conditions can coexist. A broad symptom pattern is a reason to consider more than one contributor, rather than proof of a single cervical explanation.

7. Vertebral arteries and dizziness with head turning

The carotid and vertebral arteries supply blood to the brain. Vertebral artery compression during neck rotation is a recognized but uncommon vascular condition. A position-related dizzy spell alone does not make this the most likely diagnosis.

Consensus criteria require a compatible clinical presentation and documentation of vascular compromise with appropriate imaging or sonographic testing. Dizziness during ordinary head movement is also common in vestibular disorders. (2)

Repeatedly holding the head in a position that causes marked dizziness or neurologic symptoms is not a useful home diagnostic experiment. A new or concerning pattern warrants assessment of its cause.

Arterial compromise and venous drainage problems are different questions. Demonstrating jugular narrowing does not establish vertebral artery kinking, and one test cannot substitute automatically for the other.

8. What venous imaging can—and cannot—show

Doppler ultrasound examines blood flow and can be used to investigate vessels under selected conditions. CT or MR venography can depict venous anatomy. Transcranial Doppler examines flow in intracranial arteries; it is not a direct measurement of CSF clearance.

The relevance of a result depends on the vessel examined, the measurement, body position, technical quality, and the clinical question. The phrase “80% blocked” needs clarification: a change in vessel diameter or cross-sectional area is not automatically an 80% reduction in total drainage from the brain.

Body position also changes which venous pathways carry blood. Feeling better lying down can occur for several reasons, including orthostatic intolerance and disorders of CSF pressure. It does not diagnose jugular compression.

A CT venogram is not guaranteed to reveal the cause of unexplained dizziness. Likewise, an anatomical narrowing does not demonstrate that opening it will eliminate Ménière’s symptoms, restore vestibular function, or repair a canal defect.

Our discussion of internal jugular vein compression explains the proposed cervical connection in more detail.

9. Diagnosis: matching symptoms, examination, and testing

A thorough evaluation may consider the timing of attacks, positional triggers, hearing symptoms, migraine features, medication effects, blood pressure changes, and neurologic findings. Examination may include eye movements, balance, hearing, vestibular function, and the neck when appropriate.

The HINTS examination is a specialized bedside assessment for selected patients with acute vestibular syndrome. It requires appropriate training and is not a home test or a general screening test for all chronic dizziness. Emergency guidelines recommend using it within its defined clinical setting. (1)

What does cervical motion imaging add?

The video shows stills from digital motion X-ray examinations to illustrate vertebral movement. Such images address a structural question about the neck. They do not, by themselves, identify the cause of dizziness, measure brain pressure, or confirm damage to the vestibular nerve.

A finding should be interpreted in relation to the history, examination, and the standards relevant to that test. More visible movement is not automatically a complete explanation for a complex vestibular presentation.

Eye pressure and optic nerve sheath measurements

Our 2025 study of 203 patients with chronic eye symptoms reported co-occurring cervical structural and neurovascular abnormalities, including optic nerve sheath findings. This was a retrospective clinical cohort rather than a controlled study proving that cervical instability causes glaucoma or that neck treatment reverses eye disease. (14)

Optic nerve sheath size, intracranial pressure, and intraocular pressure are related to different measurements and should not be treated as equivalent. Blurry vision, ocular hypertension, or glaucoma still needs appropriate eye care. An imaging association is not a reason to delay that care.

10. Vestibular migraine, persistent rocking, and PPPD

Vestibular migraine

Vestibular migraine can cause repeated episodes of dizziness or vertigo, sometimes without headache during every episode. Diagnostic criteria consider the number and duration of attacks, migraine history, associated migraine features, and competing explanations. Neck pain may occur with migraine without proving a cervical cause. (15)

The video raises cervical and venous mechanisms as possible contributors in selected patients. A migraine diagnosis alone does not establish jugular obstruction, and migraine symptoms should not be reduced to a single explanation based on arterial dilation.

Mal de débarquement syndrome

Mal de débarquement syndrome, or MdDS, involves persistent rocking, bobbing, or swaying. In its classic motion-triggered form, symptoms begin within 48 hours after passive motion ends, such as after a boat trip. They often temporarily improve during renewed passive movement, including riding in a vehicle.

The criteria require symptoms lasting more than 48 hours; the condition is classified as persistent when symptoms continue beyond one month. Normal routine testing does not make the experience imaginary. (16)

The established criteria do not identify jugular or thoracic outlet obstruction as the cause of MdDS. A separate diagnosis of thoracic outlet syndrome needs its own supporting findings. Hanging from a bar, Botox, or thoracic outlet surgery should not be presented as standard treatments for MdDS.

Persistent postural-perceptual dizziness

Persistent postural-perceptual dizziness, or PPPD, involves dizziness, unsteadiness, or non-spinning vertigo on most days for at least three months. Symptoms worsen with upright posture, movement, or visually complex surroundings. It is a functional vestibular disorder: altered balance processing does not mean imagined symptoms. (17)

A 2026 retrospective study analyzed 23 patients with PPPD and identified otolith dysfunction in nine, reported as 38%. These vestibular abnormalities did not predict short-term improvement under the study’s treatment program. The findings show that PPPD can coexist with peripheral vestibular abnormalities; the study did not investigate cervical instability. (18)

Our PPPD article explains the diagnosis and overlap in greater detail.

11. Inner-ear fluid, crystals, and structural openings

Eustachian tube dysfunction affects middle-ear air pressure

The Eustachian tube connects the middle ear to the back of the nose and helps equalize pressure across the eardrum. Dysfunction can cause fullness, popping, discomfort, or muffled hearing. It does not directly drain fluid from the semicircular canals. Diagnosis considers symptoms and appropriate examination or testing. (19)

Pinching the nose and swallowing does not reliably diagnose dysfunction or a cervical cause. Whether an ear “pops” is not sufficient evidence of a nerve or structural neck problem.

BPPV involves displaced crystals

In BPPV, tiny calcium carbonate particles called otoconia become displaced from their usual location and affect a semicircular canal. Certain head movements then produce misleading balance signals and brief spinning attacks.

The Epley maneuver uses a sequence of positions to move particles out of an affected posterior canal. It repositions particles; it does not break up crystals created by sluggish fluid. Persistent symptoms after a maneuver warrant reassessment for unresolved BPPV or another vestibular or neurologic condition. (5)

Ménière’s disease and endolymphatic hydrops

Endolymphatic hydrops describes enlargement of the inner ear’s endolymph-containing spaces. It is associated with Ménière’s disease, which can cause episodic vertigo, fluctuating hearing loss, tinnitus, and ear fullness. Evaluation includes the characteristic history and an audiogram, and considers vestibular migraine. (20)

A dam-and-river analogy may illustrate fluid accumulation, but it does not establish an external jugular obstruction as the cause of each case. Specialized inner-ear MRI addresses a different question from cervical venography.

Superior semicircular canal dehiscence syndrome

A defect in the bone covering the superior canal can create an additional pressure-sensitive opening, often called a third window. Diagnostic clues include dizziness or oscillopsia triggered by sound or pressure, hearing internal body sounds unusually loudly, and pulsatile tinnitus.

Diagnosis combines symptoms, physiological evidence, and properly performed high-resolution CT. Neither CT appearance alone nor one-sided symptoms establish the syndrome. (4)

Tullio’s phenomenon describes sound-induced vestibular symptoms. Autophony describes unusually loud perception of one’s own voice or internal sounds. These specific experiences help characterize the problem. They are not proof that fluid pressure has “shot through” bone or that cervical injections can repair the opening.

12. One-sided symptoms, sensory changes, and coordination

Tinnitus, fullness, or hearing loss may be more noticeable on one side. The side is a useful clue, but it cannot identify whether the cause is in the middle ear, inner ear, hearing nerve, or a vascular structure.

Similarly, narrowing of one jugular vein does not establish that the same-side inner ear is malfunctioning or that the brain will perceive a particular direction of tilt. Those proposed connections require evidence beyond matching sides.

Dizziness may coexist with fatigue, difficulty concentrating, or trouble becoming fully alert in the morning. These complaints deserve attention, but difficulty waking does not demonstrate a damaged brain arousal system. New hand tremor or loss of fine coordination should not automatically be attributed to vestibular signals or jugular narrowing.

The hearing, balance, visual, autonomic, and cervical systems can interact. Describing an interaction is different from identifying which abnormality is responsible for a particular symptom.

13. Anxiety, depersonalization, and derealization

Vestibular symptoms can affect how a person experiences their body and surroundings. Depersonalization means feeling detached from yourself or your body. Derealization means that the surrounding world feels unfamiliar, dreamlike, or unreal.

A 2026 systematic review included 23 studies and found evidence linking vestibular alterations with these experiences. Anxiety and spatial disorientation frequently occurred alongside them. The studies differed substantially, limiting conclusions about the mechanism in an individual. The review does not establish a cervical or venous cause. (21)

We retain this topic because it can explain an unsettling part of the dizziness experience that is easy to overlook. Psychological distress can accompany a real balance disorder. Sleep changes, altered sweating, temperature differences between limbs, and suspected hormonal problems may also require separate explanations.

14. The jugular bulb, hearing pathways, and hearing devices

Venous blood can pass from the sigmoid sinus into the jugular bulb, an expanded venous region near the skull base, and then into the internal jugular vein. The bulb lies close to middle- and inner-ear structures.

A high-riding jugular bulb extends higher into the temporal bone than usual. A diverticulum is an outpouching. A histopathologic and radiologic study found that jugular bulb abnormalities were relatively common, while involvement of nearby inner-ear structures was less frequent and often clinically silent. Their relevance depends on the specific anatomy. (22)

A high-riding bulb does not itself establish atlas-level compression or show that changing cervical alignment will change the bulb’s anatomy.

How sound reaches the brain

Sound vibrates the eardrum. The three small middle-ear bones—the malleus, incus, and stapes—transmit these vibrations toward the cochlea. Cochlear sensory hair cells convert mechanical movement into electrical signals carried by the cochlear division of cranial nerve VIII.

The cochlea is the hearing organ; it is not the hearing nerve. The vestibular aqueduct, cochlear aqueduct, and internal auditory canal are also distinct structures, rather than interchangeable drainage channels.

Hearing aids amplify sound. Cochlear implants bypass damaged portions of the inner ear and stimulate the auditory nerve. Needing either device does not demonstrate that jugular compression damaged that nerve. The proposed cervical–venous connection does not establish that prolotherapy restores hearing.

15. Recovery strategies and the role of prolotherapy

The relevant treatment depends on the diagnosis. Particle repositioning addresses BPPV; vestibular rehabilitation addresses selected balance and gaze-stability problems; migraine management addresses migraine. Confirmed hearing or structural inner-ear disorders may require their own treatment.

An updated rehabilitation guideline supports vestibular physical therapy for peripheral vestibular hypofunction. Its recommendations apply to the vestibular deficits studied; other causes of dizziness require a different treatment discussion. (23)

Cervical rehabilitation and newer treatment research

A 2025 systematic review included six randomized trials and three secondary analyses of manual therapy for cervical-related dizziness. Upper-cervical interventions showed improvement in dizziness intensity and impact compared with control or placebo, but certainty was low to very low. These findings suggest possible benefit in selected patients without proving ligament repair or identifying a single cause of dizziness. (24)

Temporary improvement after treatment also does not demonstrate that a particular vessel or nerve was compressed and then released.

Posture and devices shown in the video

The video discusses raising a computer screen, changing prolonged downward viewing, physical therapy, pillows, cervical supports, head weights, positioning techniques, and glasses. These examples illustrate Dr. Hauser’s structural perspective. They are not a standard equipment or exercise program for everyone with dizziness.

The discussion of a patient who sustained another injury preserves an important point: earlier improvement does not establish the condition of the neck after new trauma. Symptoms after a new injury need to be interpreted in that new context.

Prolotherapy: rationale and evidence limits

Prolotherapy is an injection approach intended to stimulate a local repair response in injured connective tissue. Our ligament-laxity review provides part of the rationale for investigating treatment directed at ligament support. (8)

This rationale differs from controlled evidence of effectiveness for a vestibular diagnosis. The research cited here does not establish prolotherapy as a treatment that repairs canal dehiscence, restores hearing, reverses vestibular hypofunction, or reliably resolves Ménière’s disease, PPPD, or MdDS.

Visit counts, reassessment intervals, and individual responses discussed in a video should not become a fixed schedule or an expected recovery time for another person.

The whole-spine discussion

The brain and spinal cord share a connected CSF system. The video’s Lake Okeechobee and Caloosahatchee River analogy illustrates this continuity. It does not establish that ordinary low-back pain results from a cervical fluid obstruction or that brain-related symptoms originate in the lower back.

Our clinical perspective is that cervical structure may deserve consideration in selected patients with persistent overlapping symptoms. Its contribution, and the benefit of treatments directed at it, remain questions for further investigation.

16. Carly’s interview: a history of neck pain, dizziness, and hearing changes

The following interview has been edited for clarity and repetition. It records Carly’s history and the discussion before her first prolotherapy treatment. It is not a report of hearing recovery after prolotherapy.

Dr. Hauser: You have been very athletic. What happened, and why are we meeting about ten years later?

Carly: I have been a dancer since I was little, including competitive dance. When I was about 12, an older girl sat on my shoulders for a lifting routine. We practiced it repeatedly, sometimes for a long period. After that, I began having nausea and dizziness.

Dr. Hauser: Did she hit your head?

Carly: No. It was repetitive. I saw different doctors, including a neurologist, and was diagnosed with POTS and cervicogenic vertigo. Treatment helped a lot, but I have always had neck pain.

Dr. Hauser: How old are you now?

Carly: I am 22.

Dr. Hauser: You also have hearing aids. How did the hearing problem develop?

Carly: In the fall of 2024, my hearing became a little muffled. I could still communicate, but as a collegiate dancer on Purdue’s Gold Duster Dance Team, I noticed that music seemed quieter. I could not hear it as well or hear people talking across the field or practice area.

I mentioned it to my mom. I also needed my wisdom teeth removed, but my hearing seemed worse afterward. I saw sports medicine doctors and ENTs. They knew I had neck pain, but could not identify where the hearing loss came from. Hearing aids or a cochlear implant were discussed.

My mom found upper-cervical chiropractors near home and school. I noticed a significant difference in my hearing when I saw them. Early in 2025, after another doctor’s appointment, my hearing decreased sharply. I was told it was profound in my left ear and severe in my right. After I began seeing the cervical chiropractors, it was described as severe on the left and moderate on the right.

I continued going monthly or twice monthly when I could, traveling from college. That made us curious about the cervical connection. We researched and found you online.

I wanted to finish my collegiate dance career, but knew I would need a break from hair whipping and repeatedly flipping my head. We arranged this appointment after I graduated.

Dr. Hauser: Did the nausea and dizziness coincide with the hearing loss?

Carly: I have had nausea on and off since the injury about ten years ago. It is something I have learned to deal with. When I am anxious, I get nauseous.

The dizziness became much worse when my hearing started to decrease. The biggest problems are hearing loss, neck pain, and tinnitus.

Dr. Hauser: Are both ears affected equally?

Carly: No. My left ear feels much worse than my right.

Dr. Hauser: Have you had other symptoms, such as swallowing problems or blurry vision?

Carly: I had some swallowing difficulty about ten years ago. I do not have blurry vision, and my memory seems fine.

Dr. Hauser: We have discussed your imaging. What do you remember about the findings?

Carly: I do not remember the exact terminology. The vertebrae were described as looking like a staircase rather than staying aligned when I moved my neck.

Dr. Hauser: We discussed multilevel cervical instability, particularly at C1–C2. What do you remember about the possible hearing connection?

Carly: I remember that it could potentially affect an artery or vein.

Dr. Hauser: The discussion focused mostly on the jugular vein. The narrowing appeared more pronounced on the left, which was also the side with worse hearing. We also discussed differences in the optic nerve sheath measurements.

Carly: My left ear is the worst for hearing.

Dr. Hauser: We discussed particular sleeping positions and arm positioning in relation to your findings.

Carly: I was told to keep my arms down and support my head with the pillow, including when sleeping on my left side.

Dr. Hauser: We also considered a possible thoracic outlet contribution and changes with head turning. You have not had prolotherapy before. How do you feel before treatment?

Carly: Nervous, because it has been a long day, but excited and hopeful that there may be an answer to the problems I have had.

Dr. Hauser: Thank you for sharing your story. Hopefully, we can report again at a later date.

Carly: Of course. I want to help other people.

What this interview illustrates

Carly describes a long symptom history, several diagnoses, changes in hearing, and an interest in whether the neck contributes. Her account preserves her experience without establishing which intervention caused the reported changes.

Matching the side of venous narrowing with worse hearing is an observation, not proof of causation. Her imaging discussion does not determine the cause of hearing loss or predict treatment response. The individualized sleeping advice in the interview should not be adopted as a general instruction for other readers.

Understanding persistent symptoms without losing the diagnosis

A continuing problem after initial treatment may reflect an incomplete response, an unresolved diagnosis, or more than one contributor. It does not automatically identify the neck as the source.

We retain a broad discussion because dizziness can affect hearing, vision during movement, concentration, confidence, and daily function. Cervical structure is one possible area of investigation in selected patients, while established vestibular diagnoses retain their own criteria and treatment evidence.

This article is for patient education and does not replace an individual medical evaluation, diagnosis, or treatment plan. New severe dizziness, neurologic symptoms, or sudden hearing loss requires prompt assessment.

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