Vertigo may be temporarily relieved by oral scopolamine, antihistamines, barbiturates, or Valium. Scopolamine can also be given by subcutaneous injection. For those who cannot tolerate frequent attacks of vertigo, surgical treatment is available. Removal of the semicircular nerve (vestibular neurectomy) can relieve vertigo, usually without damage to hearing. If the vertigo attacks are frequent and the hearing impairment is severe, cochlear and semicircular canal resection (labyrinthectomy) may be performed. Vestibular neuronitis is a condition characterized by sudden, severe vertigo. It is an inflammatory disease of the semicircular canal nerve.
The cause may be a viral infection. The first symptom is severe vertigo with nausea and vomiting, which may last for 7 to 10 days. Involuntary movement of the eyes to the affected side (nystagmus). It may recover on its own and may occur in a single episode or in multiple episodes after 2 to 18 months, but the symptoms are shorter and less severe than the initial episode. Hearing is not affected.
The diagnosis is made by audiometry and nystagmus examination. A nystagmograph is used to record eye movements. Nystagmus can also be induced by pouring ice water into the ear. MRI of the head helps to differentiate between other disorders.
The treatment of vertigo is the same as for Meniere's disease. If the vomiting is prolonged, attention should be paid to fluid replacement and electrolyte balance. Positional vertigo is a type of vertigo that induces severe dizziness in a specific head position and lasts no more than 30 seconds.
This type of vertigo can be caused by disorders that damage the semicircular canals. Examples include inner ear injury, otitis media, inner ear surgery, or embolization of the inner ear artery.
Vertigo, abnormal eye movements, occurs when the patient lies to one side or tilts the head upward. Usually, positional vertigo resolves after a few weeks or months, but it can recur after months or years. The diagnosis is made by having the patient lie flat on the examining table with the head suspended over the edge of the bed, and after a few seconds, the patient experiences severe vertigo that lasts 15 to 20 seconds and nystagmus.
Patients should avoid positions that induce vertigo. If the vertigo persists for more than 1 year, the semicircular nerve can be cut and the vertigo can be relieved. Herpes zoster of the ear is a condition in which the auditory nerve suffers from infection by the herpes zoster virus, producing severe ear pain, hearing loss, and vertigo.
Fluid-filled blisters are found on the skin of the auricle and external auditory canal. The blisters can also occur on the skin of the face or neck, the area innervated by the infected nerve. Involvement of the facial nerve can lead to temporary or permanent facial paralysis on one side of the face; hearing loss can be permanent or partially or completely restored; and vertigo can last for days or weeks.
The better treatment medication is the antiviral drug acyclovir. Analgesics relieve pain; Valium relieves vertigo. When the facial nerve is compressed, facial nerve decompression should be performed to treat facial nerve palsy. Sudden deafness is a severe hearing loss that usually develops in one ear and can occur within hours.
Sudden deafness affects about 1 in 5000 people each year. It is often caused by viral infections, such as mumps virus, measles virus, chickenpox virus, or infectious mononucleosis virus. Secondly, strenuous exercise such as weight lifting exposes the inner ear to severe pressure damage, resulting in sudden or fluctuating hearing loss or vertigo. When the injury occurs, the patient may hear a blasting sound. Sometimes the cause is unknown. The hearing loss is usually quite severe, but most people recover fully or partially within 10 to 14 days. It may be accompanied by tinnitus and vertigo. The vertigo often resolves within a few days, but the tinnitus often lasts longer.
There is no effective treatment. Prednisone may be given orally, and bed rest is recommended. Surgery may be effective in some cases. Exposure to noisy environments, such as carpentry shops, drilling, heavy machinery, gunfire, or airplanes, damages auditory receptors (hair cells) and can lead to hearing loss. Other common causes are frequently wearing headphones or listening to music near speakers. Although individual sensitivity to loud sounds varies greatly, prolonged exposure to noise can cause some degree of hearing loss. Any sound above 85 decibels is damaging to the auditory system. Shock waves from explosions (acoustic damage) can cause similar hearing loss. This type of hearing loss is permanent and is often accompanied by high-pitched tinnitus.
Hearing loss can be prevented by minimizing exposure to noise, reducing noise intensity, and moving away from noise sources. Exposure to high-intensity noise should be minimized. Fitting ear protectors such as plastic earplugs can reduce noise exposure. Hearing aids are available for patients with noise-induced hearing loss. Age-related deafness is sensorineural deafness that occurs in partially normal people.
This type of hearing loss begins after the age of 20 and first affects the high-frequency region and then gradually spreads to the low-frequency region. Individual differences in hearing loss are quite pronounced. Some people are completely deaf by the age of 60, while others have better hearing by the age of 90. Hearing loss is more common and more severe in men than in women. The degree of hearing loss may be related to the degree of noise exposure. There are no effective preventive or reversal measures for age-related deafness. Body language can be learned by lip reading. Some compensation for hearing loss can be given with the help of hearing aids. Certain medications, such as certain antibiotics, diuretics (diuretic acid, tachycardia), aspirin and its analogs (salicylates), and quinine can damage the inner ear. These drugs have an effect on hearing and balance, but primarily affect hearing. All of these drugs are almost entirely eliminated from the body through the kidneys. Therefore, any poor kidney function can increase the accumulation of drugs in the body to levels that cause damage.
Of all the antibiotics, neomycin is more toxic to hearing, followed by kanamycin, butamidokanamycin, viomycin, gentamicin, and tobramycin, affecting both hearing and balance. Streptomycin mainly damages the balance system. Vertigo and imbalance after streptomycin application are mostly temporary, however, the loss of balance when walking in the dark is permanent. Self-consciousness of instability in the external environment while walking (Dandy's syndrome).
Permanent or temporary severe hearing loss can result when diuretic acid and tachycardia are given intravenously to patients with renal failure or who are receiving antibiotics. Hearing loss and tinnitus can be produced by chronic high-dose aspirin, but are often temporary. Quinine can cause permanent hearing loss.
. Warnings
When the tympanic membrane is perforated, ototoxic medications should not be dropped directly into the ear because the medication can be absorbed into the inner ear. Pregnant women should not use ototoxic antibiotics. Ototoxic drugs are generally not used in the elderly or those with existing hearing loss, unless there is no other more effective medication. Although sensitivity to drugs varies widely among individuals, hearing loss can be avoided as long as blood levels are within permissible limits. Therefore, blood concentrations of drugs should be tracked. If possible, hearing should be checked before or during drug administration. The first symptoms of ototoxic injury include hearing loss in the high-frequency region, high-pitched tinnitus, and vertigo. The temporal bone can fracture after a violent blow. Bleeding from the ear canal or bruising of the temporal skin after trauma suggests a possible temporal bone fracture. If there is clear fluid coming out of the ear canal, a cerebrospinal fluid leak may have occurred, suggesting that the brain has been exposed and is susceptible to infection. Temporal bone fractures are often associated with rupture of the tympanic membrane, facial nerve palsy, and severe sensorineural hearing loss. Often CT can determine the presence or absence of a fracture.
Antibiotics are given intravenously to prevent meningitis; facial paralysis due to compression of the facial nerve can be treated surgically; and repair of the tympanic membrane and middle ear structures often occurs after several weeks or months. Auditory neuroma is a benign nerve sheath tumor of the vestibular nerve (eighth nerve) originating from Schwann cells.
Audinomas account for about 7% of intracranial tumors. Hearing loss, tinnitus, vertigo, and a feeling of unsteadiness are among its early symptoms. Other symptoms appear when the tumor grows and compresses the brain. Early diagnosis relies on MRI and audiologic tests, including brainstem evoked potentials.
Small tumors are removed by microsurgery to avoid damage to the facial nerve; large tumors require extensive surgical removal.