New Horizons Un-Limited Inc.

• DEFINITION
  
• CAUSES
  
• CHARACTERISTICS
  
• STATISTICS
  
• PREVENTION
  
• AWARENESS
  
• VIEWPOINT
  
• NEEDS AND SOLUTIONS
  
  • Treatment and Rehabilitation
    
• LEARN MORE about VESTIBULAR DISORDERS
  
• REFERENCES
  

• Vestibular Disorders are inner ear disorders that may cause imbalance, vertigo, dizziness, tinnitus, and hearing loss.

• Simple Glossary of Vestibular Terms was developed by an attorney. It defines some of the terms that are used in discussing vestibular disorders including the names of medical conditions, methods of treatment, and tests used to help diagnose vestibular disorders. It includes links to more information about some of the terms defined. This is part of a larger website about brain injury law. This website was developed by Attorney Gordon S. Johnson, Jr., Johnson Law office, P.O. Box 1319, Sheboygan, WI 53082 or Phone: 800-992-9447 (Brain Injury Law Group).

Various Vestibular Disorders

• Benign Paroxysmal Positional Vertigo (BPPV)

• Meniere's Disease (idiopathic (unknown cause) endolymphatic hydrops)

• Secondary Endolymphatic Hydrops

• Labyrinthitis & Vestibular Neuritis

• Perilymph Fistula

• Acoustic Neuroma

• Ototoxicity

• Vestibular Migraine

• Mal de Debarquement

• Pediatric Vestibular Disorders

• Aging, Dizziness, & Balance

• Cervicogenic Dizziness

• Otosclerosis

• Cholesteatoma

• Enlarged Vestibular Aqueduct

• Vestibular Hyperacusis

• Autoimmune Inner Ear Disease

• Superior Canal Dehiscence

Many of these disorders are complex because of their effect on the inner ear, which is partially responsible for our sense of balance, as well as to hearing. This effect may vary in severity, scope and duration. These Inner Ear Disorders or Vestibular Disorders that affect our sense of balance can be very disabling causing pressure or fullness in the ear, tinnitus (ringing or roaring), severe imbalance or vertigo (causing the person to fall, have nausea or vomit) or hearing loss. Some have unknown causes, are difficult to diagnosis, with diagnosis through exclusion by various otological and neurological tests, and are not curable. Discuss all treatment possibilities with doctors specializing in these disorders and seek second opinions. Treatments have been successful, but not necessarily in all patients. Always ask your doctor and/or pharmacist of side effects or risks.

Causes:

Characteristics:

The Vestibular Disorders Association (VEDA) lists the following possible symptoms people with Vestibular Disorders may experience. See their comprehensive list under "Symptoms" on their website.

• Vertigo and dizziness - Everyone has at some time experienced dizziness in the forms of light-headedness, vertigo, imbalance, or fainting. Most causes of vertigo (a type of dizziness) are due to a problem with the inner ear or specifically, the vestibular system.

• Balance and spatial orientation - People with Vestibular disorders may experience imbalance, stumbling and falling. When the brain is not getting good information from the inner ear about the body's balance and spatial orientation, the person must begin to depend on vision and the walking surface to orient the body's balance and place in space.

• Vision - busy surfaces, lights, etc. can confuse the person with a Vestibular Disorder as they are now relying on their vision to give the brain clues on balance. This confusion can lead to dizziness and nausea.

• Hearing - Vestibular Disorders may cause hearing loss. Another major symptom is Tinnitus, the ringing, buzzing, clicking sounds in the ear. This can lead to sensitivity to sudden or loud sounds.

• Cognitive and psychological - Anxiety and mental fatigue occurs when dealing with the symptoms of this disorder which can lead to depression. People with loss of hearing or tinnitus, lose out on pieces of conversation, can become confused easily by what is happening, or what is being said. Loss of control of one's balance can lead to loss of self reliance, self-esteem etc.

• Other - Dizziness can lead to nausea and vomiting. Some people may experience ear pain or headaches.

Statistics:

• There are no official statistics about vestibular disorders. The difficulties in diagnosing and classifying these disorders make it difficult to collect accurate information about vestibular disorders and the extent of vestibular disorders in the general population.

• VEDA (Vestibular Disorders Association) has collected some statistical information from a variety of sources. The VEDA page on statistics reports that VEDA, itself, averaged about 65,000 requests per month for information in 2005, up from 50,000 in 2003. They also report from other studies that more than 90 million Americans have had problems with dizziness or balance, that around 30% of people over 60 have experienced dizziness, that 10% of people with dizziness or balance problems experienced severe disability, and that at least 20% of the people diagnosed with a vestibular disorder were diagnosed with BPPV. Other common conditions include Meniere's Disease, labyrinthitis, and endolymphatic hydrops. To see more statistical information about vestibular disorders and a list of sources for the information presented go to the link listed above.

Prevention:

• Use safety equipment and safe practices when using factory, farm, or power tools.
• Protect the ears when using equipment of any kind that causes great change in pressure or sound.
• Become aware and be cautious taking the type of medications that can have a damaging affect on the inner ear, use other equally effective drugs if they are available. For more information, go to this article that Merck & Co., Inc., a global research-driven pharmaceutical company, has published on Drug-Induced Ototoxicity that discusses the medications that can cause damage to the inner ear.
• Mayo Clinic - Safety Tips to Prevent Falling People with Vestibular Disorders must take extra precautions to prevent falling. Vestibular Disorders can cause dizziness and/or vertigo which affects balance and mobility. The link above will take you to an article on safety tips for persons suffering from imbalance that were compiled by Occupational Therapist Olga Anderson and Physical Therapist John Carpenter, both from the Mayo Clinic Rochester.

Awareness

Needs and Solutions

• Emergency and critical care management

• Clinical diagnosis is critical. Patients need to be able to describe the sensation they are feeling, what triggered the dizziness event, the duration and severity of the attack.

• Special tests of balance function, hearing tests, CAT scan, and MRI scan are some of the tests used to diagnose a balance disorder. Referral to an ear specialist or neurologist may be necessary. Some diagnostic methods used include a rotating chair and moving platform, testing equipment that is not available in the average ear doctor’s office.

• If you did not find a clinic located near you at our page on Health and Care for Vestibular Disorders or if you want to see if there are other clinics in your area, the following websites list physicians and other health professionals located throughout the United States that specialize in diagnosing and treating vestibular disorders. The VEDA site also has lists for other parts of the world. The health professionals listed include physicians, physical therapists, and audiologists.
  • Vestibular Disorders Association (VEDA) Search By Region page provides maps that will allow you to find a list of health professionals that specialize in treating vestibular disorders in all parts of the world. On the U.S. map, click on a state to find a list for that state. For other parts of the world, click on the appropriate map.

  • Balance and Mobility Find a Balance Specialist page by NeuroCom International provides information about the different types of health professionals that specialize in the treatment of vestibular disorders. You can also find a list of specialists for any state using the US map at the bottom of the page. Click on the state for which you want to find a list of specialists.

• Patients with balance problems need to take proper precautions to avoid accidents that could be caused by their balance disorder. For instance, to prevent falls, provide clear egress through the home.

  Treatment and Rehabilitation

• The goal of treatment and rehabilitation after a diagnosis is to help the patient return to the highest level of function and independence possible and to diminish the effect of the Vestibular incident, managing vertigo, reducing frequency of attacks and preserving hearing.

  The following link will take you to an article from Washington University, "A Compilation of Treatments for Meniere's Disease," and will give you more information about various treatments currently being used to treat Meniere's Disease. This summary is compiled by Dr. Alec N. Salt, PhD, a researcher at Washington University, and will give you an overview and short description of these treatments.

  In order to help reach the goals of treatment and rehabilitation, Vestibular Disorder treatments may include the following:

  • Medication
  • Eliminating alcohol, coffee and salt may help make attacks less frequent and eliminating tobacco and stress may make them less severe.
  • Surgery
  • Treatments to help improve mobility
  • Activities and training to help improve motor skills, restore activities of daily living (ADLs), and help the patient reach maximum independence
  • Vestibular Rehabilitation is an article on eMedicine by Philip E. Zapanta, MD, that describes the Special Exercises in Vestibular Rehabilitation Therapy that helps the patient to adjust or accommodate to the Vestibular condition. This article explains how important this therapy can be in managing vertigo after 2-3 months of onset and how important the therapy is in the treatment of Vestibular disorders.
  • Education
  • Diet is extremely important in the treatment of Meniere’s Disease and several other vestibular disorders. The following sites on the Internet will help you to understand your dietary requirements better and how to meet them. The VEDA page offers a good introduction to the diet and why its important. The Washington ENT chart offers a good supplement to the VEDA page and helps one figure out what you should and shouldn't eat as far as salt is concerned. Changing your diet may be difficult as it also may require a lifestyle change. Also, consult your health care professional before you begin.
    • Dietary Considerations is a page on the VEDA (Vestibular Disorders Association) website, that will explain why you need to restrict your salt and sugar intake and limit or avoid a variety of substances including caffeine, alcohol, and nicotine. VEDA also publishes a low-salt cookbook (B-6) for $17.95 and a short publication called “Dietary Considerations with Endolymphatic Hydrops, Meniere’s Disease, & Vestibular Migraine (S-17) for $4.00. An order form and list for ordering these publications can be found under “Publications and Membership” in the toolbar at the top of the page. For more information, send e-mail to: info@vestibular.org

    • "Dietary Considerations in the Treatment of Meniere's Disease" is a link to an article from the website of the Midwest Ear Institute in Indianapolis, IN. It covers the possible affects of sodium, caffeine, and alcohol on the inner ear. It includes a table on the caffeine content of beverages and medications. It also contains a link to the article, "Sodium Content of Your Food", see below.

    • “Guidelines for a low-salt diet” will be found on the Meniere’s Disease page of the website for the Washington ENT Group in Washington, DC. The information here covers 4 steps in following a low-salt diet and then provides a chart of foods that contain high amounts of salt and foods that can be substituted in their place. This chart would be very helpful to anyone starting a low salt diet, which can be quite difficult.

    • "Sodium Content of Your Food" is a link to an article from the website of the Midwest Ear Institute in Indianapolis, IN. It provides information about the sodium content of foods. It includes a table categorizing foods by high, medium, and low sodium content and another table listing the sodium content of various foods in mgs.

  • Epley maneuver - The_Epley_Omniax/Epley Omniax is a device developed by Dr. John Epley, MD at his Portland, Oregon clinic that makes it possible to move a patient "through 360 degrees in any plane" for the purpose of diagnosing and treating positional vestibular disorders. Vesticon is a company in Portland that will be manufacturing and marketing the Epley Omniax starting in late 2006. To learn more about the Epley Omniax, go to the Vesticon website and/or the Portland Otologic Clinic website. These websites will tell you about the Epley Omniax and show you pictures of it in use. Vesticon has a list of experts and patients they can recommend for interviews by the media. (See Media Inquiries on website.) Vesticon is located at 2203 NE Oregon St., Portland, OR 97232, Phone: 503-230-0539, ext 200 or 0 or e-mail www.vesticon.com/Contact_Us/

Learn More about Vestibular Disorders

• The Ear InfoSite is a website of information about dizziness and hearing loss sponsored by the Portland Otologic Clinic. The site includes a description of how the balance system works and information about the most “Common Syndromes”. These are Meniere’s Disease, Benign Paroxysmal Positional Vertigo (BPPV), Post-traumatic Vertigo, and Vestibular Neuronitis (labyrinthitis). There is also a glossary of terms associated with dizziness and balance disorders.

• emedicine-Neuro-otology is a website of medical information for doctors and other health professionals. The Neuro-otology pages have articles covering benign paroxysmal positional vertigo (BPPV); dizziness, vertigo and balance problems; endolymphatic hydrops including Meniere’s Disease; labyrinthitis; and syncope (fainting). The articles cover the nature, symptoms, and possible causes of a health condition; procedures for diagnosing and treating the condition; and information about the possible drugs that might be used to treat the condition. Although these pages are written for medical professionals, a lay person can learn quite a bit about a health condition and its treatment from reading these pages.

  Health Link - Ears/Hearing Page-is a list of articles about hearing and vestibular disorders provided by the Medical College of Wisconsin at Milwaukee. There are articles on acoustic neuromas, Meniere's Disease, dizziness, tinnitus, and motion sickness. To access an article, click on it's title. An article may cover any of the following: the nature, symptoms, causes, diagnosis, treatment, or how to live with the condition it covers. BPPV is covered in the article on dizziness. There are several articles about tinnitus. HealthLink is sponsored by the Medical College of Wisconsin, Office of Clinical Information, 9200 West Wisconsin Ave., Suite 2975, Milwaukee, WI 53226. For more information contact HealthLink by Fax: 414-805-7967 or e-mail at healthlink@mce.edu Vestibular Balance Disorders: Vertigo, Motion Sickness, and Dizziness"> on Medicinenet.com, written by Medical Author: James K. Bredenkamp, MD, FACS and Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.

• Meniere’s Disease-Information and Support for people with Meniere’s Disease is a website written by a lady with Meniere’s Disease to help people with Meniere’s and their families and friends understand the disease better. The Home page describes Meniere’s Disease and lists links to two on-line support groups. The other pages on the website provide links to information about Meniere’s Disease. Go to “Meniere’s Info” to access a long list of articles about Meniere’s Disease and related subjects. Go to “Meds and Tests” to learn about various tests and medications that are used to diagnose and treat Meniere’s Disease. “Other Disorders” will give you access to information about other vestibular disorders such as perilymph fistula and some diseases that are not vestibular disorders such as diabetes. “Options” will give you information about various treatments you might want to know more about. “Misc. Information” covers a variety of information and subjects related to Meniere’s including an article on Van Gogh and information about social security disability. It also provides links to a few personal stories. For more information, e-mail sqm@idnsi.net

• The Meniere's Page (Washington University) on the website for The Department of Otolaryngology of the Washington University School of Medicine at St. Louis MO has some very good information about Meniere’s Disease. It has pages that cover the symptoms and prevalence of Meniere’s Disease, a list of possible treatments, trends in research, other sources of information, and an interesting page on the effects of pressure changes on Meniere’s patients. There is also a page on the salt content of various foods and a page on the effects of the menstrual cycle on Meniere’s. The page about symptoms also has the stories of four Meniere’s patients and the symptoms they have reported experiencing. There is also a question and answer page of questions submitted by patients. Questions can be submitted by e-mail from that page. There is also a link to the Cochlear Fluids Research Laboratory website from The Meniere’s Page. Click on “Learn about the inner ear fluids” to access these pages. The information on the Laboratory website is highly technical.

• Portland Otologic Clinic - Questionnaire. Dizziness may make a person confused and it’s very hard to remember all the things a person wants to tell the doctor. The Patient Questionnaire is a checklist developed at the Portland Otologic Clinic in Portland, Oregon to help patients compile a list of their symptoms before they see a doctor. It can be very difficult for a patient suffering from severe dizziness to remember all the strange symptoms he or she has experienced up to the time of the first appointment with a doctor with special training in diagnosing and treating vestibular disorders. This questionnaire lists many of the varied symptoms that patients with vestibular disorders have reported to their doctors. It’s an easy form to use and can be used by anyone to see any doctor. A common symptom of vestibular disorders is short term memory. This form can help a patient be sure to have a list of all the symptoms that have been experienced at any time even if the person forgets about them at the doctor’s appointment.

• Vestibular Disorders is a website "with a mission to educate about the subtle yet disabling symptoms that can follow even seemingly minor brain injury. This page is incorporated within the brain injury web advocacy of the Brain Injury Law Group, a community of plaintiff's lawyers across the United States united by a common interest in serving the rights of persons with traumatic brain injuries and a common commitment to fully understanding the anatomic, medical and psychological aspects of brain injury." This website describes the post-traumatic effects of vestibular damage and the use of electronystagmography to diagnose this kind of damage in brain injury cases. Auto accidents are a common cause of vestibular disorders from head injury. This website also has a glossary of terms that are used in discussing vestibular disorders and a page called Vestibular Resources with links to the resources listed. The Vestibular Resources page can be found by looking for a link (find "Next") on the glossary page. This site is written by Attorney Gordon S. Johnson, Jr., Johnson Law Office, P.O. Box 1319, Sheboygan, WI 53082 or Phone: 800-992-9447 (Brain Injury Law Group). Links to a variety of resources can be found on the page called Vestibular Resources

• Vestibular Disorders Association (VEDA) is an international organization based in Portland, Oregon that offers information and support for people suffering from inner ear disorders that cause dizziness, nausea, and balance problems. VEDA publishes information about vestibular disorders and how to cope with them. VEDA has support groups located in the US, Canada, Europe, Australia, and New Zealand. VEDA also publishes a newsletter for members called On the Level. On their website they offer information for physicians that want to learn more about vestibular disorders and you will also find a list of physicians who specialize in treating vestibular disorders to help people who may be having difficulty finding a doctor that understands their condition. VEDA can be contacted at (800) 837-8428 (voice mail) or e-mail them from their website.

• Yourlife Vitamins-Meniere’s Disease is a page of information about Meniere’s Disease on the website of a company that manufactures vitamins and dietary supplements. The page covers a description and symptoms of Meniere’s Disease, treatment and possible lifestyle changes, and information about vitamins and herbs that might be helpful. It also covers holistic medicine, psychological counseling, acupuncture, and vestibular rehabilitation. The site is straightforward about the research done on dietary supplements it mentions. It has charts about dietary supplements and links to more information about those supplements. It also has links to more information about the symptoms of Meniere’s Disease, drugs used to treat it, and other related topics. It also warns people, at the bottom of the page, to consult their doctor before trying a supplement.

References

• The Ear InfoSite is a website of information about dizziness and hearing loss sponsored by the Portland Otologic Clinic. The site includes a description of how the balance system works and information about the most “Common Syndromes”. These are Meniere’s Disease, Benign Paroxysmal Positional Vertigo (BPPV), Post-traumatic Vertigo, and Vestibular Neuronitis (labyrinthitis). There is also a glossary of terms associated with dizziness and balance disorders.

• MedicineNet.com

• The Meniere's Page (Washington University)

• The Vestibular Disorders Association (VEDA) is an international organization based in Portland, Oregon that offers a great deal of information, resources, advocacy and support for people suffering from inner ear disorders that cause dizziness, nausea, and balance problems. This includes information on causes, diagnostic tests, treatments, symptoms, research and the body's balance system.

For more on the topic of Vestibular Disorders

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