Vestibular vertigo or dizziness in the context of ear disease The vestibular organs are located in the inner ear. Accordingly, diseases of the inner ear can cause dizziness. Eg The vestibular system is embedded in the inner ear or labyrinth has its seat in the atrium of the labyrinth and in the semicircular canals. In each ear are five measuring points for the equilibrium sensation: the two maculae, sitting in the atrium and for the measurement of linear accelerations (gravity, acceleration, for example in the car. ) Are responsible as well as three cupulae who sit in the archway ampoules and for measuring rotary motion worry. Finds in this area by one of the abovementioned diseases a disturbance takes place, can be made in one of these measuring points not correct equilibrium measurement more. This means that the cerebellum, in which these measurements are processed, an incomplete receives information on the state of equilibrium of the body. The cerebellum is responding with a disorder that is usually perceived as a rotatory or postural vertigo and may result in nausea and vomiting. To counter the apparent rotation, are triggered reverse eye movements from the cerebellum, which are recognized as so-called nystagmus. Using these eye movement succeeds, some testify about the strength and the source of the imbalance. The eye movements are a Frenzel glasses, which enlarges the eyes strongly observed.
In addition, a measurement by means of a so-called Elektronystagmogramms or video goggles is possible. The brain structures have mechanisms that suppress the vertigo as is, the cerebellum learns to rely on the equilibrium sensation only to information that is accurate, the information from the diseased ear will not be considered. This learning process can be supported by a balance training, which produces movements of daily life can have sufficient training function. Ultimately, this means that you look at a vertigo shall not spare, but that physical activities support the gradual disappearance of vertigo. This process may vary depending on the age days or weeks, sometimes take months. Such a process is called habituation, it represents a central compensation of the imbalance. Medications that suppress the scams, so are more of a hindrance, as they have absorbing and soothing effects and thus also counteract the training situation described above. Steaming, dizziness suppressive drugs should be used as sparingly as possible. Only with severe nausea and vomiting are useful to bridge the acute symptoms (eg. B. Vomex suppositories or capsules, dogmatic capsules, haloperidol or Vergentan injections). The diseases listed below are generally not dangerous kind, though they may affect the quality of life often substantially. Often the fear of vertigo is worse than the actual discomfort, not least because we keep a detailed explanation of the nature of this disease is extremely important.
B. overlooked causes of dizziness (eg acoustic neuroma, heart or vascular-related circulatory disorders, multiple sclerosis, meningitis, brain hemorrhages, – In any case, however, a detailed audiological and vestibular diagnosis must be carried out so as not other – partly extremely rare. herpes zoster oticus, Lyme disease, toxoplasmosis, barotrauma = diving disease). The basic studies in the ear, nose and throat medicine usually include Tonschwellenaudiogramm, Impedanzaudiometrie, Auditory (Bera), vestibular including storage test and caloric test with Electronystagmography (ENG) evt. Otoacoustic emissions, magnetic resonance imaging (MRI) of the skull, possibly. Serological testing for detecting the above-mentioned infectious and viral diseases. Meniersche disease (Meniere’s disease) The Meniersche disease was first described in 1861 by the French. Ohrenarzt P. Meniere. In Ménière’s disease is the paroxysmal occurrence of tinnitus, hearing loss, dizziness, possibly nausea and vomiting. A typical Meniereanfall sets acutely, the symptoms may persist and hours to days. Mend slowly.
Typically occur seizures 1-2x a year on, however, the attack pattern has a large variation on: There are people who have to endure some seizures in their lives without a permanent hearing loss remains. For other patients, the disease often progresses in waves over the years, with the hearing initially largely recovered, the passage of time but usually remains on the affected ear a medium to severe hearing defect persists. In very few cases, there is severe disease progressions, d. H. There is very frequent Meniereanfällen (z. B. every few days to weeks), continuous incoordination and very pronounced hearing loss. Usually only one ear is affected, in relatively rare cases, both ears. Cause of Ménière’s disease The inner ear is filled with fluid, it consists of two fluid spaces, which are filled with perilymph and endolymph. In the Ménière’s disease, there is a disturbance of the electrolyte composition of the two liquids, characterized the osmotic pressure regulation is disrupted in particular in the endolymph, this causes an increase in pressure in the endolymphatic system. Here are the sensory cells that are responsible wieauch of incoordination for the registration of sound waves. These are affected by the electrolyte shifts and by the pressure increase in their function and thus lead to hearing impairment and unbalancing.
Unfortunately, the exact background of this disease are still not known, accordingly, it is difficult to conduct a targeted treatment of this disease. The first Meniereanfälle are often relatively mild, so they can not be clearly identified as Meniereanfälle initially. So it is often only a slight tinnitus, sometimes associated with a slight hearing impairment, mostly in the low frequencies. This is initially often mistaken for a milder sudden deafness, only in retrospect by year shows that this was the first occurrence of Ménière’s disease. Other patients have only a vertigo, which is reminiscent of the sudden failure of the vestibular system (neuropathy vestibular). Still other patients exhibit all symptoms of Ménière’s attack on (ringing in the ears, hearing loss, vertigo), but in such an attenuated form, that they can not formulate exactly what they would not normally. then enter often to be somewhat uncertain and to have a slight pressure on the ear. At this stage the Meniersche disease is difficult to see. Treatment of Meniere’s disease A clear, unambiguous and secure promising treatment of Meniere’s disease does not exist. There are many suggestions for therapy, some key points of the treatment are shown below. In acute attack is the nausea and vomiting in the foreground, here is short-term bed rest and the attenuation of these severe distress z. B.
with Vomex suppositories sense. As soon as possible but the physical activity should be resumed in order to promote central compensation operations for suppressing the imbalance (see above). In addition, infusions are administered with circulation-promoting substances, often several of these substances are available in tablet form, z. B. Trental or pentoxifylline. In recent years, has often been also tried with a hyperbaric oxygen treatment (HBO), ie, a treatment with oxygen in a pressure chamber to achieve an improvement. The results are controversial, this treatment appears to be in retreat. Also very popular is the treatment with betahistine in tablet form (Melopat, Aequamen, Vasomotal). This preparation is attributed to influence the frequency, duration and strength of MeniereAnfällen. In severe cases and lack of response to conservative treatment measures come as the outermost and final measures and operational procedures are: Transtympanic drug destruction of the sensory end points of the vestibular organ with gentamicin (chemical maze off). Here a tiny tube is placed behind the ear drum and entered daily gentamicin into the ear. With proper dosage ultimately the balance organs of this ear are destroyed and can not trigger more defaults.
Operaive openings of the inner ear with pressure relief of the endolymphatic system (saccotomy, Saccusdekompression, Vestibulotomie) Surgical removal of the organs of equilibrium of an ear or severing of the balance nerve (labyrinthectomy, neurectomy of the vestibular nerve) All these operational measures have the disadvantage of damaging the ear in question more or less strongly or even destroy. the appropriate person should then later the Ménière’s disease on the other ear occur (fortunately very rare, but quite possible ! ! ! ), so has in more pronounced lesions of Meniere’s disease is no functioning organ of balance and may not be a meaningful hearing more. therefore Operational measures remain the absolute exception ! ! ! neuropathia vestibular When Neuropathia vestibular there is a sudden loss of equilibrium of an ear, the disease is also known as vestibular neuronitis or vestibular neuritis. The disease is characterized by the sudden appearance of a rotational vertigo associated with nausea and possible vomiting.
Patients have the feeling to the side tilt (lateropulsion). It occurs no hearing loss, it will not complain about tinnitus (ringing in the ears). The exact cause of this disease is unclear, it will be discussed by virus infection-related disorders and injuries. The location of the fault is suspected in both the maze itself in the field of sensory cells as well as in the field of balance nerve. Treatment of vestibular Neuropathia As stated above, in a vestibular vertigo triggered in the acute phase, if required, that be suppressed with medication in case of imminent or already existing vomiting, vertigo (z. B. with Vomex suppositories or capsules, dogmatic capsules, haloperidol or Vergentan injections). Once the symptoms are tolerable, is to ensure sufficient physical activity to promote the central suppression of fraud. The complete disappearance of the imbalance may take weeks. Benign paroxysmal positional vertigo-Location Benign paroxysmal positional vertigo is usually in bed occurring, short-lasting dizziness (about 10-20 seconds), which occurs mainly in changes in position and when turning in bed. The cause is believed that small particles of the otolithic membrane in the maze solving (z.
B. for a blow to the head or spontaneous) and in the Innenohrflüßigkeit floating around (in the endolymph). to hooking these parts in the sensory hairs of the cupula, especially in the posterior semicircular canal, as this responsible for measuring rotary motion sensory hairs are stimulated and thereby faking a short rotation. For this disease mechanism is clear that it is a harmless disease, but the cause of which can not be addressed directly, as it does not reach the endolymph without damage to the inner ear. As stated above already in the other forms of vestibular vertigo, here is an exercise treatment makes sense that ultimately leads to the central suppression of fraud, that is, there is a gradual habituation and thus suppression in brain Shares of the cerebellum. For this purpose, the patient should consciously induce dizziness by corresponding movements. Because of vertigo is usually very violent, avoid most patients corresponding movements or leave very quickly the situation that causes dizziness. Exactly this behavior is “wrong”, it initially requires a substantial often overcome to expose himself to this actually completely harmless hoax. If there are several exercise treatment daily of benign paroxysmal positional vertigo can usually be made to disappear within a few weeks. Sometimes it is possible by special movements to solve the entangled in the sensory hairs of Cupula particles. One of these methods is the storage treatment after Semont. Through special surroundings of the body, it is possible sometimes to eliminate the dizziness within a session. This requires, however, that the doctor himself is absolutely certain that it is indeed a benign paroxysmal positional vertigo and it also certainly succeed in being able to determine the correct side.
Unfortunately, just this is successful in many cases, because of dizziness because of incipient suppression by the cerebellum is not typically pronounced and thus is difficult to see. acoustic neuroma The acoustic neuroma is a benign tumor. Approximately 8 to 10% of all space-occupying processes within the skull and 80 to 90% of cerebellopontine angle tumors prove histologically as an acoustic neuroma. There are several names for this tumor: schwannoma neurilemmoma neurofibroma The most common expression is acoustic neuroma. However, since this tumor usually starts from the 8th cranial nerve, the term Oktavusneurinom would actually be more appropriate. Yet matching the term would Vestibularisneurinom, since most of these tumors have originated from the balance nerve itself. Thus, the tumor is located between the inner ear and the brain, usually within the internal auditory canal (intrameatal) and partly outside the inner ear canal, so the brain adjacent (extrameatal). The symptoms of patients with an acoustic neuroma depends on the size of the tumor.
As early symptoms impress usually only complaints from nerve vestibular-cochlear (hearing loss, tinnitus and vertigo quite rare) as an indication of a small tumor. A warning to the physician each, especially the unilateral hearing loss. Mostly produced as a first symptom is a progressive hearing impairment on the affected side, often combined with a ringing in the ears (tinnitus). In some cases, the hearing loss may also suddenly, similar to occur in acute sudden deafness. For a fairly small percentage occur fluctuations of hearing, as in Meniere’s disease, on. Remarkably, however, is the fact that many people do not perceive their hearing or just randomly notice (z. B. the phone, as part of a routine examination). It can occur in rare cases, no subjective and not an objective hearing loss, but only a tinnitus and / or vertigo is present. About scams as initial symptom surprisingly quite a few patients complain (15%). This arises from the fact that the acoustic neuroma generally grows very slowly, thus it may gradually come to a central compensation of vestibular symptoms without significant subjective dizziness. Often only after closer browse give the patients to a low sense of insecurity, especially in the dark or by rapid body movements to feel. The scams often comes only after some time after the first symptom (hearing loss) added.
This may be the trigger, even to seek medical advice. Over time (usually after many years) occur late symptoms as an indication of a larger tumor on such. B. neighboring symptoms on the part of other cranial nerves, such as the trigeminal nerve, the facial nerve or balance problems with static or dynamic ataxia, headache to to name a few examples. For the diagnostic audiology (especially Tonschwellenaudiogramm and auditory brainstem response or ABR) and vestibular (position or storage test and caloric test) is of great importance. Should these studies provide an indication of the presence of an acoustic neuroma, a magnetic resonance imaging of the skull must be made to obtain final certainty whether there actually is an acoustic neuroma. A computed tomography is no longer state of the art study, it is far less meaningful as small acoustic neuromas can be overlooked. Acoustic neuromas fortunately benign and grow slowly over years and decades. but it reaches a certain size, it presses to remove the brain structures and needs. As long as the acoustic neuroma is small, it can be relatively safe (though in a difficult operation) remove. In addition to the various surgical options Duch the otolaryngologist or the neurosurgeon there is a method to bring these tumors by a special irradiation technique, the so-called. Stereotactic radiotherapy, also called “gamma knife”, disappear. However, the experience with this irradiation technique to show that the operation continues to be the treatment of choice.
The aim must therefore be to find the acoustic neuroma early