Ear Diseases (Part Six)

In the calm phase of the disease, we use.

• Antivertigo antihistaminic medications (Betahistine).
• Diuretics
• Psychological treatment.

Prognosis. One of the main characteristics of Morbus Meniere is the unpredictable course of the disease. On one hand, we have abortive forms that heal after a few attacks without consequences in relation to hearing, on the other hand, the disease can progress with recurrent attacks followed by periods of calm and is accompanied by permanent hearing loss.

There is also an acute form accompanied by repeated attacks that lead to complete hearing loss and are accompanied by serious balance disorders. Bilateral occurrence of the disease is rare and occurs in less than 10% of cases.

Positional Vertigo.

Clinical Signs. Positional vertigo, or otherwise known as benign paroxysmal positional vertigo. The disease is characterized by sudden, strong attacks of vertigo with a sensation of spinning objects (dizziness). The disease often erupts at night as a result of immediate standing up or changing position.

Pathogenesis. Positional vertigo has a peripheral origin and is related to a lesion at the level of the balance end organ. Theoretically, the disease is triggered by small deposits called otoliths that float in the endolymph of the semicircular canals, and the disease is called canalolithiasis. These otoliths have detached from the macula. During head movements, these small parts cause an excessive bending of the cupula, resulting in the appearance of the typical symptoms of the disease.

Treatment. In practice, the Dix-Hallpike maneuver is used, which is based on the rapid change of head position from lying to sitting to create the possibility of detaching and repositioning of the otoliths.

Central Vestibular Disorders.

Clinical Presentation.

• Sudden attacks of vertigo with a short duration of 1-2 sec.
• Vertigo attacks accompanied by falling to the ground without loss of consciousness.
• Dizziness accompanied by visual disturbances, diplopia, hemianopsia, scotoma, etc.
• Dizziness accompanied by dysarthria and personality disorders.

Pathogenesis. Central nature vertigos are a result of multifocal disorders of the central nervous system. These are accompanied by symptoms of oculomotor disorders and somatosensory disorders.

Investigation and treatment of these disorders are done by the neurology specialty. The most common cause is vascular insufficiency of the brainstem leading to ischemic and hemorrhagic lesions.

Hearing-related disorders.

Sudden Deafness.

Clinical Signs. The patient feels pressure in the ear while disturbing noise in the ear starts to appear followed by a marked decrease in hearing. Within a few minutes, a marked decrease in hearing begins, ending in complete deafness.

Pathogenesis. In most cases, the cause remains idiopathic or unknown, viral infections, microcirculation disorders in the middle ear, immunological reactions are also accused.

Diagnosis. Symptoms are usually unilateral. The audiogram shows a neurosensory hearing loss for high and medium frequencies up to complete deafness. For the verification of the diagnosis, examinations such as Tympanometry, otoacoustic emissions, vestibular tests, etc. are assisted.

Treatment. The goal is to improve cochlear microcirculation and oxygenation as quickly as possible.

• Intravenous solutions with low molecular weight such as dextran or systemic vasodilators.
• Corticosteroids.

Prognosis. If treatment starts within the first 24 hours, recovery is often partial or complete within a few days. Spontaneous improvement may occur. The prognosis is poor for patients suffering from diabetes, hypertension, or vascular disease with permanent damage.

Progressive Hearing Loss or Neurosensory Deafness.

The disease begins between the ages of 30 -50 years. The cause is unknown.

Clinic. The hearing loss is bilateral with varying degrees of hearing loss. It starts with a sudden hearing loss that continues to progressively worsen, often accompanied by noise in the ear. Complete deafness occurs over a period that requires years or decades.

Diagnosis. Progressive bilateral hearing loss assessed with audiometry.

Exclusion of etiological factors that could be metabolic, genetic, autoimmune, infectious, toxic, etc.

Exclusion of extracochlear, psychogenic factors, and hearing losses of central nature.

Treatment. Placement of hearing aids or cochlear implantation.

Presbycusis. Symmetrical bilateral hearing loss for ages over 50 years is an age-related hearing loss. People over 50 years of age suffer from this disease, and about one-third of people over 65 years of age have significant hearing loss, estimated at about 35 dB or more in tonal audiometry.

Audimutism. The term is inaccurate as it does not imply delayed speech development. The child does not speak although they are able to hear. The term audimutism in the strict sense includes children who do not start to speak after the age of three communicate through gestures for their needs and are unable to speak words but do not have mental defects and demonstrate normal hearing.

There is a connection between audimutism and early childhood brain damage. The term deaf-mute has been replaced with delayed or lack of development of speaking ability.