Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. The labyrinth in relation to the ear The labyrinth is composed of the semicircular canals, the otolithic organs i.
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Hearing loss is more significant and is less likely to fluctuate. Attacks of vertigo may be replaced by more constant struggles with vision and balance, including difficulty walking in the dark and occasional sudden loss of balance. Some of these late-stage symptoms can become more problematic in conditions of low lighting, or with fatigue, or when a person is exposed to visually stimulating situations. Duration and frequency of attacks Attacks can last from 20 minutes to 24 hours.
They can occur with the frequency of many attacks each week; or they can be separated by weeks, months, and even years. The unpredictable nature of this disease makes managing it challenging. It also complicates the ability of scientists and physicians to study it.
Is there a cure? However, medical treatments exist that can help manage it. Treatment Existing treatments fall into two categories. Some treatments aim at reducing the severity of an attack while it is occurring; some treatments attempt to reduce the severity and number of attacks in the long term. The goal of this treatment is to reduce inner-ear fluid pressure.
Some physicians, more commonly outside of the U. Some drugs used for this include diazepam Valium , lorazepam Ativan , promethazine Phenergan , dimenhydrinate Dramamine Original Formula , and meclizine hydrochloride Antivert, Dramamine Less Drowsy Formula.
Vestibular rehabilitation therapy VRT is sometimes used to help with the imbalance that can plague people between attacks. Its goal is to help retrain the ability of the body and brain to process balance information. When successful, this can help a person regain confidence in the ability to move about.
One such method, a intratympanic gentamicin, destroys vestibular tissue with injections into the ear of the aminoglycoside antibiotic gentamicin. Recently, intratympanic steroid injections have been used with less risk of hearing loss and peristent imbalance. Another less conservative treatment method involves surgery. Two categories of surgery are available. The goal of the first type is to relieve the pressure on the inner ear.
Surgery to reduce pressure is not as widely used now as it was in the past due to questions about its long-term effectiveness. The goal of the second type of surgery is to block the movement of information from the affected ear to the brain. The process involves either destroying the inner ear so that the ear does not generate balance information to send to the brain, or destroying the vestibular nerve so that balance information is not transmitted to the brain.
In either instance, physical therapy is useful to help the brain compensate from the loss of inner ear function due to surgery. Symptoms can disappear one day and never return. Or they might become so severe that they are disabling. Key features of communicating with family and friends include informing them about what might happen with the onset of an acute attack and how they can help. If a low-sodium diet is effective, family and friends should be informed about how important it is for them to support adherence to the diet regimen.
Changes in lifelong eating patterns can be easier with the assistance of others. Managing an acute attack involves preparation. This includes consulting with a physician about any appropriate drugs that can be taken when an acute attack occurs, and deciding ahead of time when it is appropriate to go to a hospital.
During an attack, it is helpful to lie down in a safe place with a firm surface, and avoid any head movement. Sometimes keeping the eyes open and fixed on a stationary object about 18 inches away is helpful. In order to control dehydration, a doctor should be called if fluid intake is not possible over time due to persistent vomiting. After an acute attack subsides, it is not uncommon to want to sleep for several hours. Resting in bed for a short time is appropriate, if the person is exhausted.
But it is also important for the person to get up and move around as soon as possible so that the brain readjusts to the changed balance signals. Precautions need to be taken in this process to accommodate any new balance sensations. Successfully coping with symptoms involves understanding the disease.
Authors: P. Tumarkin A. The otolithic catastrophe: a new syndrome. British Medical Journal. Torok N. Hain TC. Serc betahistine. Further reading.
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