Inner ear / balance problem

Otofreq

Hello Peter.

I am an audiologist practicing in a balance center in Grand Rapids, Michigan. As you might imagine, providing diagnostic information over the internet is frought with problems. I will do my best to answer whatever questions you have.

A couple of points of importance:

There have been posts here suggesting the Epley Maneauver. This is totally contraindicated if you are truly experiencing just vestibular neuronitis. The Epley is treatment specifically for Benign Paroxysmal Positional Vertigo. It requires proper training and a thorough understanding of the mechanisms of the vestibular system. The Epley should not be performed unless you have BPPV, and the involved ear and semicircular canal is clearly identified.

If your problem was cervical vertigo, then possibly Chiropractic treatment would be of some benefit. I do not see how it would provide relief for vestibular neuronitis. I could explain that to you more in another post if you wish.

Virus attacks do not necessarily cause you to have symptoms such as the flu etc. They can be specific to the inner ear or even just a part of the inner ear (hearing or balance) or the associated nerves. If your problem was indeed virus related (you may never know), it has probably done it's damage and gone on it's way. There may be medications to help you but that should be discussed with your doctor. Regardless, vestibular therapy is the correct way to go in such cases. This will take time. Your brain needs to compensate for the problem. It is a natural compensation, and therapy only aids in that process.

Patience and vigilant compliance with the therapy regimen will ultimately get you where you want to go.

Best wishes.

elgordo

drserena

undefinedVery cool. We ride bike too....Dr. Alyson actually conducted a cycling study in our office measuring power output with our custom orthotics.

undefined Benign Positional Vertigo means basically "non pathogenic or non-serious" and involves the labrynthine or inner ear. So the ENT ruled this out- good. MRI ruled out pathology to the vestibular nerve. Any alterations in taste, smell, vision, or difficulty talking? Does your ear feel full, plugged, or itchy? Is your ear red? Have you had a recent infection of some sort? Have you been prone to ear problems in the past? Would you describe that you have more dizziness or loss of position in space? Did you have a recent accident or fall to the head?

As much as chiropractic can also affect the cranial nerves exiting out from the spine in the upper cervical region (ie. vestibularcochlear nerve-CN 8) which affects vertigo it also involves the neck which is a HUGE area of "balance" receptors for the body-letting your body know where it is in space. Why did they say it was a virus? Is it because they can't find anything else at this point? I wouldn't doubt that its possible but let's consider elsewhere. The body is more complicated than anyone could imagine. Just because vertigo is commonly associated with the ear doesn't mean necessarily coming from the ear. I've had neck pain clear up by supporting the feet-kinetic chain....think cassette and chain on your bike.

undefinedLewit states that upper cervical spine receptors are very important for equilibrium and thus, "it is no coincidence that vertigo and dizziness are very frequently of cervical origin."11 Basic scientists support this statement. For example, Guyton states that, "by far the most important proprioceptive information needed for the maintenance of equilibrium is that derived from the joint receptors of the neck."

Read the second chiroweb information for more explanation and diagnostic orthopedic tests used to help determine some of this.


undefined BPV can be caused by head and neck trauma, colds, etc and these all also affect the neck. If you were reading some of this correlation than it would only make sense to also have chiropractic, but that doesn't mean you can't recieve chiropractic if BPV is not what you have. If you read the first two chiroweb sites you will see that they are not discussing chirorpactic and treating BPV but chiropractic and treating the neck which affects proprioceptors which affect equilibrium.

It sounds like your in good hands. Think of it as also a spinal check-up since youv'e never had one, much like a dental check-up. You only have one spine, you know and you should value it like you do your teeth. Benefits you should also be experiencing include improved range of motion, decreased neck tension, improved strength into the upperbody, as well as improved nervous control to the organs affected by cervical nerves.

Be patient and give it time. The first few visits are really fine tuning and allowing the doctor to understand how your body as an individual responds to care. The tissues surround the neck will want to play "tug-o-war" so it takes some consistency to "put 'em in their place".

In Health,
Serena

peterwright

Hi Otofreq

Thanks for taking the time to post.

I think that on balance it is likely that I had or have a virus and that vest neuronitis is the most likely diagnosis. My doubt lies in that the ENT could not confirm this due to insufficient nausea and an inability to show that any hearing deficiency was NOT there before I came to see her. On top of this my GP had me taking Stugeron and so i was medicated when I saw her.

I have been doing some of the exercises she gave me and have been exposing myself to general life activity such as work and driving and walking, in the hope that this will help my brain to re-adjust.

My reason for looking at the Chiropractic option (apart from the uncertain diagnosis above) is that I had a sore neck for 2 weeks leading up to the attack and I also had a heavy fall from my bike in jan/Feb this year and banged my head and neck. i felt that Chiro treatment might also help my recovery speed up by freeing up the neck ?

Please can you advise on what are the most effective exercises to finish the rehab process. I really feel I am at 80% and a little bit stuck there. Improvement is difficult to quantify now and progress seems very slow / plateaued. I want to be sure I am doing the right thing ?

Thanks for any help.

Peter

FallenRider

Had Labarynthitus last year - the viral kind - causes you to be sick constantly for a couple of days and you loose your balance for quite some time. I was unable to ride or drive for over three months! Bloomin awful - complete loss of condition and very depressing - so I sympatise.

All I could do for much of the time was lie down. Once you are able to walk properly - go for longer and longer walks - this does seem to help somewhat - although this may just be the fact that I was outside!

Hope you get well soon.

ianf

I have suffered from a balance problem for 28 years - ever since contracting meningitis which has damaged the nerves of my inner ear, also causing some hearing loss at particular pitches. After the meningitis (which also partly paralysed an arm and shoulder movements) it took some 11 years before I got to ride a bike regularly again. One thing that I found was that I could no longer corner or descend with confidence forcing me to reassess what and how I was going to ride. These days I ride mainly time trials and the occasional circuit races where the bends are not too sharp. Cycling in the mountains (such as on Majorca or in the Alps) has caused me particular distress because I cannot cope with descending at speed or the angle of hairpin bends, I am now back on the track (Manchester) but still nervous on wheels. All I can say is that you are lucky that this is just a temporary condition and that you should exercise great care and patience and await your recovery. In my case it is permanent and I just have to live with the fact that I get shot out of the bunch on sharp/steep corners/bends and keep out of others' way so as not to be a danger to other people. Thank God for the time trial scene in the UK. At least I can ride alone and unpaced and not be too bothered about the time I lose on sharp bends.

__________________
ianf

rockitj

I have Meniere's disease. I was diagnosed in 2001 and went through 1 1/2 years of hell, but am now in the best health of my life. Excuse me for such a long post, but this is a subject that has been life altering for me. When this started, I was 48 years old, obese, and a heavy smoker who did not exercise. Up until the final resolution in Jan. 2003, I was unable to work, or drive and was basically home bound. I never knew when an attack might occur, how long it would last, or how severe the symptoms would be. I have since quit smoking, lost 70 lbs., started riding a bike last July and now am riding about 175 miles a week and loving it. The four symptoms of Meniere’s disease are, vertigo, ringing in the ear (tinitus), slow loss of hearing in the affected ear, and a feeling of pressure or fullness in the ear. There is no cure for the disease, only management of the symptoms. It strikes randomly and it is not known why. If this is what you are feeling, I suggest you seek the absolute best medical care available to you.

Here's my story, I'm sure your circumstances will vary, but I hope it helps you. On the day after my son was married in Sept. 2001, when I awoke to go to work, I was dizzy and nauseous and couldn't walk. I suspected an ear infection and went to my doctor. Several courses of antibiotics failed to help and I was referred to a local ear specialist. After several weeks of treatment and process of elimination, his diagnosis was Meniere's disease. He prescribed Meclazine and vestibular rehabilitation, neither of which did anything to help. This doctor was pretty vague about the disease and having never heard of Meniere's, I went home and did a Google search on it. What I found and read scared the heck out of me. Thankfully, I live about an hour away from New Haven, CT and I went to Yale University Hospital for treatment. I was lucky to be treated by a world class Otologist there, Dr. John Kveton. A battery of sophisticated tests confirmed Meniere's. The one sure treatment is surgical removal of the inner ear. This stops all symptoms permanently, but obviously with complete deafness in that ear. Since my hearing loss was only moderate, Dr. Kveton wanted to try all other treatments and save the hearing in my affected ear, which he was able to do. Over the next year, I was given a series of increasingly invasive treatments to stop the vertigo. The first step in treatment was life style changes. Low sodium, no nicotine, caffeine or alcohol plus a steady low dosage of Valium to try to control the symptoms. This alone helps a percentage of people with the disease, but did not help me. In March of 2002, I had outpatient surgery to install a shunt (vent) in the inner ear cavity. Again this did not improve my condition. The next step in treatment was injections through the eardrum of an antibiotic that poisons and deadens the vestibular nerves. This worked temporarily for me, but the nerves regenerated and the symptoms returned. At this point I was in the 15 percentile that doesn't respond to any of the usual treatments. The only option left that would preserve my hearing was to surgically sever the vestibular nerve. This involves removing a half dollar size piece of skull behind the ear, moving the brain aside and severing the nerves and then closing the opening. I had this done in January of 2003 and it was a lifesaver, I have not had vertigo since and have the confidence that I won't again. My balance is not the best, especially in tight quarters, but it is adequate enough. While I was ill, I would walk as much as I could to get out of the house. I later progressed to jogging and then to bike riding because it is lower impact. I now lead a full life and live a healthy happy lifestyle. Good luck to you and I hope this helps.

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05 Specialized Roubaix Comp / 04 Specialized Sirrus Elite

rule62

Wow...what a story rockitj! That is a hell of a turn-around. Way to go!!!

peterwright

Thanks for the info and help guys - puts my problem into perspective for me.

I am being impatient as i want to get back to normal.

It will happen when it is ready.

Peter

Otofreq

Peter,

There is some debate in our literature concerning this subject. However, at our lab,we make the following distinctions: With vestibular neuritis, one would not necessarily expect to see associated hearing loss. This is because the vestibular nerve is distinct from the sense organs of the cochlea and the auditory nerve (though vestibular and auditory branches comprise the 8th cranial nerve). Labyrinthitis frequently has hearing loss as an associated symptom. This is one way the two syndromes are differentiated.

I would refer you to the following web site for a comprehensive discussion of this condition. You will note that there is no mention of cervical involvement as a possible contributing factor. There is a reason for that which should become clear to you as you read the article. Also, note that neuronitis is usually a one time experience. The odds are that given time this problem will resolve naturally. Therapy, as I said before ,is a means to aid in the recovery.

http://www.dizziness-and-balance.co...at/vneurit.html

Below is another site that discusses cervical vertigo. You will see that there is much contraversy on this subject too. I would consider cervical vertigo as a possible factor given your reported head/neck injury. I concur with the article as it does advise extreme caution in seeking chiropractic treatment of this condition.

http://www.dizziness-and-balance.co...l/cervical.html

As regards your request for effective exercises; I am not expert in vestibular therapy. As an audiologist, I am most involved with the diagnostic side of balance disorders. A physical or occupational therapist with special (advanced) training in treatment of balance disorders is the person you want to ask.

Otofreq

I would question the diagnosis of virus. It is unlikely that a virus comes and goes as you report. I believe your physician was suggesting a diagnosis of Meniere's desease.

If you research the literature on this disease, you will find that long term use of Meclizine is not indicated. Rather, a diurectic and low sodium diet is most often prescribed. I would consult with your physician about this.

peterwright

Hi all
Just an update for you all. I have been hammering my trainer for a few days now and attempted my first road ride agian on Monday this week - well I survived a two hour session..but it was an exhausting process due to the anxiety factor. I had not factored in how frightened I would be on a bike I used to feel so comfortable on. I then took a day off yesterday and then completed a 4 hour ride today on a very long straight road and once again am on my knees but stayed upright. Just like my body has adjusted to walking with this disequilibrium I am left with I am trying to get used to riding with it. I struggle with slow speed manoevres such as roundabouts or junctions where I have to look over my shoulder, also getting a bottle out and having a drink is a nightmare !

Anyway, I am working hard on rehab and i will get there at some point.

Cheers all.

Peter

drserena

Hi Peter,

"reaching for bottle is a nightmare".....at least you have your sense of humor. I completely know what you mean....I remember riding for so long on a mtn bike and using a camelback and then learning to roadride and reach for that little bottle on thin wheels....ahhhh!

nerdag

An Epley particle repositioning is only useful for benign paroxysmal positional vertigo - caused by particles in one's semicircular canals.

It won't do anything for viral neuronitis, which is an inflammatory condition.

As a medico in training myself, I wouldn't trust anybody to do an Epley's on me apart from a neurologist. I've seen one too many a GP stuff exacerbate BPPV because they weren't doing it properly.

nerdag.