What is Vertigo?

Vertigo accompanied with a headache is the most common neurological symptom. Vertigo is even more challenging as a greater proportion of more advanced age people, presented vertigo as the dominant symptom in many other pathological episodes, such as cardiovascular diseases.

Vertigo is defined as the illusion of movement of the patient manifested as rotation of the body, pushing or swinging sideways, forward or backward and prone to falling. These symptoms are false and most times is very annoying though are not dangerous.

Not to be confused with vertigo, feeling of dizziness that occurs in the form of the faint, fall from deafness, visual disturbances, orthostatic hypotension, panic attacks or even loss of consciousness.

Vertigo is largely labyrinthine aetiology. In the human body there are two bodies equilibrium, mazes, which are placed in each ear and send information to the brain balance centres. Such information is essential for maintaining the balance of the body and every time one of the two mazes irritated or has impaired function, imbalance of stimuli occurs and is delivered to the cortex of the brain, which interprets the movement and the effect is dizziness, rotation, unsteady gait, loss of support, accompanied by nausea and vomiting, probably.

Typically in 80% of dizziness are due to inner ear lesions or lesions of vestibular tract, while in a lower rate due to lesions of the central nervous system (multiple sclerosis, vascular infarcts or haemorrhages brain tumours, brain abscesses, cerebellum, etc.), psychogenic causes, side effects from medications, postural hypotension, hypoglycaemia, etc.

Causes of vertigo

The causes of peripheral vertigo reasons include:

  1. Vestibular neuritis. Characterized by intense vertigo and vomiting, invaded abruptly and lasts from a few days to three weeks. Any movement of the head at the beginning aggravates the symptoms and why the patient avoids any traffic. The patient often suffering or recovering from a viral infection and therefore likely to cause viral infection that affects the vestibular nerve.
  2. Disease Meniere.  Caused by an increase in the amount of Endolymphatic hydrops due to the increase pressure of endolymphatic fluid present in the inner ear characterized by deafness, tinnitus and vertigo. As the disease worsens, hearing loss will worsen during episodes and improve after treatment.
  3. Benign paroxysmal positional vertigo. Characterized by brief episodes of intense vertigo when the patient moves to a particular position. The characteristic position is supine with the head turned to the side, so that the patient labyrinth is down. This can be effectively treated with repositioning movements such as the Epley manoeuvre conducted by an experienced audiologist seeing an improvement of symptoms in 90%.
  4. Acoustic neuroma. It is a benign slow growing tumour that is characterized by unilateral hearing loss, tinnitus and vertigo. The hearing loss is progressive and involves mainly the top high frequencies.
  5. Bilateral dysfunction mazes. It is a rare disorder which may be inherited or acquired.
  6. Concussion of the labyrinth. Induced after a head injury and the patient may present with simultaneously fluctuating hearing loss and tinnitus.
  7. Labyrinthitis. This is inflammation of the labyrinth (inner ear) and occurs as a complication of infection causing unpleasant sensations of dizziness and nausea.

Diagnosing Vertigo

To diagnose vertigo requires detailed history and neootologiko-audiology audit which will include tests causing vertigo and will usually provide data for the damaged system including: visual, vestibular, cerebella, somatosensory. Clinical examination includes examination of vestibulo-spinal and vestibulo-ocular reflex and vertigo test position.

An examination of hearing with tonal audiometry and evoked acoustic potentials of the brainstem gives us information on possible damage to the labyrinth or auditory pathway. Controlling the posterior labyrinth thermal irrigation, Electronystagmography oscillating bearing and guiding us in finding the patient labyrinth. It should be noted that the specialized tests that are done for vertigo are necessary, because these will be excluded diseases with a similar clinical picture.

The dynamic isorropometria in specific cases helps distinguish lesions of various systems of balance. These tests will help the patient to find the cause and to provide timely, appropriate treatment will improve symptoms of vertigo greatly.

Treating Vertigo

The treatment of vertigo is done with the help of medication, exercise or in rare cases, surgically.

The drugs are administered when the vertigo is acute and are usually antiemetic and vestibular sedatives. Although these drugs improve the acute symptoms, the chronic phase is worse, because it prevents the central nervous system from developing mechanisms to balance the damage so according to the directive of the treating physician they should be discontinued.

Symptoms of vertigo despite being intensely, more often than not dangerous and can be reduced by using special exercises. The exercises are intended to cause the symptoms and help the brain to compensate for the disparate responses from the two labyrinths,” educating” them to ignore stimuli that cause vertigo.

The exercises include daily repetition of movements of the head and body causing vertigo consistently slowly symptom to wane. To start effectively counteract these exercises should be performed at regular intervals for a period of at least 3 months.

Note that what is referred to as ‘stomach vertigo’, is substantially not. Stomach vertigo is actually a misunderstanding of the phenomenon of nausea and vomiting, which are of course related to the digestive system, but are nothing more than neuro-vegetative manifestations of vestibular syndrome.

The word tinnitus (tinnitus), which is sometimes called ‘head noise’, we mean the sounds coming from inside the head. For many people, the hum is a ringing in one or both ears. For you, it may be a buzzing, a hissing, clicking or humming like a sea. Tinnitus can be persistent or transient.

Are ringing in the ears a frequent problem?

Yes. Almost everyone at some point has felt for a few minutes a slight ringing or other noises in the ear. Some people have more annoying and constant types of tinnitus.

Approximately 30 million Americans consider tinnitus as a problem. A million or more people believe that tinnitus prevents them from having a normal life.

Tinnitus is a disease?

No. Just as a fever or headache may accompany many different diseases and so tinnitus can be a common symptom of many problems, either physical or psychological.

What causes tinnitus?

Very often the cause of tinnitus remains a mystery. Only when a specific factor associated with the appearance or disappearance of tinnitus we can refer with confidence to the cause. Blows to the head, large doses of certain drugs such as aspirin, anaemia, hypertension, exposure to loud noise, stress, ear plug cell and several types of tumours, are examples of the different situations that can cause tinnitus.

What happens in my head that causes tinnitus?

Although there are many theories about how sounds are produced in the brain, it is not known the exact procedure. Only one thing is certain, tinnitus is not a matter of fiction for the patient.

Does the fact that I have tinnitus in the ear mean that I will have hearing loss?

Not necessarily. Although tinnitus is a symptom, which has many of those with hearing impairment, does not mean that everyone with tinnitus ears will have hearing loss. Some people have and some do not.

Why is tinnitus worse at night?

During the day, there are distractions in your various occupations, while the sounds around you can make the tinnitus less noticeable. When the environment around you is quiet, the ringing in the ears may look stronger and longer. Your weariness can also worsen tinnitus.

What should I do for ringing in the ears?

Since tinnitus is a symptom, the first step you should do is to diagnose the root cause. You should have a medical examination with particular attention to the control of those factors usually associated with ringing in the ears-such as high blood pressure, liver function, taking certain medications or various allergies. The ears should be checked by an Otolaryngologist who will diagnose if there is hearing loss.

What is the treatment for tinnitus?

The most effective treatment for tinnitus is to treat the main cause. Unfortunately, quite often the cause can not be determined, but in some cases the tinnitus alone may require treatment. The treatment can be done with medicines, vitamins or biofeedback, hypnosis and amplification devices, which are forms of treatment that have been found very helpful for some people. The ‘self-help groups’ can share various information and strategies that will help them live with their problem.

People with a mild form of tinnitus, generally do not require treatment. If it is determined that they are not suffering from an illness or from a severe brain injury or disorder, or even that it is not hard of hearing, usually find that you can cope with ringing in the ears or even ignore them.

What are the amplification devices?

Amplification devices like hearing aids and produce sounds which ‘hide’ or obscures tinnitus. Some people prefer this kind of outside sounds and buzzing in their head. The characteristics of tinnitus, such as tone and intensity, determine the kind of noise that will be implemented. When a person has hearing loss along with tinnitus ears, amplification devices and hearing aids can work together as a ‘tool’.

As with other forms of treatment amplification devices are useful for some but not for all people.

As well as hearing aids and a detailed and careful examination by an Otolaryngologist will decide whether amplification devices really help the patient.

Hearing aid may help tinnitus?

If you have hearing loss, it is highly likely that hearing aids will help to relieve tinnitus and to enhance your hearing.

Contact an Otolaryngologist to decide whether to use the help of hearing aids. The ENT and the audiologist will help you in selecting, purchasing and installing the most appropriate for your headphones. It will also help you on how to use them most effectively.

CHOLOSTEATOMA: A SERIOUS CONDITION OF THE EAR

  • What is a cholosteatoma?
  • What causes cholesteatoma?
  • What are the symptoms?
  • Is it dangerous?
  • What is the treatment?
  • If I do nothing, what will happen?
  • Will I always have this problem?
  • Can it be removed or treated?
What is a cholosteatoma?
 
The cholosteatoma is a skin growth found in an abnormal area of the middle ear, behind the ear drum. It is usually due to repeated infections which can cause perforation of the drum. Often cholosteatoma take the form of a cyst or blister wherein skin cells stack on top of one another in the ear. Over time, the cholosteatoma can increase in size and destroy sensitive bones of the middle ear. Hearing loss, dizziness and paralysis of facial muscles is rare but can be a result of continuous development of cholosteatoma.
 
What causes cholosteatomas?
 
The cholosteatoma usually caused due to malfunction of the Eustachian tube and from infection of the middle ear. The Eustachian tube carries air from the back of the nose to the middle ear to equalize the air pressure. When the Eustachian tube does not work normally, usually due to allergy, common cold or sinusitis, the air in the middle ear is absorbed thereby creating a partial vacuum. The vacuum pressure causes a retraction cyst that stretches the drum especially in areas that are weak due to previous inflammation. The cyst is often cholosteatoma. A rare form of congenital cholosteatoma (present from birth) can occur in the ear and elsewhere as well as the adjacent bones of the skull base. Whereas the type of cholosteatoma that can follow ear infections are more common.
 
What are the symptoms?
 
Initially the ear secretes discharge and sometimes displays a bad odour. As the cholosteatoma cyst increasing in size it can cause a feeling of fullness and pressure in combination with hearing loss. You may feel pain behind or inside the ear, especially at night that can disturb the sufferer. Dizziness, muscle weakness on one side of the face particularly by the affected ear may occur. All the above are reason enough for the patient to seek medical advice.
 
Is it dangerous?
 
The ear cholosteatoma can be dangerous and cannot be ignored. Bone erosion can cause dispersion of the contamination to the surrounding areas of the inner ear or the brain. So if left untreated can lead to hearing loss, brain abscess, meningitis and rarely death.
 
What is the treatment?
 
An examination by an ENT doctor can confirm the diagnosis. The initial treatment recommended is a thorough cleaning of the ear, antibiotics and ear drops. The treatment requires stopping the continuous secretion to control the inflammation. The extent and characteristics must also be evaluated. Chronic cholosteatomas usually require surgical treatment to protect the patient from dangerous complications.
 
Headphones and balance test, radiographic, mastoid and skull base examination and often CT scans are necessary to estimate the residual hearing level and extent of corrosion. The surgical treatment in most cases is done under general anesthesia. The main goal of surgery is to remove the infection and cholosteatoma to obtain a dry ear that is not inflamed. Protecting hearing and retrieval of auditory capacity is the second objective. In cases of severe damage to the ear hearing reparation may not be possible.
 
Surgical repair of the facial nerve or procedures to control dizziness are rarely required. The rebuilding is not always possible during the first surgery and therefore a second operation may be necessary after 6-12 months. During the second operation we try to repair their hearing while exploring the middle ear cavity and mastoid for any recurrence of cholosteatoma.
 
Admittance to the hospital is in the morning of the same day of the surgery and surgery is done early in the morning so that patients may be released on the same day. For some patients it is necessary to stay overnight. In rare cases of severe inflammation it may require some days with vigorous antibiotic treatment in the hospital before and after surgery.
 
The total period of abstention from work is usually one to two weeks. Follow up examination after surgery is necessary and important because the cholosteatoma may recur. When there is an open cavity due mastoeidectomy it is recommended to have visits every few months in the practice to clean the cavity and reduce the risk of new infection. In some patients there should be periodic examination of the ear throughout the duration of their life.
 
SUMMARY:
 
Cholosteatoma is a serious and dangerous but treatable ear condition which can only be diagnosed by medical examination. Persistent earache, discharge from the ear, ear pressure, hearing loss, dizziness, facial muscle weakness are all signs that need examination by a specialist ear, nose and throat doctor.

Otitis in children and antibiotics

Ear infections are one of the main reasons why children are administered antibiotics. According to some, ear infections are the most frequent cause of administration of antibiotics in children.

Many experts question the need for antibiotics to treat ear infections in a large number of children, they believe that most cases of otitis do not need antibiotics, and treatment can be done in other better ways.

Recently a research review of clinical studies to date, done by physicians experienced in infectious diseases, showed that antibiotics help only 1 in every 8 children affected by otitis.

In these studies in children with otitis were given either antibiotics or placebo. The results showed that in 81% of children receiving placebo, the otitis was treated. In children receiving antibiotics, showed that 94% of children were cured.

This suggests that the children who needed antibiotics when presented with otitis are very few and limited to  1 for every 8 children with otitis.

Allowing administration of antibiotics is dangerous. Germs that grow inside the ear can quickly develop resistance to antibiotics. So, if there is a true bacterial infection if administered antibiotics, bacteria are pushed to become resistant.

Should a real infection occur at a later time, then antibiotics are powerless to combat it.

Experts recommend as the administration of antibiotics should be done under very strict criteria. If infection occurs with no presence of pus in the ear drum, then the pain and fever presenting in children can be treated with antipyretics, analgesics and anti-inflammatory medications.

The existence of inflammation and pus supports the existence of bacterial infection and antibiotic treatment is recommended. But it should be noted as identified from antibiotics surveys to benefit only 1 in 8 children.

When doctors make a diagnosis of otitis without evidence of contamination by bacteria, they should wait even 48 to 72 hours before giving antibiotics. The re-assessment will indicate whether the problem will go away or if signs documenting an infection from bacteria. In such a case you will need antibiotics.

Most ear infections go away without intervention. The most common reasons that cause various infections are viral and antibiotics in these cases do not help.

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