Dizziness and balance disorders: A-Z glossary
An extreme or irrational fear of heights. Vertigo (loss of balance/dizziness) is often incorrectly used to describe the fear of heights.
Agoraphobia is usually defined as a fear of open spaces, however, agoraphobia is an anxiety disorder which consists of the fear of experiencing a difficult or embarrassing situation from which the sufferer cannot escape; such as situations where they feel trapped, insecure, out of control, or too far from their personal comfort zone. Panic attacks are a common feature of agoraphobia.
Alcohol can be a problem for some people with Ménière’s disease as it can cause the tiniest blood vessels at the very end of the system to contract and so restrict the blood supply to the inner ear. Small amounts of alcohol - half a pint of beer, a glass of red wine or a pub measure of spirits - can actually improve the peripheral circulation, but any more has the opposite effect.
Arlevert is a combination drug made up of Cinnarizine & Dimenhydrinate. Cinnarizine is a specific calcium antagonist; dimenhydrinate is an antihistamine with anticholinergic properties. Arlevert is used to treat vertigo of various origins (central and/or peripheral vertigo), including otogenic vertigo, vertigo because of vestibular neuropathy, Ménière’s disease, Ménière-like syndrome and vertigo because of vertebrobasilar insufficiency. This combination medication has only just been licensed for use in the UK, however, Arlevert has been available in Germany for a number of years.
Attendance Allowance is a tax-free benefit for people aged 65 or over who need help with personal care because they are physically or mentally disabled. In order to claim Attendance Allowance you must have had the disabling condition for at least six months.
An audiogram is a test to see if your hearing is impaired and which ear is affected. Using a set of headphones, you will be asked to listen to sounds produced at different frequencies and levels of loudness. The audiologist will ask you to indicate each time you hear a sound and record the softest sound you can hear at each frequency. This is known as your hearing ‘threshold’. One ear is tested and then the other.
Audiology is concerned with the science of hearing, particularly diagnostic testing and the rehabilitation of hearing impaired individuals. You may get referred for treatment to the audiology department of your local hospital if you have problems with hearing and/or balance.
The sense of balance is controlled by a “balance system” which brings together information from three different sources:
- Vision – you can literally see where you are and where you are going
- All the sensors in the body – the joints, muscles, soles of the feet and so on. With these sensors you can feel where you are and how you are moving
- A set of fluid-filled tubes in the inner ear known as the vestibular organ. This gives out signals whenever the head is moved or tilted.
Information about your position and movements from these three sources is fed to the brain. The brain acts like a computer, combining the information from all the senses to give a stable picture of the world and to control head, body and eye movements. If any part of this balance system is giving out unusual or faulty information then dizziness and imbalance may result.
Benign paroxysmal positional vertigo (BPPV)
The definition of BPPV can be broken down as follows:
- Benign – because it is not due to serious disease, though it can be quite disabling.
- Paroxysmal – because it occurs in short bursts of up to a minute only.
- Positional – because it is provoked specifically by movement to or from certain positions.
- Vertigo – the type of dizziness defined as an illusion of movement, either of the sufferer or of their surroundings, not just a fear of heights!
Betahistine is also known by the brand name Serc. It is a histamine analog and is one of the most commonly prescribed drugs for Ménière’s disease, vertigo or dizziness in the UK. Betahistine is used to treat vertigo, tinnitus and hearing loss associated with Ménière’s disease. Betahistine works by acting on histamine receptors that are found in the walls of blood vessels in the inner ear. By activating these receptors, a process is started which is thought to reduce the pressure of the fluid that fills the labyrinth in the inner ear. This helps to relieve the symptoms associated with Ménière’s disease. It is a prescription only medication.
Bilateral Ménière’s disease
If you suffer from bilateral Ménière’s disease, both ears are affected.
Bone anchored hearing aid (BAHA)
Bone anchored hearing aids use bone conduction to transmit sound to the inner ear. A bone anchored hearing aid is a hearing aid placed on the bone on the affected ear. The sound is transmitted through the bone from the affected side to the normal side. The sound is heard in the normal side but the person thinks they are hearing it in the bad side.
Coffee and tea containing caffeine can sometimes be a problem for sufferers of Ménière’s disease. Caffeine can cause the tiniest blood vessels at the very end of the system to contract and so restrict the blood supply to the inner ear. A cup or two is one thing but 10 or more strong coffees a day can make your symptoms much worse.
Calcium Channel Blockers, sometimes called calcium-antagonists, are drugs that prevent, at different parts of the body, the activity of calcium. The calcium channels in our body are different depending on where they are, e.g. if they are on the blood vessels of our head, our inner ear or on our heart. Therefore, the drug that we give has to be specific to those channels. Stugeron (cinnarizine) is a calcium antagonist, although not a powerful one. This acts mainly on small blood vessels and prevents constriction on these vessels. In theory it therefore improves the micro circulation of the ear.
The caloric test investigates the function of the horizontal semicircular canal in the inner ear. It involves stimulating the semicircular canal, by introducing warm or cold water or air into the outer ear canal, and recording the eye movements (nystagmus) produced. It requires little sophisticated equipment and is, therefore, the test used by most hospital departments. It is a test that looks at the balance function and it may help to differentiate which ear is affected. In Ménière’s disease it can be vital to have this information if surgery is being considered.
Cinnarizine is an antihistamine medication. It is also known by the brand name Stugeron. Cinnarizine is used to control travel and motion sickness. It is used to treat the symptoms of nausea, vomiting, vertigo and tinnitus associated with Ménière’s disease. Cinnarizine is also used to treat disorders of the middle ear.
The cochlea is part of the inner ear. The cochlea is the sense organ that translates sound into nerve impulses to be sent to the brain. The cochlea contains three fluid chambers: two contain the same type of fluid and the middle one, the endolymph chamber, contains a different type of fluid – this is the one that gets swollen in Ménière’s disease. Tiny bones in the middle ear transmit sound from the eardrum across the middle ear and vibrate against the cochlea. Vibrations in the fluid cause tiny hair cells in the fluid inside the cochlea to vibrate and generate nerve impulses that then travel to the brain. The cochlea is shaped like a spiral and gets it name from the Greek word Kokhlias meaning snail.
A cochlear implant is an electronic hearing device. Where hearing aids amplify sounds so they may be detected by damaged ears, cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognises the signals as sound. A cochlear implant has several different parts - some internal and some external. The internal parts cannot be seen and are implanted at surgery. They consist of a magnet, receiver/stimulator and electrode array. The external parts are worn behind the ear like a conventional hearing aid and consist of a head coil (to attach to the internally implanted magnet), programme and volume control, sound processor, microphone and battery.
Cognitive behaviour therapy
Cognitive behaviour therapy (CBT) is a short-term treatment which can help you to change how you think (cognitive) and what you do (behaviour). Changes in these areas can help you to feel significantly better in coping with your day-to-day life. CBT is used to solve a variety of problems, from anxiety, sleeping difficulties and depression to drug and alcohol addiction. As well as coping with these long term conditions, CBT is increasingly being used to help manage tinnitus.
A consultant, sometimes referred to as a specialist, is a doctor who has chosen and trained in a speciality area, e.g. ENT, otolaryngology, neurology. You are usually referred to an appropriate consultant by your GP. Consultants can be seen on the NHS or privately.
Counselling sessions are designed to help self exploration and understanding to identify thoughts, emotions and behaviours that lead to a greater sense of personal resources and self determined change. This means that counselling helps you to find ways to adapt, make the most of your situation and gain confidence in yourself to try new ways of thinking and feeling that can improve the quality of your life. Counsellors are trained to listen. You can express your thoughts and feelings freely knowing that the counsellor is there for you and will understand your situation. The counsellor will not impose his or her views on you; it is your individual perception of the situation that is important. Often family and friends are themselves too involved in your life to allow you to express yourself freely. The relationship with the counsellor is confidential.
A CT (or CAT) scan stands for computerised tomography. The scan takes pictures of the body from different angles using x-rays and uses a computer to put them together. The CT scanner is a large machine. You will be required to lie down inside the scanning machine. The machine will move you backwards or forwards a small distance after each x-ray. You will be asked to lie very still, but breathe normally. The radiographer operating the machine will leave the room during the scan, but will be able to talk to you via an intercom. Several scans will be carried out. It is a painless procedure and may last from a few minutes to 30 minutes.
As many of you will have experienced, diagnosis of Ménière’s disease can often be a long and frustrating process. There can be many other reasons why people have balance problems and it often takes the medical profession a couple of years before they will comfortably diagnose Ménière’s disease. Diagnosis is usually made by an ENT Consultant, who will be able to run a series of tests, such as the MRI scan, which will rule out other possible causes of the symptoms.
Hearing loss is one of the three the symptoms of Ménière’s disease and, as with every aspect of Ménière’s disease, it affects everyone differently. In the early stages, during a vertigo attack there is a variable amount of hearing loss, a sensation of fullness and discomfort in the affected ear. In the intermediate stages, permanent hearing loss develops and continues to fluctuate with the vertigo attacks. The hearing loss increases in the later stages.
Coffee, tea and alcohol can be a problem as they cause the tiniest blood vessels at the very end of the system to contract and so restrict the blood supply to the inner ear. Following a low-salt diet can help to reduce the frequency and severity of attacks of vertigo in some people.
Diplacusis is when the same tone is heard as a different pitch in each ear. With vestibular disorders the pitch in the affected ear is slightly higher than in the unaffected ear. A Ménière’s patient has a distorted ear and so has a distorted receiver. If a 512 hertz tuning fork is struck and the patient is asked if it sounds of a different timbre, tune or quality, almost invariably the Ménière’s patient says yes the sound in the affected ear is of a different quality and frequently of a different pitch. Associated symptoms with diplacusis are hyperacusis and recruitment.
Diuretic medicine increases the production and flow of urine from the body, used to remove excess fluid from the body. In Ménière’s disease diuretics are used to help remove the excess salt in the fluid from the body.
Disability living allowance
Ménière’s disease is a condition that produces symptoms of varying severity. Depending on how severely you are affected, you may be entitled to receive Disability Living Allowance.
If you have been diagnosed with any balance disorder, you are required to inform the DVLA.
This test evaluates the signal that comes from your ear if you put a loud sound into the ear, and it records the electrical signals in and around the ear. It measures a part of the brain wave that comes from the inner ear, and, if there is an abnormal form to that potential, it’s thought to be due to Ménière’s disease or hydrops.
This is a test where electrodes are put on the patient’s forehead which measure the eye movements. These tests of eye movements work out how well the eyes are wired into the brain, and how well the nerve responds controlling your eyes, because some of the things that may cause dizziness can affect the nerves controlling the eyes.
Employment and Support Allowance (ESA)
Employment and Support Allowance offers financial help to people unable to work due to an illness or disability and offers personalised support and financial help, so that you can work if you are able. Employment and Support Allowance replaced Incapacity Benefit from 27 October 2008. Visit GOV.UK for further info (external site).
Endolymphatic hydrops is a disorder of the vestibular system of the inner ear. It stems from abnormal fluctuations in the fluid called endolymph, which fills the hearing and balance structures of the inner ear. In Ménière’s disease there is too much endolymph fluid in the inner ear. This condition of excess fluid is referred to as endolymphatic hydrops. Endolymphatic hydrops are referred to as primary or secondary. Primary idiopathic endolymphatic hydrops, known as Ménière’s disease, occurs for no known reason. Secondary endolymphatic hydrops occur in response to an event, such as head trauma, or an underlying condition, such as an autoimmune disorder.
The endolymphatic sac is part of the membranous inner ear. Saccus decompression surgery is a surgical operation on the endolymphatic sac of the inner ear. There are several variations. They aim to reduce the pressure of fluid in the sac.
This is the most common procedure to relieve the symptoms of BPPV. BPPV is the most common cause of vertigo. The Epley manoeuvre begins by making the patient dizzy with the appropriate Hallpike test. The patient is then rolled over (in stages, pausing for about half a minute in each position) onto the opposite side, before being sat up again. This manoeuvre floats the chalk crystals (that cause the problem) round the affected canal and out of the far end, back to where they belong.
In our experience, most people with Ménière’s disease report no difficulty at all with flying, indeed some report feeling better for the experience. If your main problem when flying is severe ear pain, it is not likely to be a result of Ménière’s disease. Thirteen per cent of people get pressure in the ear when flying. Frequent attacks of vertigo, or the uncertainty of when an attack might occur, may make you reluctant to travel, but there are a few basic steps which you can take to make travel that little bit easier; whether you’re just going out to do the week’s shopping or are off for a holiday abroad.
There is often fear and loss of confidence associated with Ménière’s disease which prevents many people from leading a normal life. This feeling is real and understandable because no one can predict when an attack is going to occur. Social contact often becomes limited because of the worry of experiencing an attack in public places. All this fear boils down to the one fear of not being able to cope. When you know how to handle things, they look different. The anxiety doesn’t go away but you know you have some control and this is the key to dealing with fear. Eventually you will learn how to handle both Ménière’s disease and the fear.
Fight or flight
When you feel particularly stressed, anxious, angry or fearful, you may be more likely to experience dizziness. This is because some of your body’s automatic reflexes are linked to your emotions and thoughts through a process called the “fight or flight” response. Your brain interprets any strong emotions or frightening thoughts as a signal that you are in danger, and automatically prepares your body to either fight or run away. This means that your heart rate increases and your breathing gets faster as blood is pumped to your muscles. A side effect of this is that you may feel sick or dizzy, since breathing too fast causes you to take in too much oxygen, which can make you dizzy.
Many people who have Ménière’s disease describe a feeling of ‘fullness’, or a build up of pressure in their ear. This is a common symptom for people with Ménière’s disease and can be likened to the feeling some people get when they have a heavy cold or experience a pressurised environment, such as air travel. It is a strong belief that Ménière’s disease involves an excess pressure of the sodium-rich fluid (called endolymph) that surrounds this area of the inner ear. That is why it is thought that reducing salt in your diet may be helpful, because it may reduce the pressure of that fluid. The build up of this fluid accounts for the feeling of fullness in people’s ears before an attack. The sudden release of that pressure, with the chaos that ensues, accounts for the sudden attack of vertigo that you have, and for the sudden changes in hearing that happen.
The balance system is a very complex integrated system in the brain that functions subconsciously - you don’t need to think about it. Normally when you do something you don’t have to think about where your arms and legs need to be, it happens automatically. As soon as you need to think about your balance and it comes to a conscious level and you need to concentrate on how you are going to get across the room to the door or where you are going to put your feet your brain becomes cluttered and occupied with these problems and you become forgetful. The brain is like a computer and its processing time is being taken up with things that you normally don’t think about, your balance. Something has to suffer and that is usually your normal thought processes and you find it difficult to cope with what’s going on.
Although there is currently no proven evidence that Ménière’s disease is a genetic disorder, there is a familial occurrence in some groups; around 7-10% of sufferers have a family history of the disease. There are studies looking into the genetics involved in Ménière’s disease and this may be an area to analyse further in the future.
Gentamicin is an antibiotic belonging to a family of similar drugs called aminoglycosides. The drug is injected into the middle ear using a variety of techniques. Some doctors place a plastic tube into the eardrum, others use a small pipe through which the drug is placed and others use a very fine needle to inject it through. Depending on the technique used, one to 12 treatments are given. The end result is a pool of gentamicin sitting in the middle ear. This passes through into the inner ear and destroys the cells that register movement in the balance organ. It is like cutting the wire leading from a faulty light switch thereby preventing the light from flashing on and off.
A grommet is another name for a tympanostomy tube. Grommets are inserted into the eardrum to allow air into the middle ear space. There should be air in the middle ear space because it is connected to the back of your nose through the Eustachian tube. It is thought that it is possible that the pressure in the two systems might be different and grommets will allow that pressure to equalise. Since the fluid inside the inner ear is actually exposed in terms of the pressure change to the small membrane called the round window membrane, it is possible for changes in pressure in the middle ear to affect the pressure in the fluid compartments. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. If it is necessary to keep the middle ear ventilated for a very long period, a “T”- shaped tube may be used. Materials used to construct the tube are most often plastics such as silicone or Teflon.
Hair cells in the inner ear send balance signals back to your brain via the vestibular nerve. Your whole inner ear is filled with endolymphatic fluid. The fluid moves around your inner ear when you move. The hair cells in your balance organ are activated to send signals to your brain when they are moved by this fluid. Like the balance organ, the hearing organ is also covered in tiny sensory hair cells, and is filled with the same endolymphatic fluid. In Ménière’s disease, the sensory hair cells at the centre of your hearing organ are damaged first, causing tinnitus and hearing loss for low pitched sounds. As the disease progresses, the hair cells on the rest of your hearing organ can also become damaged, eventually affecting your ability to hear all sounds.
One of the symptoms of Ménière’s disease is loss of hearing. Sufferers are usually only affected in one ear and, while there is one normal hearing ear, there may well be no difficulty in hearing in normal situations. In a minority of patients however, Ménière’s disease may develop in the second ear. The organ in the inner ear which controls the hearing is called the ‘cochlea’.
Hormones are chemicals released by cells that affect cells in other parts of the body. There are a group of Ménière’s sufferers who report an in increase in symptoms around menstruation. In a recent study from Los Angeles six out of 109 women with Ménière’s disease stated their symptoms were worse immediately before their menstrual period. The exact mechanism is uncertain. One potential explanation is that the change in the concentration of female hormones oestrogen and progesterone immediately before a period, together with an increase in a further hormone called aldosterone, leads to fluid retention, and this increases the volume and pressure of the endolymph within the inner ear hence worsening the vertigo. Other explanations have suggested that the hormonal change at this time alters the blood’s viscosity hence there is a reduction in the inner ear’s microcirculation with a loss of function.
When a person is unable to tolerate everyday sounds, which don’t seem to bother other people, as they seem too loud, the medical term given to this is hyperacusis.
Ménière’s disease is a condition of the inner ear. The inner ear has two main parts:
- The cochlea, which is responsible for hearing.
- The vestibular apparatus, which is responsible for balance and motion.
The labyrinth is a system of fluid passages in the inner ear, which includes both the organ of hearing (the cochlea) and the organ of balance. Due to its ‘maze-like’ appearance the labyrinth is named after the mythical maze which imprisoned the Minotaur.
Labyrinthitis is inflammation of the part of your inner ear known as the labyrinth. The labyrinth is made up of channels filled with fluid which control your balance and hearing. When you move your head, the fluid in the channels moves and this tells your brain which direction you are moving in and how far and how fast you are going. This information helps your body to balance. Your hearing is controlled by the part of the labyrinth known as the cochlea.
Read more about labyrinthitis vestibular neuritis.
A labyrinthectomy is a surgical procedure which destroys the whole inner ear; that is the hearing and vestibular function. It can be done by drilling out the bone and removing all of the labyrinth which is the Osseous Labyrinthectomy. You can also open the inner ear and destroy some of the soft tissue in there, and this is described as a Labyrinthectomy as well.
Certain changes in lifestyle can be beneficial to people with Ménière’s disease and can help them in controlling their symptoms. Dietary changes, such as not overloading with salt, sugar and caffeine can be helpful, as can controlling stress and complementary/alternative therapies.
Lipreading is ‘seeing the sound of speech’ — the movements of the lips and the tongue, together with facial expression and body language are all clues for the lipreader. The lipreader will also observe the syllables, the natural flow, the rhythm and phrasing and the stress of speech.
A lipspeaker is a hearing person who has been professionally trained to be easy to lipread. The lipspeaker must be clearly visible to the lipreader as they silently and accurately repeat the words, supporting their meaning with gesture and facial expression.
When a chronic condition strikes a member of a family, it brings with it a host of powerful emotions. These emotions, such as shock, are common with the loss associated with bereavement. You may go numb and stop functioning or deny what is happening. You may get into a state of frantic energy. You may lose your concentration and memory, get depressed or start to have panic attacks. You feel sad if someone dies and, in a sense, with chronic illness, part of you does die. You may find that as well as the health you took for granted, you may also lose your self-confidence, your job and your ability to do certain things, such as sport. By accepting this loss, and focusing on what you can do rather than what you can’t, with time you can overcome the loss and regain control.
Magnetic resonance imaging (MRI) scan
One of the tests you may receive when you visit the ENT department is an MRI scan. The scan uses a strong magnetic field and radio waves to produce detailed pictures of the inside of your body. When investigating patients suffering from dizziness, this specialised investigation will be used to look at the ear, including the inner auditory canal between the inner ear and the brain, and at the brain itself. It is used to exclude a tumour in the auditory nerve and brain.
Mal de debarquement syndrome (MdDS)
Mal de debarquement Syndrome is a condition which causes the sufferer to have a constant feeling of imbalance and unsteadiness after exposure to motion such as a cruise or flight. After debarking (debarquement) the individual continues to feel ‘at sea’. Although many people may get this sensation temporarily after travelling, MdDS sufferers experience these symptoms constantly.
There is no specific medication for Ménière’s disease; however, medication may be given to treat the symptoms. betahistine (Serc), prochlorperazine (Stemetil) and cinnarizine (Stugeron) are most commonly prescribed to people with Ménière’s disease/vertigo. Some people may also be prescribed a diuretic.
Meditation is a way of being in a focused and attentive, yet relaxed state. It is not a treatment, but a practice. A therapist may not be needed as the techniques can be self-taught. Some of the more common forms of meditation include the use of breathing techniques, mantras, focusing on an object, guided meditation, listening and mindfulness. Meditation can be used in many ways, including as a relaxing antidote to stress/stress-related illnesses, a treatment for insomnia, a way of changing consciousness for pain relief, a route to personal growth or as a spiritual practice.
Ménière’s disease is a condition of the inner ear. The symptoms of Ménière’s disease are vertigo (severe dizziness), tinnitus and hearing loss. The cause of Ménière’s disease is unclear and there is currently no known cure.
The Meniett device (Medtronic-Xomed) is a portable, battery operated, low pressure wave pulse generator. It consists of a device box and an earpiece linked by a clear plastic tube. The ear piece is placed in the ear canal by the user and then the Meniett is switched on. It then creates a low pressure wave that is transmitted to the ear by the ear piece. Transmission of the pressure wave to the inner ear relies on a grommet being present in the ear drum. This is to allow the air pressure wave through to the middle ear, where it can act on the inner ear via the round window membrane.
Migraine is the most common neurological condition and affects over six million people in the UK. A migraine is made up of several symptoms. The main symptom is a headache that lasts between four and 72 hours. The headache is usually moderate or severe and is often just on one side of the head and a throbbing pain. It can also be made worse by physical activity. Other symptoms of migraine include nausea and sickness, and sensitivity to light or sound. Approximately 10% of people with migraine experience unusual symptoms (called an aura) that affect vision, physical sensations, or speech. Visual symptoms might include blurred vision, blind spots, seeing patterns or flashing lights. Physical sensations might include pins and needles or numbness.
As well as the symptoms of migraine detailed above, the aura part of a migraine can also include similar symptoms to Ménière’s disease, symptoms of dizziness or vertigo, tinnitus and hearing loss. These aura symptoms usually last between 5 and 60 minutes before the headache starts (although there is also a type of migraine where these symptoms can happen without a headache). Although experts do not know what processes are involved in migraine, it is thought that the inner ear may be damaged by ongoing migraine attacks (also increasing the risk of BPPV).
Read more about migraine-associated vertigo.
A feeling of sickness with an inclination to vomit.
A neurectomy is the surgical removal of a nerve or section of a nerve. A vestibular neurectomy is one surgical procedure which may be performed for Ménière’s disease. The vestibular nerve carries information from the balance organ to the brain. In this procedure the nerve is cut stopping the abnormal information reaching the brain.
The scientific study of nerve systems.
A tumour on a nerve or in nerve tissue.
A branch of otology concerned with those parts of the nervous system related to the ear, especially the inner ear and associated brainstem structures.
Nystagmus is an uncontrolled movement of the eyes, usually from side to side, but sometimes the eyes swing up and down or even in a circular movement. Most people with nystagmus have reduced vision. For more information, visit the Nystagmus Network (external website).
Inflammation of the ear.
Inflammation of the external ear canal (the tube between the outer ear and eardrum). Otitis externa can be caused by an infection or allergic reaction. It is sometimes referred to as ‘swimmer’s ear’ because it can be caused by getting water into the ear canal.
Bacterial infection of the middle ear. Acute otitis media is a short-term ear infection that often comes on suddenly. Chronic otitis media is when ear infections keep coming back or one infection lasts a long time.
Any of the small particles of calcium carbonate in the inner ear.
The study of diseases of the ear.
The study of the anatomy and diseases of the ear.
The study of diseases of the ear, nose and throat.
Drug or chemical related damage to the inner ear which subsequently damages the organs responsible for balance and hearing. Ototoxicity can result in temporary or permanent disturbances of hearing, balance or both.
Pathology is the scientific study of the nature of disease and its causes, processes, development, and consequences.
Perilymph is the fluid that fills the space between the bony labyrinth and the membranous labyrinth in the inner ear. A perilymph fistula is an abnormal opening in the fluid filled inner ear; in most instances it is a tear or defect in one of the small thin membranes between the middle and inner ears.
Personal Independence Payment (PIP)
The Personal Independent Payment (PIP) is a new benefit to help disabled people live full, active and independent lives. It replaces Disability Living Allowance (DLA) for people of a working age (aged 16-64) from 8 April 2013. Visit GOV.UK for further information (external site).
Positional vertigo is dizziness provoked specifically by movement to or from certain positions. Benign paroxysmal positional vertigo (BPPV) is the commonest cause of vertigo. Movement provoked vertigo responds best to balance retraining with specific exercises. BPPV is the most readily treatable form of vertigo, using repositioning manoeuvres. It must be recognised, however, that not all positional vertigo is BPPV which must be distinguished from other, much rarer, causes of positional vertigo.
With a posturography test, you stand up in a machine and are secured with a harness; you look rather like you are about to take part in a parachute jump! During the test you are constantly moving, although not very much. The body is constantly allowing you to move backwards and forwards. If you tilt too far one way, the body senses bring you back again, and vice versa, that is what everybody does. The test watches how far people sway; the less of a balance mechanism you have, the more you sway.
The membranous inner ear is like a delicate complex balloon filled with a special fluid called endolymph that is rich in potassium ions and essential for proper function. The inner ear is especially sensitive to any disruption in potassium levels. One of the theories is that Ménière’s disease may be caused by metabolic disturbances involving the balance of sodium and potassium in the fluid of the inner ear. The chemical symbol for potassium is K.
Prochlorperazine is an anti-sickness drug and acts to reduce the impact of the abnormal signals coming from the balance organ helping to relieve the nausea and vomiting. It is also known by the brand names Stemetil and Buccastem. Prochlorperazine is used to relieve the symptoms of nausea, vomiting and vertigo associated with Ménière’s disease, labyrinthitis and other inner ear disorders.
A radiologist is a medical doctor who specialises in the reading and interpretation of X-rays and other medical images, such as an MRI or CT scan.
Recruitment causes your perception of sound to be exaggerated. Even though there is only a small increase in the noise levels, sound may seem much louder and it can distort and cause discomfort. Someone with recruitment can have problems only with specific sounds and frequencies or may have problems with all sound in general.
The round window is one of the two openings into the cochlea of the inner ear. It is closed off from the middle ear by the round window membrane. It allows fluid in the cochlea to move, which in turn ensures that hair cells of the basilar membrane will be stimulated and that audition will occur.
The Saccule (otolithic organ) is part of the balance organ of your inner ear.
This is a surgical procedure used for people with Ménière’s disease. The aim of the procedure is to stop the vertigo attacks, while preserving the hearing in that ear. There are several variations; all aim to reduce the pressure of the fluid in the endolymphatic sac.
A natural mineral made up of white cube shaped crystals composed of two elements - sodium and chlorine. When chemically united they form the compound sodium chloride or NaCl. Salt is used to season and preserve food. Small amounts of salt are essential in our diet, however most adults consume more than the recommended daily intake. Around 75% of the salt we eat is already contained within the foods we buy. It’s the sodium in salt that can be bad for your health. Sodium is usually listed in the nutritional information on food labels. Salt is also listed on some foods, but not all. If you know how much sodium is in a food, you can work out roughly the amount of salt it contains by multiplying the sodium by 2.5. So if a portion of food contains 1.2g sodium then it contains about 3g salt. Salt reduction is widely recommended for people with Ménière’s disease/vertigo, as reducing salt intake is thought to result in a reduction of endolymphatic pressure which may help reduce the symptoms of dizziness.
A Schwannoma is a tumour of the tissue that covers nerves. These tumours develop (and take their name) from a type of cell called a Schwann cell. Schwannomas are often benign (not cancerous). A vestibular schwannoma is a benign, slow growing tumour that develops on the balance and hearing nerves of the inner ear. A vestibular schwannoma is also called an acoustic neuroma.
There are three semicircular canals within the inner ear; known as the ‘horizontal’, ‘posterior’, and ‘anterior’ canals. The three canals are all at right angles to each other so that together they can detect movement across all the different angles you can move through. The semicircular canals are covered in tiny sensory hair cells which send balance signals back to your brain (via your vestibular nerve).
Stress is not believed to be the cause of Ménière’s disease, but it can exacerbate symptoms. Studies have shown that your body is less able to cope with dizziness when you are stressed. When you are under stress your body gets ready to fight or run away, known as the ‘fight or flight’ stress reflex. So you may become more dizzy and sick than you would if you were stress free.
The temporal bones form part of the sides and base of the skull. There are two temporal bones – one on either side. The temporal bones are closely involved in the anatomy of the ear and a number of important anatomical structures are housed within them. Temporal bone form is often studied by researchers looking at hearing disorders as some abnormalities can be linked to the formation of the temporal bone.
The temporomandibular joint (TMJ) is the area directly in front of the ear on either side of the head where the upper jaw and lower jaw meet. It is one of the most frequently used joints of the body. TMJ disorders are complex problems of the jaw joint and can be caused by a number of behaviours or conditions. Common symptoms of TMJ disorders include headache, ear pain, jaw sounds, dizziness, ear fullness and tinnitus. There are several treatment options for TMJ. Source: www.medicinenet.com (external website).
Tinnitus is the name given to the condition of noises in the ears and/or head with no external source. Tinnitus noises are described variously as ringing, whistling, buzzing and humming. The noise/s may be heard in one ear, both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high-pitched. There may be a single noise or two or more components. The noise may be continuous or it may come and go. Tinnitus is not a disease or an illness, it is a symptom generated within a person’s own auditory pathways. The precise cause of tinnitus is still not fully understood.
Transtympanic can be defined as ‘trans-’ meaning across and ‘tympanic’ relating to the tympanum (cavity of the middle ear). Thus, in transtympanic gentamicin (often also referred to as intratympanic) the gentamicin is injected through the tympanic membrane into the inner ear.
Dizziness induced by sound is known as Tullio phenomenon. It was first described by Pietro Tullio in 1929. Loud noises cause spinning vertigo for the sufferer, often accompanied by hearing loss and tinnitus. The dizziness associated with Tullio phenomenon is a symptom, not a condition, and so treatment will depend on the cause. It mainly occurs in four ear conditions: perilymph fistula, Ménière’s disease, vestibulofibrosis and postfenestration surgery.
Tumarkin’s otolithic crisis
Tumarkin’s Otolithic Crisis, also known as drop attacks are when a person will fall to the ground with no warning. The person will remain awake and will not lose consciousness. A drop attack feels as if you are being pushed violently and suddenly, causing you to fall. The symptoms are usually gone as quickly as they appear, and you can get up straight away and carry on with whatever you were doing (unless you get a drop attack at the same time as an acute attack of vertigo). During these attacks, the hair cells on your otoliths are suddenly activated, causing your balance to be severely disrupted. Drop attacks are sometimes experienced in the later stages of Ménière’s and do not affect everyone. Experts do not know how or why this happens.
One of the hearing tests which patients may undergo is tympanometry. A little rubber bung on a probe attached to the tympanometer is placed in the ear. You feel a pressure change and usually a varying noise. The test measures how well your Eustachian tube is working by bouncing sound off the eardrum.
Tympanostomy tube (T-tube)
A tympanostomy tube (T-tube) is a larger type of grommet. The tube is inserted into the eardrum to allow air into the middle ear space. There should be air in the middle ear space because it is connected to the back of your nose through the eustachian tube. It is thought that it is possible that the pressure in the two systems might be different and grommets will allow that pressure to equalise. Since the fluid inside the inner ear is actually exposed in terms of the pressure change to the small membrane called the round window membrane, it is possible for changes in pressure in the middle ear to affect the pressure in the fluid compartments. The tube itself is made in a variety of designs. The most commonly used type is shaped like a grommet. If it is necessary to keep the middle ear ventilated for a very long period, a “T”- shaped tube may be used. Materials used to construct the tube are most often plastics such as silicone or Teflon.
The thin membrane separating the middle ear and external ear is known as the tympanic membrane (eardrum). The name derives from the latin term ‘tympanum auris’ meaning drum.
Unilateral means one-sided. When a person with Ménière’s disease is referred to as having unilateral Ménière’s, this means only one ear is affected.
Urea is a natural substance related to urine. Professor Gibson in Australia calls it the Cinderella drug and in his many years of practice he has never known a patient have an attack of Ménière’s disease within four or five hours of taking an oral dose of Urea. It is an osmotic diuretic so it helps to lose fluid quickly. It is not readily available in the United Kingdom at present. If it is available and you’ve got a very important function, like a ball to go to, then at least you know that that evening you will get home without having had an attack.
The utricle is a one of the two otolithic organs of the inner ear.
Vertigo is a condition with a sensation of whirling and a tendency to lose balance. It is often referred to as dizziness or giddiness. Vertigo is often incorrectly used to describe a fear of heights. The symptom of vertigo often implies a disorder of the inner ear or vestibular system.
Vestibular is to do with a structure that is a vestibule (entrance), such as the vestibule of the ear. The vestibular system in the body is responsible for maintaining balance, posture, and the body’s orientation in space.
Vestibular evoked myogenic potentials (VEMPS)
VEMPS is a reflex. When you put loud sound into the ear this sound stimulates the bit of the inner ear called the saccule and it sends impulses through the nerve of hearing and balance to the brain and reflects back. VEMPS are used to assess if this is functioning properly. The response is measured on the neck muscle. Discs are attached to the patient’s collarbone on the left and right, another disc is attached to the mid-point and another higher up. We put the head phones on, put the sound in and monitor the response.
A type of migraine headache in which the balance system is also affected. As well as symptoms of migraine, vertigo/dizziness may also be experienced. The migraine and vertigo symptoms do not always occur simultaneously for sufferers.
Read more about migraine-associated vertigo.
Vestibular neurectomy (nerve section)
A neurosurgical operation. The nerve from the balance organ in the inner ear is cut, stopping the abnormal messages reaching the brain and therefore stopping the vertigo.
The nerve running to the vestibule. The vestibule is in the inner ear and is like an internal spirit level. This nerve, along with the semicircular canals, works with the brain to sense, maintain, and regain balance and a sense of where the body and its parts are positioned in space.
Inflammation of the vestibular nerve. Main symptoms are vertigo (severe dizziness), balance problems and nausea.
Vestibular rehabilitation is a programme of head, eye and neck movements, often led by a physiotherapist, to assess balance function and re-educate the balance system so the person becomes more stable. The more customised this balance training is to the individual, the better the results.
The vestibulocochlear nerve is responsible for the sense of hearing and is also important to the body’s sense of balance.
A vestibular schwanomma is a benign (non-cancerous) slow growing tumour that develops on the balance and hearing nerves of the inner ear.