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DATE: July 28, 2014    TIME: 5:19 AM

Vertigo

What You Should Know

Audiology patients come first

There are several types of balance disorders caused by the inner ear, but two of the most common are Benign Paroxysmal Positional Vertigo and Meniere’s Disease. We offer vertigo treatment in Orange County, Southern California.

Symptoms

Vertigo literally means the sensation of movement. It is often described as a sensation of dizziness or spinning, a feeling of falling, lightheadedness or feeling woozy, visual blurring and disorientation. This may be accompanied by nausea, vomiting and/or sweating.

Causes

Diagnosis of the cause of vertigo is complicated because there are over 70 different causes of vertigo, and other medical conditions such as ear infections, blood pressure changes, and vision problems may contribute to the disorder. Migraines are also a very common cause of vertigo (migraine-associated vertigo) which may exist even without the typical headaches. Some medications may also contribute to the problem, we will evaluate your medical situation as part of our vertigo treatment in in the Los Angeles and Orange County area. Two of the most common causes of vertigo that we see are:

Benign Paroxysmal Positional Vertigo (BPPV)

It has estimated that at least 20% of patients who suffer from vertigo have BPPV. BPPV is defined as an abnormal sensation of motion brought on by certain positions or movements. It may be accompanied by involuntary eye movements triggered by inner ear stimulation. Dr. Shohet offers Orange County Vertigo treatment in Southern California.

The inner ear consists of three canals that contain tiny crystals that help maintain a sense of balance. When particles in the inner ear break off and accumulate in one of the canals, moving the head in certain directions may cause the particles to trigger a sense of dizziness.

The symptoms of BPPV include a sensation of spinning and nausea. An individual may experience BPPV when rolling over to the left or right in bed, when looking up for an object on a high shelf, looking down or quickly to the side. Episodes of vertigo generally last less than a minute, but may induce prolonged nausea or ill feelings. Feel better again with our vertigo treatment in Orange County program.

Two tests may be used to diagnose BPPV. A noninvasive positional procedure called a Dix-Hallpike test is used to accurately determine if a person has BPPV. Electronystagmometry (ENG) tests balance function.

Treatment entails a noninvasive positioning procedure. Performing these easy head maneuvers move the particles out of the canals in the inner ear and can stop the symptom of dizziness. Medication may also be prescribed to treat the nausea and dizziness.

For more helpfull tips about Benign Paroxysmal Positional Vertigo (BPPV) and the primary treatment for moving the calcium carbonate particles away from the area that causes nausea and dizziness. When visiting our Newport Beach treatment center, we provide you with comfort and care that stands out among other centers for Orange County vertigo disorder treatment.

Ménière's disease

Ménière's disease is a condition in which excessive fluid build-up in the inner ear causes episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), and the sensation of fullness in the ear. We offer Ménière's disease treatment in Orange County, Southern California.

Diagnosis is based on the findings of a history and examination, and audiometric and vestibular tests.

Although there is no cure for Ménière's disease, there are treatment options that can help control the symptoms and lessen the frequency of attacks of vertigo. Many patients benefit from reducing their intake of sodium, alcohol and caffeine, and avoiding nicotine. Vitamin supplements and diuretics may also help. Vestibular suppressant medications (such as antihistamines or sedatives) may help calm the inner ear. In cases where medical management fails to bring relief, surgery may be indicated. In these instances, Endolymphatic Sac Surgery may be of benefit. This is a procedure that drains and opens the endolymphatic sac, the structure that is responsible for inner ear fluid metabolism. The operation takes approximately 1-2 hours and is performed under general anesthesia at our Orange County office.

Some other cutting edge treatments offered through Shohet Ear Associates can help alleviate the symptoms of Ménière's Disease. The Meniett device sends pressure pulses to the middle ear that help reduce excess fluid and restore the balance of the inner ear's hydrodynamic system. The treatment is performed at home several times per day for an indefinite period. For more information , visit meniett.com.

In severe cases of episodic vertigo, Transtympanic Gentamicin treatment may be used to deaden the balance portion of the inner ear. Injections of a drug called gentamicin are given through the ear drum using a small needle. This procedure can be used to treat one side, without affecting the other. The procedure carried at our Orange County treatment center is not usually painful because an anesthetic is used to numb the ear drum. Between one and three treatments are usually necessary.

Diagnosis

The first step is a thorough evaluation as part of our vertigo treatment in Orange County CA. Diagnostic tests that may be conducted include Electronystagmography (ENG) and Vestibular Autorotational Test (VAT) to evaluate balance function. Electrocochleography (ECOG) and Auditory brainstem response tests (ABR) assess the cochlea and acoustic nerve. Shohet Ear Associates offers the full range of computer-assisted technology in our office to help determine the cause of these disabling conditions.

Treatment

There are various options for treating the causes of vertigo. Depending on the diagnosis, treatment may involve sophisticated, multidisciplinary methods or simpler approaches to curing the root cause of the balance disorder.

One option includes treatment for conditions that may be contributing to the balance problem, such as ear infection, BPPV or Ménière's disease. Another possible Orange County treatment option includes balance retraining exercises (vestibular rehabilitation) that help patients to compensate for their balance disorder. The exercises include movements of the head and body developed especially for the patient. Vestibular retraining programs are conducted by professionals with knowledge and understanding of the vestibular system and its relationship with other systems in the body.

Comparison of Treatments for Meniere's Disease

         
  Advantages Disadvantages Possible Risks Efficacy
Trans-tympanic gentamicin        
Small amount of gentamicin antibiotic injected behind the ear drum in the office.
  • Office procedure
  • Local anesthetic
  • 30 min procedure
  • Brief recovery period
  • Can repeat injections
  • Some discomfort with procedure
  • May require repeat injections
  • Must keep ear dry for one week
  • Occasional disequilibrium - may require balance physical therapy
  • Ear drum perforation
  • Infection
  • Hearing loss (5-25%)
  • Dysequilibrium
  • 60-90% control vertigo
Meniett Device        
A small vent tube is placed in the ear drum. Then, an ear plug type device is worn that delivers low pressure pulses to the inner ear on a daily basis.
  • Office procedure
  • Local anesthetic
  • Portable device
  • No "down time"
  • Option for bilateral  disease
  • Requires daily use of device
  • Three treatments of 5 min each, daily
  • May need to use indefinitely
  • Must avoid water in ear with tube
  • Ear drum perforation
  • Infection 
  • Tube may dislodge
  • Hearing loss (1-2%)
  • 67% control vertigo
  • 27% improve hearing
Endolymphatic Sac Surgery        
The endolymhatic sac within the inner ear is decompressed surgically. Then the excess fluid is free to drain.
  • Good control of vertigo
  • May improve hearing
  • Low morbidity
  • Single procedure
  • Outpatient surgery
  • General anesthesia
  • Return to work within one week
  • Surgical discomfort
  • Infection
  • Hearing loss (1-2%)
  • Ear fullness
  • Facial paralysis (<1%)
  • Spinal fluid leak (<1%)
  • 81% control vertigo
  • 20% improve hearing
         
Note:        
With any of these options, although they may be successful initially, they may not be permanent. Secondly, undergoing one option  now does not eliminate the opportunity to try an alternative therapy in the future.
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