01 · Mechanism

The Structural–Neurological Pathway

The atlas (C1) houses the vertebral arteries as they pass through the transverse foramina and make their final turn toward the foramen magnum before joining the basilar artery. It also forms the direct bony housing for the caudal brainstem and the roots of cranial nerves VII–XII as they exit the jugular foramen and hypoglossal canal. A structural misalignment of C1 — even a few degrees of rotation or lateral flexion — can:

Alter vertebral artery geometry, reducing flow to the basilar artery and its branches, including the anterior inferior cerebellar artery (AICA) and labyrinthine artery — the sole blood supply to the cochlea and vestibular labyrinth. This is a recognized mechanism discussed in cases of sudden sensorineural hearing loss (SSNHL) and vertigo with a vascular component.
Create sustained proprioceptive mismatch from upper cervical mechanoreceptors (C1–C3), which project directly into the vestibular nuclei — driving cervicogenic dizziness and disequilibrium that mimics, or compounds, peripheral vestibular pathology.
Increase dural tension at the craniocervical junction, affecting CSF dynamics and irritating brainstem structures involved in autonomic regulation of the eustachian tube, sinus mucosa, and salivary/lacrimal glands (parasympathetic outflow via CN VII and IX) — contributing to chronic ETD and recurrent sinonasal congestion.
Compress or tension the upper cervical sympathetic chain, which regulates vascular tone in the head and neck — relevant to tinnitus, migraine-associated vestibulopathy, and vasomotor rhinitis.

The Lazar Method (QSM3) uses digital motion X-ray, infrared thermography, and nerve scanning to identify a specific, measurable atlas misalignment and correct it with a low-force, non-rotational adjustment — distinct from high-velocity, full-spine "clicking" instrument techniques, which deliver a generalized thrust without pre-adjustment imaging or post-correction verification.

02 · Clusters

Where the Signature Shows Up

Three symptom-and-finding clusters, each tied to a specific brainstem structure downstream of the craniocervical junction.

Cluster A

Auditory & Cochlear

Cochlear nuclei & superior olivary complex at the pontomedullary junction; the VIII nerve root-entry zone.

Asymmetric or sudden sensorineural loss with no clear otologic cause
Somatosensory or pulsatile-quality tinnitus
Aural fullness with normal middle-ear pressure
Sound-pressure sensitivity / hyperacusis

Cluster B

Vestibular & Balance

Vestibular nuclei & vestibulocerebellar pathways; the medial longitudinal fasciculus.

Central or cervicogenic pattern with normal peripheral vestibular function
Persistent positional dizziness, negative for BPPV
Moderate-to-high Dizziness Handicap with an unremarkable workup
Motion- and visual-motion intolerance

Cluster C

Sinus Pressure & Autonomic

Trigeminal spinal nucleus & superior salivatory nucleus; parasympathetic (vidian) outflow and tensor veli palatini control.

Facial or sinus pressure with normal imaging
Chronic congestion / non-allergic rhinitis unresponsive to therapy
Eustachian dysfunction with normal tympanometry
Cervicogenic headache alongside the above

Clinical note — QSM3 assessment is non-invasive and does not interfere with concurrent audiologic, vestibular, or medical management.

03 · Audiolibrium™

The Complementary Laser Protocol

Alongside QSM3 upper cervical correction, Lazar Spinal Care also offers Audiolibrium™ — a Class IV high-intensity laser protocol targeting the inner ear. It's a Lazar Method™ protocol in its own right, and for referrals in Cluster A (Auditory & Cochlear) and Cluster B (Vestibular & Balance), it's often considered alongside — or instead of — structural correction, depending on what the workup shows.

Structural

QSM3 Upper Cervical

A low-force, non-rotational correction of the atlas (C1), guided by digital motion X-ray, infrared thermography, and nerve scanning. Addresses the mechanical / neurological pathway described above.

Laser · Inner Ear

Audiolibrium™

A Class IV high-intensity laser — not a low-level or "cold" laser — delivering therapeutic energy deeper into inner ear tissue. Offered as a complementary option alongside existing medical care, not a replacement for it.

See the full Audiolibrium™ protocol →

In practice: patients are evaluated for both mechanisms at the same visit. Some are a fit for QSM3 alone, some for Audiolibrium™ alone, and many benefit from both — the structural exam determines which.

04 · Tests

Test-by-Test Referral Triggers

Standardized assessments this specialty already runs, and the pattern that flags a brainstem-level signature.

Test	What It Measures	Pattern / Threshold	Why It Implicates the Brainstem
Audiogram Cluster A	Hearing thresholds across frequencies and speech discrimination.	Asymmetric or sudden sensorineural loss with no clear otologic cause.	Auditory pathways and their vascular supply are sensitive to upper-cervical / brainstem loading.
Tympanometry Cluster C	Middle-ear pressure and eustachian-tube function.	Normal middle-ear pressure but persistent aural fullness.	Aural fullness without middle-ear pathology can reflect autonomic / cervical contribution.
VNG / ENG Cluster B	Vestibular-ocular reflexes; central vs. peripheral vestibular function.	Central or cervicogenic pattern with normal peripheral vestibular function.	Central vestibular findings point to brainstem / upper-cervical integration, not the inner ear.
Dizziness Handicap Inventory Cluster B	Self-reported functional impact of dizziness.	Moderate-to-high score with an unremarkable peripheral workup.	Persistent handicap despite normal peripheral testing suggests a cervicogenic / central source.
Dix-Hallpike Cluster B	Positional provocation for BPPV.	Persistent positional dizziness but negative for BPPV.	Positional symptoms without canalithiasis implicate cervical proprioceptive / brainstem input.
Sinus CT Cluster C	Structural sinus disease.	Normal imaging with ongoing facial pressure or "sinus" pain.	Facial pain without sinus pathology can be referred from upper-cervical segments (trigeminocervical convergence).
Tinnitus Assessment Cluster A	Character, laterality, and modulation of tinnitus.	Somatosensory or pulsatile-quality tinnitus without an otologic cause.	Somatic modulation of tinnitus reflects dorsal cochlear nucleus / upper-cervical convergence.

05 · Referral Criteria

Talking Points

Upper cervical work isn't the same as general chiropractic adjusting — the Lazar Method™ is imaging-guided and specific to the atlas, using precise measurements before any correction is made, not a generalized full-spine instrument technique.
If a patient reports new hearing changes, tinnitus, or dizziness after any neck manipulation, it's worth having their upper cervical alignment and vertebral artery mechanics evaluated regardless of what technique was used — that assessment can be done quickly with scanning, no guessing.
For patients where the audiogram and imaging are clean but symptoms persist — dizziness, ETD, tinnitus — cervicogenic contribution is underrecognized and worth ruling out before calling it idiopathic.
We're not treating the ear or sinus — we're evaluating whether a structural issue at C1 is disrupting the neurology and blood flow that feeds those systems. If it's not a factor, the scan will show that too.

Refer when: findings cross two or more clusters above, or any single test shows a brainstem-pattern flag in a patient with a history of cervical trauma, persistent post-concussive symptoms, or a presentation that doesn't localize cleanly to a cortical lesion.

Discuss With Your Patient

How to introduce The Lazar Method™ in the room, and what to send afterward in writing. Both are framed as complementary, not a replacement.

In the Room

"Your testing showed a pattern that often comes from how the head sits on the upper neck — the atlas, specifically. There's a comprehensive workup called The Lazar Method™ — postural assessment, nerve scans, and motion x-ray studies — that determines whether this has a mechanical component, or whether a laser therapy called Audiolibrium™ is a better fit. If it does, the correction itself (called Quantum Spinal Mechanics) is non-invasive — no popping, cracking, or twisting of the spine. It doesn't replace anything we're doing here — it just looks at the same problem from a structural angle. I'd like you to see Dr. Lazar at Lazar Spinal Care."

In Writing

Hi [First Name] — following up on your testing today.

I'm referring you to Dr. Lazar at Lazar Spinal Care for The Lazar Method™ — a postural assessment, nerve scans, and motion x-ray studies — to see whether this has a mechanical component to it, or whether Audiolibrium™ (their inner-ear laser therapy) is the better fit.

If it does, their correction protocol (Quantum Spinal Mechanics) is non-invasive — no popping, cracking, or twisting of the spine. It's complementary to what we're doing here, not a replacement.

Ask our front desk for the referral link, or call Lazar Spinal Care directly.

— Dr. [Provider Name]

06 · When to Refer & How

Quick Reference

Test	Refer if you see…
Audiogram	Asymmetric or sudden sensorineural loss with no clear otologic cause.
Tympanometry	Normal middle-ear pressure but persistent aural fullness.
VNG / ENG	Central or cervicogenic pattern with normal peripheral vestibular function.
Dizziness Handicap Inventory	Moderate-to-high score with an unremarkable peripheral workup.
Dix-Hallpike	Persistent positional dizziness but negative for BPPV.
Sinus CT	Normal imaging with ongoing facial pressure or "sinus" pain.
Tinnitus Assessment	Somatosensory or pulsatile-quality tinnitus without an otologic cause.

Direct Referral Contact

Lazar Spinal Care · Attn: Care Coordinators

203 S. Zeeb Rd., Suite 106 · Ann Arbor, MI 48103

(734) 274-5107 · lazarspinalcare.com

Method: QSM3 — Quantum Spinal Mechanics, an orthogonal-based upper cervical specialty within the NUCCA / Grostic family. Non-invasive structural correction; no rotation, no twisting.

What we send back: Structural assessment summary, alignment imaging review, and a clear yes / no on whether the patient is a QSM3 or Audiolibrium™ candidate. Co-management welcomed.

Refer a Patient →

07 · Resources for Your Office

Put This to Work

A desktop wallpaper for your team, and printable materials for the front desk and exam room — no design work required.

Desktop Wallpaper

💻 Put this on your desktop A real wallpaper you'd actually want, with a small referral card in the corner +

Ocean

Beach

Flowers

Mountains

Forest

Cat

Dog

1920×1080 Standard 2560×1600 Mac 3440×1440 Ultrawide

Printable Materials

Patient Referral Sheet

A one-page, patient-facing handout explaining why they're being referred and how to schedule — hand it over at checkout.

Suite Card

A compact quick-reference card for the front desk and exam rooms — test-by-test referral triggers and the direct referral link.

You've Been Referred

Your Next Step: Lazar Spinal Care

Your provider identified findings that may be connected to how your upper cervical spine (the very top of your neck) is aligned — or, for certain ear and hearing symptoms, may benefit from Audiolibrium™, a laser-based inner-ear therapy.

What happens at your visit: a conversation with Dr. Lazar, a full structural and neurological workup (Posture IQ, nerve scan, imaging as indicated), and a clear yes/no on whether QSM3 upper cervical care, Audiolibrium™, or both are a fit for you. No commitment required.

Schedule Your Visit

(734) 274-5107

drlazar.com/npappt

203 S. Zeeb Rd., Suite 106
Ann Arbor, MI 48103

Scan to schedule

Lazar Spinal Care · The Lazar Method™ · This is a complementary evaluation and does not replace your ENT or medical care.

Ann Arbor · Michigan

When test findings carry a structural signature.

QSM3 Upper Cervical & Audiolibrium™ · The Lazar Method™

Test	Refer if you see…
Audiogram	Asymmetric or sudden sensorineural loss with no clear otologic cause.
Tympanometry	Normal middle-ear pressure but persistent aural fullness.
VNG / ENG	Central or cervicogenic pattern with normal peripheral vestibular function.
Dizziness Handicap Inventory	Moderate-to-high score with an unremarkable peripheral workup.
Dix-Hallpike	Persistent positional dizziness but negative for BPPV.
Sinus CT	Normal imaging with ongoing facial pressure or "sinus" pain.
Tinnitus Assessment	Somatosensory or pulsatile-quality tinnitus without an otologic cause.

Refer in under a minute.

1. Go to refer.lazarspinalcare.com/provider or scan the code →
2. Complete the form.
3. Our care coordinators take it from here.

Refer Onlinerefer.lazarspinalcare.com/provider
or call (734) 274-5107

Visit203 S. Zeeb Rd., Ste 106
Ann Arbor, MI 48103

Print for each exam room, scheduling station, and check-out station.