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Department of Otolaryngology
Vestibular Rehabilitation for Dizzy Patients Most patients enter the program after a neurotologic evaluation of their dizziness by Stephen Wetmore, MD, who specializes in problems of hearing and balance. As part of the evaluation process, most patients will undergo hearing and balance tests that are performed by the audiology staff. If it appears that the person's sensation of dizziness may respond to the new vestibular exercise program, the therapist will teach the patient how to perform various types of exercises that are geared to readjust the balance system. The major selection criterion for the new program consists of dizziness that is precipitated by changes in body posture or head positioning. The exercise program is tailored to the patient's diagnosis and physical condition. Most aspects of the program are carried out at home using a variety of exercises. Most of the exercises will temporarily make the patient feel more dizzy in order to condition the brain to overcome the dizziness. The exercise program usually lasts at least 6 weeks. Patients with benign paroxysmal positional vertigo (BPPV) are candidates for a special type of maneuver that eradicates this form of dizziness. Many patients with uncomplicated BPPV can be treated in the doctor's office with particle repositioning maneuvers. Patients with motion intolerance or motion induced dizziness often benefit from vestibular rehabilitation. People who experience episodes of dizziness in an unpredictable fashion, such as those with Meniere's disease, are not candidates for vestibular exercises. Cochlear Implants - Hearing for the profoundly deaf Recently, the WVU Cochlear Implant Program has seen a surge of patients receiving implants. Virtually all patients who receive cochlear implants are able to hear sounds at a much lower decibel level than before surgery. Although the implant is supposed to be used in conjunction with lip reading, as many as half the patients are able to use the telephone after receiving the device. Currently, more than 100,000 patients worldwide have received cochlear implants. Candidates for cochlear implantation are evaluated by Dr. Stephen Wetmore and his team of audiologists. After undergoing the two and one-half to three hour operation, the patient is usually discharged home the same day. In four to six weeks the patient spends one to two days with our audiology team to have the device programmed. Patients who have had some degree of hearing earlier in life and who have good speech usually learn to use the device rapidly. Children who were born with profound hearing loss require intensive therapy in order to benefit from the cochlear implant. Cochlear implantation costs between $50,000 to $60,000. Most of the cost is the device itself. Fortunately, most third party payors will pay for the cochlear implant because it is no longer considered experimental and is FDA approved. Meniere's Disease Meniere's disease is thought to result in an excess of fluid in parts of the inner ear. The main treatment consists of a diuretic, that is, a pill that helps the body get rid of excess fluid, and a low salt diet. Ancillary treatments may include symptomatic treatment with drugs to suppress dizziness, such as meclizine (Antivert) or diazepam (Valium). The majority of patients with Meniere's disease derive significant relief with medical treatment. Those who fail medical treatment are offered surgical treatment, which is often successful. Hearing Loss A conductive hearing loss results when the sound waves have difficulty getting transmitted from the air outside the ear to the tiny hair cells in the cochlea (inner ear) where the sound waves are transmitted as nerve impulses. An obstruction of the ear canal from wax or from swelling of the ear canal as seen in swimmer's ear can result in a conductive hearing loss. After the sound waves travel through the ear canal they cause the tympanic membrane (eardrum) to vibrate. These vibrations are transmitted through the three tiny ear bones of the middle ear space and cause movement in the fluid that resides in the inner ear. The middle ear contains air that is replenished through the eustachian tube each time that we swallow. An upper respiratory infection can cause the eustachian tube to malfunction resulting in fluid instead of air in the middle ear. This fluid dampens the effective transmission of sound through the ear bones resulting in a mild or even moderate hearing loss. A middle ear infection prevents sound transmission in the same fashion. Middle ear fluid is a very common occurrence in children, occurring at least on one occasion in 70% of children. Less common causes of conductive hearing loss include skin cysts that are related to eustachian tube malfunction, middle ear birth defects that result in malformed ear bones, and otosclerosis, a bone disease of the stapes that results in decreased movement of that bone and ineffective transmission of sound waves into the inner ear. Most causes of conductive hearing loss are treatable either medically or surgically. Sensorineural hearing loss occurs when the hair cells in the cochlea are damaged and fail to transform vibrations of the inner ear fluids into electrical signals that are transmitted to the brain. Inherited malformations of the inner ear can either cause hearing loss at birth or else a progressive hearing loss later in life. Some inherited causes of hearing loss are associated with other inherited abnormalities, such as eye problems, heart abnormalities, or abnormalities of other body systems, but the majority of people with inherited hearing loss have no other abnormalities. Idiopathic sudden sensorineural hearing loss is a disease probably caused by viruses that result in sudden loss of hearing. The audiometric patterns are not of a sensorineural hearing loss. The hearing loss occurs suddenly, that is over the course of seconds to minutes and often is associated with ringing in the ears, and is sometimes associated with dizziness. Corticosteroid therapy, if given within the first ten to thirty days is usually helpful in the treatment of this condition. A very common cause of sensorineural hearing loss is exposure to loud noises. This type of hearing loss results from long-term exposure to noise, such as in coal mines, factories, or from shooting guns or listening to loud music. As a general rule if your ears are ringing after you leave a noisy environment, the sound could be damaging to your inner ears. Ear muffs or ear plugs can protect the individual from inner ear damage in most circumstances. The aging process can also result in hearing loss. Part of the hearing loss seen in old age may be due to the long-term effects of noise exposure in our industrialized society. Elderly people in primitive societies usually do not exhibit the same degree of hearing loss as is seen in industrialized countries. Some individuals have a genetic predisposition for a progressive hearing loss as they get older. A number of other conditions, such as Meniere's disease, sudden sensorineural hearing loss, and head injuries can cause sensorineural hearing loss. Sensorineural hearing loss can also result from diseases that affect the auditory nerve that connects the hair cells to the brain. An example would be the acoustic neuroma, which is a benign tumor of the auditory nerve that results in a slowly progressive one-sided hearing loss often associated with ringing of the ear. Most causes of sensorineural hearing loss can be treated with hearing aids. Those individuals with a profound hearing loss in whom a hearing aid is not providing adequate help may benefit from a cochlear implant. Otitis Media Acute otitis media is the term for the middle ear infection that results in an earache often followed a day or two later by pus draining from the ear. Antibiotics are the main treatment. If the child develops repeated bouts of acute otitis media over a relatively short period of time, insertion of ventilating tubes is recommended. Otitis media with effusion is the collection of fluid in the middle ear that results from eustachian tube malfunction and causes a stuffy sensation in the ear and a mild to moderate hearing loss. Often otitis media with effusion will resolve without specific treatment. If it does not resolve spontaneously, antibiotics are often prescribed even though antibiotics are only effective in 15 to 20% of cases. If the fluid persists for more than 3 months and is causing a significant hearing loss, surgical removal of the fluid and insertion of ventilating tubes is warranted. The intermittent or persistent hearing loss seen in young children with otitis media may result in delayed acquisition of speech and in learning disabilities. Facial Nerve Paralysis (Bell's Palsy) |
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