Labyrinthitis, Tinnitis, Menieres Disease

Labyrinthitis A balance disorder involving inflammation of the labyrinths, housing the vestibular system May be caused by either a viral infection or a bacterial infection Head trauma, allergies, and upper respiratory tract infections have also been known to cause labyrinthitis Symptoms: Rapid undesired eye movement, nausea, chronic dizziness, general ill feeling associated with vertigo, patient may not be able to keep balance May lead to permanent hearing loss and tinnitis Even after treatment, patient may overcompensate for years to life, causing balance issues

The Vestibular System Vestibular System: 3 semicircular canals Senses change in rotational movement Otoliths Senses change in linear movement The body combines sensory information from the eyes with information from the vestibular system to make adjustments to balance and movement Vestibulo-ocular reflex: Information on head movement is relayed to the eye muscle to coordinate visual focus during motion Labyrinthitis causes the vestibular to improperly sense changes in direction

Connection to Anxiety Labyrinthitis can lead to anxiety and anxiety can lead to dizziness Psychosomatic: dizziness caused by anxiety Somatopsychic: Vestibular dysfunction causes the body to feel a sense of imminent physical danger Network Alarm Theory: Involves noradrenergic, serotonergic, and other neural systems which are stimulated by increased sensitivity in locus ceruleus

Pre-hospital Treatment Nothing can be done outside the hospital concerning the actual disease Benzodiazepines can be used to treat acute anxiety Zofran can be used to treat vomiting One may reassure the patient that treatment is effective... Studies show that patients who believed that their symptoms were out of control did not recover as well even after the physical damage had healed Doctors may administer antibiotics and chronic anxiety medication to treat patient

Tinnitis Tinnitis is not a disease but a symptom From Latin, means “ringing” Patients may hear any persistent sound: music, tones, whistling, ticking, crickets, ringing, buzzing, whining, roaring, beeping, etc. May be caused by ear infections (including labyrinthitis), foreign objects, wax, nose allergies, injury from loud noises, aspirin, low levels of serotonin Since most people have minor tinnitis, it is usually only diagnosed in cases where it causes problems with normal activities such as sleep The world's largest bell (Tsar Bell): 200 tons; cast in 1655; hoisted into a tower 19 years later; fell to the ground and shattered in the fire of 1701

Tinnitis Study In 1953, 80 tinnitis-free university students participated in a study They were placed inside an anechoic chamber 93% reported hearing a buzzing, whistling, or pulsing sound Study did not report differences in race All students lived in an industrial nation Similar studies report higher levels of tinnitis in industrialized nations

Disconcerting News Tinnitis that pulsates with heartbeats indicate abnormal blood flow near the ear May indicate atherosclerosis May indicate life-threatening problems such as: carotid artery aneurysm or carotid artery dissection Could also be a phenomenon in which the patient has a heightened sense of blood flow through the ear Can be objective (audible by someone other than the patient) Tinnitis can result in the place of some hearing loss... the frequency heard in the tinnits will no longer be heard by the patient from outside the ear. In other words, after a rock concert, a patient will lose some of the receptors (deafness) or they will falsely relay information (tinnitis)‏

Notable People with Tinnitis Ludwig van Beethoven Martin Luther

Moby Steve Martin

William Shatner Ted Nugent Lars Ulrich

Meniere's Disease Caused by increased volume and pressure of the endolymph in the inner ear Classic symptoms include: Bouts of dizziness, vomiting, tinnitis, hearing loss (one ear or both), and a feeling of fullness in affected ears Patients may have any number of the symptoms as well as many others associated with the inner ear (such as nystagmus) Nystagmus: uncontrolled movement of eyes Patients usually suffer these symptoms in “attacks” Can lead to permanent hearing loss and balance problems Unknown cause

Possible Causes Endolymphatic Hydrops: excessive fluid buildup in the inner ear Fluid may burst out of the normal pathways and damage parts of the inner ear, explaining the multiple and broad range of inner ear symptoms including a feeling of fullness Endolymph: the fluid that flows through the inner ear Over time, damage from swelling can cause more severe hearing loss and balance problems Herpes virus is another possible cause since it is dormant in many people until the immune system is suppressed, as in trauma or infections. Symptoms develop after the virus erodes the inner ear

Exacerbation of Symptoms Excessive sodium intake Caffeine Alcohol Tobacco Aspartame Allergies Pregnancy Menstruation Fluorescent Lighting

“Drop Attacks” Some patients report a sudden feeling of vertigo If not seated or lying, the patient usually falls to the ground Some patients are unable to stand until medication takes effect or the attack subsides Often patients feel as though they are being pushed or pulled Be suspicious of trauma related injuries in these cases

Prehospital Treatment Treatment is limited outside of the hospital Treat the symptoms of the patient Zofran Use dim lighting inside the ambulance Treat trauma related problems if necessary Doctors may use a multitude of treatments ranging from diet changes to surgery and medication

Alan B. Shepard First American astronaut Diagnosed with Meniere's Disease in 1964 Performed only one spaceflight before being grounded as a result of the disease Participated in an experimental surgery to correct the disease After a successful surgery, he flew to the moon on Apollo 14

Sources “Labyrinthitis.” 16 May 2008. Wikipedia. 20 May 2008. http://en.wikipedia.org/wiki/Labyrinthitis “Tinnitis.” 24 May 2008. Wikipedia. 27 May 2008. http://en.wikipedia.org/wiki/Tinnitus “Menieres Disease.” 20 May 2008. Wikipedia. 27 May 2008. http://en.wikipedia.org/wiki/M%C3%A9ni%C3%A8re's_disease Heller, Morris F. M.D.. Bergman, Moe Ed.D.. “Tinnitus Aurium in Normally Hearing Persons.” Ann Otol, vol 62. 1953: Pg 73-83. The Merck Manual of Diagnosis and Therapy Eighteenth Edition. Merck Research Laboratories, Merck and Co., INC. Whitehouse Station, NJ. 2006.