Interview with a specialist in the field of diseases of the ear, nose and throat, professor New York Eye and Ear Inifirmary
Almost every one of us, regardless of age, has to deal with such unpleasant sensations as dizziness and imbalance in space. In some cases, their causes are not threatening and the symptoms disappear without a trace. In other cases, such violations significantly worsen the condition of patients and are a reflection of heavy organic lesions. The latter often occur in older people. Dr. Igor Branovan today tells our readers about the possibilities of timely recognition of these conditions, their prevention and treatment.
Igor Branovan: People, young and old, with so-called vestibular disorders very often appeal to me. Most often, they complain of various powers of dizziness, as well as a loss of balance. The latter state is also called imbalance. These complaints usually appear as a result of dysfunction of the vestibular apparatus. The vestibular apparatus is located in the inner ear, which in addition to this is the organ of hearing. In our previous conversation, I have already said that the organ of hearing consists of three parts – the outer, middle and inner ear. Each of them performs its functions. In the inner ear, in addition to the organ of hearing, there is also the most important organ of the person – the organ of balance. Such an arrangement “in the neighborhood” of the organs responsible for hearing and balance leads to the fact that, in a number of conditions affecting the inner ear, there are simultaneously symptoms of a change in hearing and an imbalance in space. We, otolaryngologists, this combination of symptoms facilitates the formulation of the correct diagnosis, and therefore the choice of the correct treatment.
The vestibular apparatus is not the only human organ responsible for the state of equilibrium. He, as it were, coordinates the vestibular functions of several other organs, which also maintain the state of equilibrium of a person. When all these systems work smoothly, synchronously, the person has no violations, and therefore no complaints. In addition to the vestibular apparatus, the organ of vision, the eyes, as well as signaling from the nerve endings located on the periphery, in particular, the legs, are involved in maintaining the correct balance. And finally, a significant role in this complex system belongs to certain centers of the brain, where all the information goes. It is here that the response of the human body is realized and the feeling that determines the balance of a person in space is recreated. Violations in any of these links and give symptoms in the form of dizziness, loss of orientation in space, etc.
The most typical example of vestibular disorders caused by a lesion in the inner ear is sudden dizziness, loss of balance, accompanied by nausea, vomiting, and some other symptoms. Most often, this symptom occurs in many people, completely regardless of age, while sailing at sea. Hence the most popular name for this condition is “seasickness”. In fact, this state may also appear while flying on an airplane, driving in a car, on a swing, etc. These are all symptoms caused by rocking movements, rolling. Why is this happening? The causes of these symptoms can be divided into functional and organic. In the first case, the changes are often reversible. In the fight against them, a very important role belongs to the specially designed exercises that stimulate the vestibular apparatus. Exercises help a person to adapt to changes in body position in space. They take only a few minutes, but they need to be done often – 5 to 10 times a day. In people of young or middle age, the frequent cause of vestibular disorders is the occurrence of an acute infection process in the labyrinth, education, which is part of the vestibular apparatus (labyrinthitis). Most often labyrinthites are of viral origin. The inflammatory process usually develops on one side. In this connection, synchronous signaling from the periphery (ears) to the center (brain) is disturbed, which leads to dysregulation of the body’s equilibrium system. Fortunately, in most cases this condition disappears within 1 to 2 weeks and leaves no consequences. In more rare cases, with a heavy labyrinth of bacterial origin, inflammation in the maze can lead to serious consequences with damage to the vestibular apparatus. This leads to the development of vestibular disorders for a much longer period. Vestibular disorders sometimes occur as complications of the infectious process in areas adjacent to the inner ear – in acute inflammation of the middle ear (otitis), in inflammation of the temporal bone (mastoiditis) located near the auricle of the pterygoid process. In addition to these organic lesions, disorders of the vestibular function can be caused by benign paroxysmal positional vertigo disease (in Russian, translated: benign paroxysmal positional vertigo). In this disease there is a sharp dizziness when turning the head. Despite the severity of the resulting condition, we can effectively treat it with a special exercise system.
In older people, the most frequent cause of dizziness is a violation of the blood supply to the brain responsible for vestibular function. Such disorders occur both in acute cases (stroke) and in the chronic course of the disease (atherosclerosis of the arteries that feed the brain, for example, the carotid artery). This type of dizziness is usually not associated with the inner ear and the vestibular apparatus located in it.
Often vestibular disorders occur in patients with diabetes. They have these disorders usually occur in connection with the defeat of the peripheral nerve endings, often on the legs. As a result, the synchronous flow of signals to the brain, which would have to come from the eyes, the inner ear, and from the extremities, is disturbed. Such an imbalance of the alarm and causes dizziness.
The cause of dizziness that is not associated with the vestibular apparatus is low blood pressure (hypotension). This condition is often observed in people of young age, more often in women, especially in hot weather. This usually manifests itself with a sharp change in body position, when moving from a horizontal to a vertical position (orthostatic hypotension). The resulting short-term lack of blood supply to the brain causes a sudden dizziness, sometimes even fainting.
An example of the involvement of the organ of vision in maintaining balance is people who have sharply deteriorated or lost vision with one eye (with cataracts). In these cases, the person not only loses his sight, but for some time also experiences an imbalance, since the signaling to the brain has been violated. However, this condition eventually passes due to the development of adaptation to this violation. A similar situation may arise immediately after the selection of new points.
Sometimes patients come to us who have increasing complaints at the same time about hearing loss and vestibular disorders. With the help of special examinations in such cases, we often find that these patients have a tumor, which is called schwanoma or acoustics – neuroma. This is a tumor of the vestibular nerve itself. The tumor is usually benign in nature, but over time it squeezes this nerve, which goes from the vestibular apparatus to the brain and the auditory nerve, which connects the cochlea (auditory organ) with the brain. This leads to the simultaneously indicated complaints. Helps us to make the correct diagnosis special examination using nuclear magnetic resonance (MRI). This is a relatively new method, which differs from the standard MRI method widely used in the USA by a much higher degree of accuracy: with its help we are able to detect tumors with a diameter of several millimeters.
For the timely detection of the correct diagnosis, we always try to work closely with doctors of other specialties and above all with neuropathologists and therapists. The fact is that very often people complain to doctors about dizziness. For therapeutic and neurological patients, a longer, chronic course of the disease is more characteristic. Problems directly related to the lesion of the vestibular apparatus usually arise acutely, associated with an acute infection or injury. These conditions are better treatable and pass relatively quickly. Sometimes there are relapses that usually do not suffer from severe pain. Unlike vascular diseases, it is more characteristic for vestibular lesions that dizziness disappears when the condition improves, but imbalances do not completely disappear.
An isolated lesion of the vestibular apparatus is characterized by a condition well known as Meniere’s syndrome. It is common in young people between the ages of 20 and 30. The main complaints are severe dizziness, occurring several times a week, sometimes several times a day. According to the patients ’story“ everything is spinning around, ”there is noise and pressure in the ears, hearing loss. This is accompanied by nausea, vomiting. The condition is usually short and after a few minutes it may disappear without a trace.
– What caused the development of Meniere’s syndrome?
The development of this disease is due to impaired circulation of fluid present in the inner ear. This fluid is constantly produced in the cavity of the inner ear and normally leaves it. When the fluid begins to accumulate in the cavity of the inner ear, stretching its walls leads to irritation of the nerve endings and the appearance of symptoms of the disease. The treatment of this disease is not an easy task and requires a lot of patience on the part of both the patient and the doctor. For treatment, diuretics are used, which reduce the amount of fluid in the body, and the use of table salt is limited. If these measures do not help, it is necessary to conduct a more radical treatment by injecting antibiotic gentamicin directly into the inner ear cavity, which inhibits the excessively high activity of the vestibular apparatus. If this does not help, then you have to use surgery – with the help of craniotomy, a drainage is introduced directly into the cavity of the inner ear to suck off excess fluid.
If a patient has vestibular disorders and they are not associated with cardiovascular diseases, I begin a thorough examination of the patient with the help of special tests. I have already noted above that the organ of hearing and the vestibular apparatus are interconnected and, accordingly, often influence each other. It is therefore very important to check hearing in patients with vestibular disorders. A hearing test is a simple and quick test, and I usually start the examination of such patients with this very thing. The detection of hearing impairments allows you to proceed to a much more complex specialized test immediately to test the function of the vestibular apparatus. Its name is Electronistagmography (ENG). With the help of this test is determined by the relationship of hearing and vision. If a person has impaired function of the vestibular apparatus, then their synchronous connection is broken. When this occurs
For accurate testing of the state of the vestibular apparatus, we widely apply the test using water of different temperatures. This is a very important test.
– What other treatment methods do you use in treating vestibular apparatus lesions?
An important role in the treatment of lesions of the vestibular apparatus is played by a number of drugs used by us. These include agents that directly affect the function of the vestibular apparatus, and antibacterial and anti-inflammatory drugs. It all depends on what caused these violations. Timely diagnosis and treatment of these conditions is our most important task. I want to draw attention to the great importance of special exercises in the prevention and treatment of lesions of the vestibular apparatus. A timely appeal to a specialist otolaryngologist in most cases helps to effectively cope with these conditions.