Inner Ear Disturbance: Labyrinthitis, BPPV, and Meniere's Disease
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This article discusses the pathophysiology, clinical presentation, physical examination, diagnostics, and treatment of Labyrinthitis, Benign paroxysmal positional vertigo (BPPV), and Meniere's disease. It also highlights the interrelation between these diseases and the importance of proper diagnosis for designing a suitable treatment plan.
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Running head:INNER EAR DISTURBANCE Inner Ear Disturbance Name of the Student Name of the University Author Note
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2 INNER EAR DISTURBANCE Labyrinthitis, Benign paroxysmal positional vertigo, and Meniere's disease are mostly iter-related. So a patient suffering from inner ear disturbance must be tallied under the litmus of symptoms, physical examination, clinical presentation and diagnosis in order to confirm the existence of any of the above mentioned disease and this will help in designing suitable treatment plan. Labyrinthitis Pathophysiology Labyrinthis is an inflammatory response that occurs within the inner ear in response of infection. A short lived, minor infection may turn into temporary or permanent reason behind hearing loss (Mildenhall, 2010). Clinical presentation Therearedifferentkindsoflabyrinthisnamelyvirallabyrinthitis,autoimmune Labyrinthitis and bacterial labyrinthis. Viral labyrinthitis is characterized by sudden loss of vestibular function and hearing. It has cute onset accompanied by vertigo and vomiting. Autoimmune labyrinthitis is a part of systemic autoimmune disease, Wegener granulomatosis and is regarded as an uncommon cause of sensorineural loss of hearing. Bacterial labyrinthitis occurs via direct bacterial invasion(Mildenhall, 2010). Physical examination Complete head and neck examination with a special emphasis on otologic, cranial and ocular nerve portions. A brief neurological examination is also recommended. However, viral labyrinthis is confused with vestibular neuritis and thus conditions considered in the grounds
3 INNER EAR DISTURBANCE ofdifferentialdiagnosisoflabyrinthitisincludecerebellarinfarct,presyncopaland vertebrobasilar insufficiency (Mildenhall, 2010). Diagnostics Diagnostic used include computed tomography (CT) scan before lumbar puncture in case of possible meningitis. CT scan also helps to rule out mastoiditis. Other tool used is MRI, vestibular testing and audiography (Dommaraju & Perera, 2016). Treatment Treatment for viral labyrinthitis includes hydration and bed rest. Antibiotic treatment is prescribed for the treatment of bacterial labyrinthitis and surgical care is recommended for labyrinthitis arising from otitis media. Patients with profuse vomiting and nausea are advised in-patient care along with intravenous and antiemetric medications (Dommaraju & Perera, 2016). Benign paroxysmal positional vertigo (BPPV) Pathophysiology Mismatch in the sensory information as encoded in thesemicircular canal, which maintain the spatial orientation is responsible for the disease manifestation (Kim & Zee, 2014). Clinical presentation Onset of BPPV is sudden and the severity varies from patient to patient, People who suffer from BPPV do not always feel dizzy. Severe dizziness occurs in response to head movements(Kim & Zee, 2014).
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4 INNER EAR DISTURBANCE Physical examination Physical manifestation of the disease varies from patients to patients. In case of patients with severe BPPV, slightest movement of head is associated with vomiting and nausea. Patients also have a continual feeling of foggy or cloudy sensorium(Kim & Zee, 2014). Diagnostics Dix-Hallpike maneuver is the standard clinical test employed for the detection of BPPV. It is performed via rapidly moving the patient from sitting position to supine position with head position at 45-degree to right. After 20-30 sec stand-time, the patient is retured to sitting position(Kim & Zee, 2014). Treatment Maintreatmentoptionsincludewatchfulwaiting,vestibularrehabilitation, vestibulosuppressant medication, canalith repositioning and surgery(Kim & Zee, 2014). Meniere's disease Pathophysiology Meniere disease is defined as a disorder of inner ear, popularly known as idiopathic endolymphatic hydrops. However, the exact pathophysiology of Menire is controversial. The main underlying mechanism is assumed to be a sudden distortion of membranous labyrinth resulting from the over accumulation of endolymph (Bogaz et al., 2017). Clinical presentation According to the American Academy of Otolaryngology – Head and Neck Surgery Foundation,Menierediseaseisdefinedasrecurrent,episodicetspontaneousvertigo associated with hearning loss, tinnitus and aural fullness.
5 INNER EAR DISTURBANCE Physical examination Physical examination varies with the phase of the disease. During remission, physical manifestations appear completely normal. However, during acute attack, patient experience severe vertigo along with significant distress. Other vital signs include elevated blood pressure, high pulse rate and respiratory rate(Bogaz et al., 2017). Diagnostics Analysis of symptoms, along and audiometric results is used to diagnose the disease. Laboratory studies include MRI and CT scan(Pyykkö et al., 2013). Treatment In-patient care is generally unnecessary. The treatment is mostly directed towards actual symptoms of the acute attack or aim towards the prophylactic prevention. The main medical management is to provide symptomatic relief(Bogaz et al., 2017).
6 INNER EAR DISTURBANCE References Bogaz, E. A., da Silva, A. F. C., Ribeiro, D. K., & dos Santos Freitas, G. (2017). Meniere’s Disease Treatment. InUp to Date on Meniere's Disease. InTech. Dommaraju, S., & Perera, E. (2016). An approach to vertigo in general practice.Australian family physician,45(4), 190. Kim, J. S., & Zee, D. S. (2014). Benign paroxysmal positional vertigo.New England Journal of Medicine,370(12), 1138-1147. Meniere's Disease. (2017).American Academy of Otolaryngology-Head and Neck Surgery. Retrieved 5 February 2018, from http://www.entnet.org/content/menieres-disease Mildenhall,J.(2010).Thepathophysiologyoflabyrinthitis.JournalofParamedic Practice,2(7), 297-303. Pyykkö, I., Nakashima, T., Yoshida, T., Zou, J., & Naganawa, S. (2013). Meniere's disease: a reappraisal supported by a variable latency of symptoms and the MRI visualisation of endolymphatic hydrops.BMJ open,3(2), e001555.