There are many
options for the treatment of vertigo. No one can reliably restore the normal
function of the inner ear. We all depend upon our inner ear is to provide
information about where we are in physical space. Some surgical procedures offer
the opportunity to stop disease in the inner ear. These procedures are few in
number. They include injection of steroids and the use of endolymphatic sac
decompression surgeries to reduce the pressure in the inner ear. Most operations
are designed to eliminate the function from a sick or damaged inner ear. Such
procedures have varying levels of potential risk and benefits.
Steroid injection
Recently, some physicians have begun using steroid
preparations. In 1979 McCabe first described a process we called autoimmune
inner ear disease. This disease process could be in part diagnosed and in part
treated with the use of steroids. At the time that he originally described the
disease he recommended the use of oral steroids. These drugs have numerous side
effects. Most will cause patients to experience changes in personality and some
can lead to frank psychosis. Many patients who have problems with their stomach
will experience ulcer like symptoms. Some patients may also experience
significant changes in their vision. If one has acne, the skin problem can be
made worse. Many people retained water and have difficulty in sleeping. In order
to combat these problems, recently physicians have been trying to inject a
steroid directly into the middle ear space. There is no agreed-upon dosage
scheduled for this usage. Some remarkable successes have been reported. Some
patients have lost hearing completely. It is unclear what the long-term results
will be like in most patients.
Rehabilitation exercise
Our perception of orientation in space comes from
our own experiences. Some of us are born with greater ability to stay balanced.
Whether we are born with skills or we learn them, all of us have the ability to
improve our orientation in space. This can be summarized by the expression, ‘a
ballerina can be made and not just born.’ A ballerina can be taught to learn new
techniques in order to maintain her balance. At the beginning of the space
program many astronauts suffered from space sickness. Training improvements
reduce the symptoms that most astronauts experience. This kind of training is
available through many physical therapists.
Endolymphatic sac decompression
For patients who suffer from Meniere's disease a
controversial operation called the endolymphatic sac decompression procedure has
been used for many years. This operation is successful in some patients but not
all. The success rate has been reported as low as 50 percent and as high as 90
percent. The operation is completed under general anesthesia. Most patients can
have the operation and go home the same day. Some patients experience dizziness
immediately following the operation. They may require an overnight stay. Severe
hearing loss is uncommon but can occur. Risk of hearing loss is 2%. There is a
small risk of facial paralysis as a result of the operation. Most patients find
that the risks are acceptable. Other surgical risks tend to be small.
Gentamicin injection
Gentamicin is an antibiotic which has been used for
serious infections for many years. One of the side effects of this drug is that
it damages portions of the inner ear. It has its greatest effect on the hair
cells in the inner ear. It may also affect other cells in the inner ear. When
the drug is given through the vein, it gets into all of tissues in the body. It
is then cleared from the body through the kidney. Patients who experienced renal
failure are more likely to have a toxic event with this drug. Most physicians
recommend that hearing and balance function should be monitored if this drug is
given systemicly.
Recent experience has shown that when this drug is
injected in the middle ear, it can be absorbed directly into the inner ear.
Absorption can be somewhat variable. Some patients are born with a deficiency of
an enzyme which metabolizes that drug in the inner ear. These individuals may
experience increased rates of hearing loss. Perhaps five percent of the
population lack this enzyme. While some centers have reported success with as
little as one injection, most physicians apply more drug over a longer period of
time. In spite of early enthusiasm, some failures have been identified. The
exact failure rate is unclear. An estimate of failures may be as bad as 30
percent. Besides hearing loss, there are a few potential complications. Some ear
drum perforation have been reported with all injections through the tympanic
membrane.
Vestibular nerve section
The vestibular nerve section can be accomplished
through different surgical approaches. In any case, the procedure involves
opening the skull and moving aside a segment of the brain. This delicate
procedure can usually be done without difficulty. The hearing and balance nerves
are separated and the balance nerve is divided. This eliminates the abnormal
function from the affected ear. The procedure is usually successful.
Approximately 80 to 90 percent of those individuals who undergo the operation
eliminate or substantially reduce their symptoms of vertigo. There is a chance
of hearing loss and facial paralysis. Some patients can experience complete loss
of hearing on the operated ear following this operation. Patients who have this
surgery experience one last severe attack of dizziness. Usually patients are
hospitalized for approximately one week following the operation. Over the next
three -- six weeks most patients experience improvement in their symptoms. Many
can return to part time labor in a few weeks. More severe complications such as
seizure can occur.
Labyrinthectomy
The gold standard of vertigo control remains the
labyrinthectomy. In this operation, inner ear contents are removed. The
operation usually is short in duration. Following the operation most patients
experience one last attack of dizziness. This attack may last between 24 hours
and five days. When the patient is able to walk and eat, they are discharged
from the hospital. Most patients find that they feel better in a period of two
-- six weeks. There is a small risk of facial paralysis with this operation. All
patients who have a labyrinthectomy will lose the remaining hearing in the
operated ear.
Conclusion
Control of vertigo can be
achieved in most patients. The procedures all have risks but most risks are
considered acceptable considering the severity of the problem. Each individual
must customize their treatment plan with their physician.