Balance; It is the ability of a person or object to stand upright without falling over. Dizziness, which is an illusion of movement, is a general definition referred to as vertigo in medical language and is not a disease, but a symptom that may indicate many diseases or conditions.
How do we maintain our balance?
While the human body maintains balance, three basic systems come into play; Visual system, Inner ear and Musculoskeletal-deep sensory system. Warnings coming from these systems are processed, perceived and evaluated in the brain and related structures, and thus the person continues to maintain balance. When there is a problem in perceiving or evaluating balance information in any of these structures, for example in the inner ear structures or brain-related structures, the person loses his balance and complains of dizziness.
In this case, the person may feel like he or the environment is spinning, even though he is not actually moving. Patients presenting with dizziness may complain of staggering or imbalance, as if the ground is shifting under their feet, or they may describe a situation so severe that they think the walls are collapsing on them or an earthquake.
For all these reasons, listening to the patient's complaints in detail and allocating enough time for this is the most important step in reaching a differential diagnosis. Important information such as the duration of the patient's dizziness, how it is described by the patient, and whether there are accompanying findings provide guidance for the diagnosis. Therefore, patients presenting with dizziness may need to be evaluated together with many branches, especially ENT, Neurology, Internal Medicine, and Ophthalmology.
The inner ear balance system (Vestibular System) detects the movements of the head, interacts with the eye muscles and exchanges information with the musculoskeletal system. As a result, the work of all these systems together in 'Balance' is the most important and necessary step for us to maintain our balance.
As a result of the connections between the inner ear balance system and the eyes, involuntary eye movements called 'nystagmus' may occur in some pathologies. . The most objective symptom of dizziness, which is a subjective complaint, that can be observed by an ENT physician is these involuntary eye movements.
The presence, degree and type of involuntary eye movements in the eye, the position in which they occur will be guiding in terms of which area of the balance system is pathology, and whether the cause of the dizziness is the ear and related structures or the brain and its related structures.
Ear-nose. Throat diseases can include many diseases and conditions that can cause dizziness. The most common causes of dizziness we see in ENT practice include BPPV, Meniere's disease, and vestibular neuritis. Now let's briefly talk about these diseases with the names you are used to.
BPPV (Benign Paroxysmal Positional vertigo): (Sudden onset benign positional vertigo)
It is a very common condition, popularly known as 'displacement of crystals or ear stones'. So what actually are these crystals? Where does it come from? Or do they actually already exist inside our ear and change their location?
Structures of the inner ear:
Otoconia (Calcium Carbonate and protein biocrystals) are found attached to a gel-like structure within the balance organ of the inner ear. . When these crystal particles break away from here and escape to other parts of the inner ear, that is, the canal structures that detect movement, and get stuck there, the crystals in the canal create a sensation of stimulation/movement, even if the patient is not in motion. While the eyes, brain and musculoskeletal system try to adapt to this new stimulus, a feeling of movement occurs even if the person is not actually moving. This situation results in dizziness.
In this case, the patient comes to us with a feeling of dizziness, which occurs especially with certain positions of the head, is triggered by sudden movements, and subsides within a few minutes.
As a result, when these crystal structures, which actually exist in the inner ear system and are tightly connected to where they are, break off for some reason and move to other parts of the inner ear, they create a situation called BPPV, popularly known as 'movement of crystals'.
In the treatment of this condition, first of all, it is determined which area / channel in the ear these crystals have escaped to, and then these crystals are removed by appropriate positioning maneuvers. The aim is to send them back to where they belong. In the meantime, although treatments that will relax the patient and relieve complaints such as nausea and vomiting are used, the important thing is to apply maneuver therapy.
Meniere's Disease:
Meniere's Disease is a disease defined by the scientist Prosper Meniere a long time ago (in 1861). In this disease, which progresses with attacks of dizziness, symptoms such as hearing loss, ringing in the ears, feeling of fullness and pressure in the ears can be observed. It can be seen slightly more in women than in men. The main underlying reason is the increase in pressure in the inner ear structures for some reason (excessive production of inner ear fluids or failure to recover them from the environment). During periods when the pressure increases, the patient begins to have a dizzy attack and other symptoms, and when the pressure returns to normal, the attack regresses.
Hearing tests (audiometric examination) must be performed in the differential diagnosis of these patients. Again, for the differential diagnosis, a test called caloric test, which is applied to the patient's ears while in a lying position - hot and cold air / water can be guiding.
We use some medications in the treatment of a patient with whom we suspect Meniere's Disease. In addition to medications that suppress the feeling of dizziness and nausea, medications with diuretic properties may be recommended. Diuretic drugs aim to maintain fluid balance in the inner ear and keep the pressure balanced. In addition, some medications that increase the blood flow and nutrition of the inner ear can be used. In addition, steroid group drugs are administered directly into the ear either orally or intratympanically, aiming to reduce inflammation/edema/inflammation in the ear.
In addition to all this medical support and treatment, salt restriction, regular exercise and stress management. It is also useful in reducing the frequency of attacks.
Surgical treatment may also be considered for patients who do not respond to medical treatment and have difficulty in performing their daily activities.
Vestibular Neuritis:
Inflammation/edema/inflammatory condition of the balance nerve
Sudden onset of severe dizziness. Nausea, vomiting It is a table that shows itself with a. It occurs due to inflammation in the balance nerve for an unknown reason. The distinguishing point here is that the patient does not have hearing loss. Dizziness may continue for days. The severity of rotation may increase with head movements, but it is often not related to position. In the treatment, medications to suppress nausea, vomiting and dizziness may be given.
Vestibular Rehabilitation: This therapy, called Balance Physical Therapy, aims to reduce the patient's chronic balance complaint by giving some exercises. This balance rehabilitation program can be applied with the help of a therapist in patients with age-related chronic balance problems, in cases related to the above-mentioned diseases related to the inner ear balance system, in some brain-related diseases or in persistent balance disorders that occur after surgical interventions.
The aim of this rehabilitation program is to activate some adaptive mechanisms in the human brain.
In general, the aim is to increase gaze stability, increase postural stability, and prevent recurrent dizziness with some movements, thus improving daily life activities.
There are many factors that affect recovery in vestibular rehabilitation. Centrally acting drugs, especially drugs that suppress the feeling of dizziness (vestibulosuppressants, antidepressants), prolong the average time required for recovery. Again, the benefit from vestibular rehabilitation may decrease in the presence of conditions such as the presence of an underlying tumor or ongoing inflammation of the inner ear structures (labyrinthitis).
Ringing in the Ears (Tinnitus): Tinnitus, which is a very common condition, can be defined in different ways from person to person (humming, buzzing, noise coming from the ear, stream). sound, water sound). Tinnitus, like vertigo, is actually a symptom.
This complaint can be heard by others other than the patient (objective tinnitus) or cannot be heard (subjective tinnitus). Patients often fall into the second group.
Objective tinnitus often affects some vessels, nerves or muscles. It may occur as a result of different diseases (palatal myoclonus, different functioning of the palate muscles), hypertension or dysfunction in the jaw joint.
Subjective tinnitus is the perception of sound without any acoustic stimulus.
Tinnitus may be unilateral or may develop in both ears. It may occur after exposure to noise. There may be an underlying hearing loss. For this reason, a hearing evaluation of a patient with tinnitus complaints is essential. Even if the person does not have any problems with hearing in his daily life, this evaluation must be made so that it can be understood whether there is an underlying hidden hearing loss.
While tinnitus is not very disturbing for some people, some patients may be affected enough to have difficulty in continuing their daily lives and even falling asleep. This situation can be explained by neurophysiological mechanisms and connections. Based on this, habituation therapy comes into play and the person is tried to adapt to this sound by activating or deactivating different systems.
Tinnitus is also tried to be suppressed with some medical treatment options. (such as vitamins, agents to increase blood flow to the inner ear, antidepressants) Tinnitus masking studies with hearing aids are also among the treatment alternatives.
In summary, patients with tinnitus complaints should be evaluated with a detailed history and examination, blood tests should be performed, inner ear structures should be imaged with tomography or MRI, blood pressure measurements and follow-up, hearing evaluations should be made, and treatment should be tailored according to all these results. A path to follow must be determined.
Allergic Rhinitis:
Rhinitis, commonly known as the flu, is a disease that is very common in society and can affect everyone several times throughout their lives. is a table. However, some people may experience frequent cold attacks. The nose, which is our breathing organ, becomes edema with rhinitis, discharge begins, and a disorder in the breathing function of the nose occurs. The person may experience difficulties in daily activities, school and work life. More importantly, a nose that cannot provide normal ventilation function predisposes to recurrent or chronic middle ear diseases.
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