What is Dizziness (Vertigo)?
It is the feeling that oneself or one's surroundings are spinning. Vertigo, contrary to popular belief, is not the name of a disease, it just means dizziness. Dizziness is often caused by an inner ear problem. Some people describe their balance problems with words such as "feeling dizzy, feeling shaky, floor slipping, inability to stand, feeling like falling, being pulled to and fro". Feeling unstable and wobbly without a spinning sensation can also be caused by an inner ear problem.
Ear diseases also often cause dizziness. Especially middle ear infections, inner ear infections, "Benign Paroxysmal Positional Vertigo", which is called the shift of crystals in the inner ear, Menierre's Disease and Vestibular Neuronitis are common causes of dizziness.
What is crystal shift (Benign Paroxysmal Positional Vertigo)?
Under normal conditions, there are crystals called "otoliths" that look like salt in the inner ear structures that provide our balance in our ears. These crystals are contained in a gel layer. If these crystals somehow slip from where they should be and escape into the semicircular canals, the patient will experience dizziness. As for why this disease occurs, blows to the head, prolonged bed rest, some ear surgeries can be counted among the known reasons, or there may be no reason.
Typically, this dizziness occurs when turning left or right in bed, trying to get something off the shelf in the kitchen, or on the stairs. It lasts as little as seconds, it can be very severe, it can be accompanied by nausea and vomiting. There is no hearing loss or ringing in the ears.
How is crystal shift (Benign Paroxysmal Positional Vertigo) treated?
History is very important in the diagnosis of Crystal Shift Disease. When this disease is suspected, the diagnosis is made with a maneuver called the 'Dix-Hallpike' maneuver. When the diagnosis is made with this maneuver, the crystals are placed in place by using gravity with a maneuver called the 'Epley' maneuver in the treatment, and the patient is thus treated. The effectiveness of even a single treatment maneuver is very high. After the Epley treatment maneuver, some recommendations are given to the patient. It is recommended for the patient to sleep in a sitting position with more than one pillow behind his back for two nights, and to lie on his side for 7 nights, starting from the 3rd night, turning over the shoulder on the opposite side of the problematic ear (for example, turning over the left shoulder if the right ear is sick). From the tenth night, the patient can return to his normal life.
What is Menierre's Disease?
Meniere's Disease is a disease that occurs in attacks, manifested by ringing in the ear, buzzing, a feeling of fullness, hearing loss and dizziness. The resulting dizziness may persist for a long time. The patient may experience nausea and vomiting during the attack. Hearing loss is temporary in the first attacks, typically includes low tones, that is, deep sounds, and hearing returns to normal after the attack. However, as the number of attacks increases, permanent hearing loss can also be seen. In some patients, falls may occur without loss of consciousness.
The exact cause of Meniere's Disease is unknown. It is thought that there is a 'swelling' in the structure of the inner ear called the endolymphatic sac. The most important element in diagnosis is the history, that is, what the patient tells. Hearing and balance tests can be used.
How is Menierre's Disease treated?
Treatment can be evaluated in two contexts: attack treatment and preventive treatment. In the treatment of attacks, if the patient has nausea and vomiting, he should be hospitalized and serum therapy, intravenous diazepam and diphenhydramine treatments can be given. After the attack, preventive treatments are given. A lot of research has been done on Meniere, many preventive treatments have been tried. The first step in treatment is lifestyle changes. The patient is advised to eat without salt, to quit smoking if he smokes, not to drink fermented beverages such as wine and beer, and to stay away from stress. Betahistine is the most commonly used agent in drug therapy. Good results have been reported recently with high-dose betahistine. Again, diuretic drugs called acetazolamide can be used to restore the salt balance in the inner ear, which is thought to be disrupted. This medicine may cause a decrease in potassium salt, so the patient should consume foods rich in potassium such as apricots, potatoes and bananas while taking this medicine, and should inform the doctor if tingling and numbness occur in his hands and feet.
If the attacks cannot be controlled despite these treatments, ear injection treatment may be considered. Here, cortisone or gentamicin injections are applied primarily to the middle ear in a patient with impaired hearing.
Surgical treatments can be applied in patients who do not benefit from drug treatments. Here we can talk about surgeries that preserve or not preserve hearing (Endolymphatic sac surgery, Vestibular neurectomy and Labyrinthectomy). As a result, the aim of Meniere's treatment is to keep the disease under control with lifestyle changes and drug treatments. Very few patients require surgical treatment.
