Labyrinthopathies (Vestibulopathies) in Practice of a Therapeutist

Abstract

Introduction. In 1861, Prosper Meniere for the first time proved that the cause of dizziness, nystagmus, and vertigo disorders may be the disease of the anterior part of labyrinth. Today, illness with such symptoms belongs to labyrinthopathies, that is, non-malignant diseases of the labyrinth. Aim. To describe the basics of classification, primary diagnosis, urgent and planned treatment of labyrinthopathies. Materials and methods. The basics of classification, primary diagnosis, urgent and planned treatment of labyrinthopathies are given. The history of study, clinical signs, modern diagnostic methods, treatment of Menier’s disease and other labyrinthopathies are summarized briefly. In particular, post-traumatic labyrinthopathies, which are becoming more frequent, are not yet diagnosed. Results. There are different labyrinthopathy classifications that are used by the specialists. The doctor-therapist should know that labyrinthopathies (vestibulopathy) can be: a) aperiodic; b) long, periodic. Meniere’s disease is one of the most widespred labyrinthopathies. Among the causes of the disease: allergy; disturbance of the water-salt exchange, for example, due to the prolonged use of glucocorticoid drugs; infection; immune system disorders, including autoimmune effects; changes of the blood pressure (more often – hypotonia); imbalance of the vegetative nervous system; the degeneration of the elements of the inner ear; skull trauma; injury during the rehabilitation operations, hearing enhancement interventions; stresses, conflict situations; vascularization disorders; genetic predisposition; features of the structure of soft tissues of the inner ear, deficiency of gyaluronidase; accumulation of mucopolysaccharides in the endolymph, changes in the ionic composition of the liquids of the inner ear (prevalence of potassium ions over sodium ions); violation of vegan innervation. The pathogenesis of the disease is determined by the most endolymphatic hydrops. Classical symptoms of Meniere’s disease are periodic attacks (attacks) of vestibular decompensation: dizziness, nausea, vomiting, increasing hearing loss, mostly one-sided, noise in the ears. The attack usually begins with dizziness, disturbances in the balance, followed by the noise in the ears, which does not disappear after the carotid cuff, hearing loss, and vertigo disorders. This condition usually lasts for 1-3 hours, less often – up to 10 hours. Subsequently, the period of remission occurs, which may have a different duration from a few days to a year. In the majority of patients, spontaneous nystagmus, a violation of the static and kinetic equilibrium are determined. The audiometric determination is mostly horizontal, at least an upward or slightly downward curve without a bone-to-air “rupture”. The latter, in the end, may appear in the period between attacks. Characteristic symptoms are a positive phenomenon of accelerated volume increase, as well as a dysplastic body: the same tone is perceived by the sick ears as lower (sometimes – as higher) and sharper. A characteristic symptom is hearing fluctuation: it generally worsens, but there are some periods of its improvement (up to the entire recovery at the onset of the disease). Caloric breakdown is hyporeflexia. The treatment is directed at various possible causes and to various pathogenesis links. Conclusions. A general practitioner should be aware of the possible connection of complaints of dizziness with the diseases of the ear. If in the past the patient had a transport injury, it should be referred to specialists – vertebrologists, otonevrologists, neurosurgeons, traumatologists for special studies – radiation (computer tomography, MRI), laboratory, audiometry, nystagmography etc.

Keywords

• labyrinthitis
• Lermoyez syndrome
• Meniere’s disease
• post-traumatic labyrinthitis
• vertigo