OTOLOGY Postural responses without versus with acute external cervical spine fixation: a comparative study in healthy subjects and patients with acute unilateral vestibular loss Silvia Bohne • Sabrina Heine • G. Fabian Volk • Joachim Stadler • Orlando Guntinas-Lichius Received: 29 June 2011 / Accepted: 27 December 2011 / Published online: 12 January 2012 Ó Springer-Verlag 2012 Abstract Using a diagnostic prospective cohort single center study design, the influence of a cervical collar on standing balance during dynamic postural perturbations in healthy adults and patients with acute unilateral vestibular dysfunction was measured in 31 healthy subjects and 27 patients with acute unilateral vestibular loss. The main outcome measures were completed standard protocols on the Sensory Organization Test (SOT) and Motor Control Test (MCT) of the NeuroCom Equitest Ò computerized posturography platform measured without and with acute cervical fixation, respectively. Paired t test showed no significant difference during the six conditions of neither the SOT scores nor analyzing the SOT strategies or during the MCT between the non-fixed and fixed neck in healthy subjects and in the patients (all p [ 0.05). Older healthy subjects showed decreased SOT scores but equal MCT results. The age effect was more dominant in the patients when wearing the collar. Gender had no influence whether in healthy individuals nor in patients. In almost all condi- tions of the SOT but only in some MCT subtests patients had significantly lower scores than healthy subjects without collar and with collar (all p \ 0.05). In conclusion, the SOT but only some subtest of the MCT could clearly distinguish between healthy adults and patient with acute unilateral vestibular loss. Equilibrium scores did not change significantly when the cervical spine was fixed with a collar. Acute fixation of the neck with a collar seems not to affect standing balance, even not when vestibular, visual and/or somatosensory input are also reduced. Keywords Balance Á Postural control Á Posturography Á Proprioception Á Neck Á Vestibular loss Introduction To prevent us from falling, the human balance system needs mechanisms to keep the center of gravity (COG) over the base of support [1]. Stable upright posture and the relative head and eye position rely on afferent information from the vestibular, visual and proprioceptive systems. The cervical spine and the neck provide an important part the proprioceptive input. There is an immense densification of cervical mechanoreceptors and muscle spindles in the cervical region [2, 3]. The cervical muscles permanently give information to and receive information from the central nervous system. Furthermore, there are specific bilateral connections of the central nervous system between the cervical receptors, the visual and vestibular system taking part at the cervico-collic reflex, the cervico-ocular reflex, and the tonic neck reflex. These reflexes are an important component of the multisensory system coordi- nating stability of the head, eyes and balance [4]. Experimental manipulation of the cervical propriocep- tion system, for instance by vibration, can lead to increased body sway and pathological changes in trunk position during stance and gait activities [5, 6]. Injuries to soft tissue structures of the cervical spine can lead to proprioceptive deficits and impairment of the head and neck position sense [7]. Typical injuries results from whiplash-type traumata or recurrent minor traumata in high-impact sports [7]. Some patients with such traumata complain of chronic dizziness S. Bohne Á S. Heine Á G. F. Volk Á J. Stadler Á O. Guntinas-Lichius (&) Department of Otorhinolaryngology, University Hospital Jena, Lessingstrasse 2, 07740 Jena, Germany e-mail: orlando.guntinas@med.uni-jena.de 123 Eur Arch Otorhinolaryngol (2013) 270:61–67 DOI 10.1007/s00405-011-1911-5