Lend Me Your Ears: A Study of Middle and Inner Ear Disorders

May 10, 2018
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About 5% of all dizziness is due to vestibular neuritis or labyrinthitis. It occurs in all age groups, but cases are rare in children. Meniere's disease and labrynthitis are inner ear disorders that cause dizziness, vertigo, and hearing loss due to fluid buildup and infection to the vestibular nerve. The inner ear contains the sensory organs for hearing and balance, which is why treatment options for these conditions include everything from cognitive therapy to surgery. On the other hand, otitis media is an infection of the middle ear caused by fluid build up. The middle ear is an air-filled chamber located behind the eardrum, and the eardrum and middle ear pass sound to the inner ear. Otitis media with effusion involves the collection of non-infected fluid in the middle ear space. Treatment options for otitis media, which is mostly prominent in young children, includes the insertion of tubes to drain the fluid. Many ear disorders can be the result of genetic variations that cause abnormalities in the volume or regulation of endolymph fluid in the middle ear, although other causes are also to blame. Because middle and inner disorders can lead to serious side effects, such as hearing loss, it is imperative that patients investigate different treatment options in order to control the symptoms associated with different ear disorders.


The middle ear infection otitis media has many causes and symptoms. Otitis media is an ear infection of the middle ear, the area just behind the eardrum. The causes of otitis media are linked directly to the eustachian tubes of the ears. It happens when the eustachian tubes, which connect the middle ear to the nose, get blocked with fluid. These ear infections usually start with a cold. Although adults can get ear infections, they are most common in infants and young children (Otitis Media, 2017, para. 5). Otitis media with effusion (OME) is a collection of non-infected fluid in the middle ear space. It is also called serous or secretory otitis media (SOM). “This fluid may accumulate in the middle ear as a result of a cold, sore throat or upper respiratory infection” (Otitis Media with Effusion, para.17). OME is usually self-limited, which means, the fluid usually resolves on its own within four to six weeks. However, in some instances the fluid may persist for a longer period of time and cause a temporary decrease in hearing (Kozin, 2014, para. 2). The fluid may become infected. The middle ear is an air-filled chamber located behind the eardrum. Together, the eardrum and middle ear pass sound to the inner ear. (DeFatta, 2011, para. 2). Children are more prone to getting ear infections than adults. One of the reasons for this is that eustachian tubes are smaller in children than they are in adults. This makes it difficult for fluid to drain out of the ear even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. (Ear Infections, 2017, para.11-13 ).


The symptoms of otitis media are brought on by clogged ears. Otitis media with effusion can result in conductive hearing loss, which has been linked to the delayed development of speech and socialization skills. (Stoodley, 2006, para. 6-7). “A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument” (Ear Infections, 2007, para.4). Other symptoms of these ear infections can include feeling pressure in the ear, ear pain, discharge from the ear, and ringing in the ears. Otitis media is the most common illness for which children visit a physician, receive antibiotics, or undergo surgery in the United States.


Vestibular neuritis and Meniere's disease are caused by several factors and the symptoms are vertigo and hearing loss. Vestibular Neuritis is called by viral infection of the vestibular nerve and is characterized by the sudden onset of disabling vertigo often associated with nausea and vomiting without auditory symptoms. “It has been claimed that vestibular neuronitis affects only the vestibular portion of the cranial nerve and that the cochlear portion is left unaffected” (LaRoure, Para.3). When one of the two vestibular nerves is infected, there is an imbalance between the two sides, and vertigo usually appears.Vestibular neuritis is another term that is used for the same clinical syndrome. In vestibular neuritis, the virus that causes the infection is thought to be usually a member of the herpes family, the same group that causes cold sores in the mouth as well as a variety of other disorders (Hain, 2012, Para,7).


Causes of Meniere's disease are not well known, but scientists have many guesses. Clinical symptoms and audiometric tests are the basis for the diagnosis; however, differential diagnosis may be extremely difficult, since most of the findings are subjective and not specific. Misdiagnosis is probable, thus highlighting the great need for objective and reliable testing (Vassiliou, 2011, para.3). “The symptoms of Meniere’s disease are caused by the buildup of fluid in the compartments of the inner ear, called the labyrinth. The labyrinth contains the organs of balance (the semicircular canals and otolith organs) and of hearing (the cochlea)” (Meniere’s Disease, 2010, para.4). Some researchers think that Ménière’s disease is the result of constrictions in blood vessels similar to those that cause migraine headaches. Others think Meniere’s disease could be a consequence of viral infections, allergies, or autoimmune reactions. “Because Meniere’s disease appears to run in families, it could also be the result of genetics” (Meniere’s Disease, 2010, para.8). Although there is no solid evidence, doctors believe that in some cases Meniere’s disease may be the result of genetic variations passed down through families.


Meniere’s disease symptoms include vertigo, hearing loss, and tinnitus. Episodic vertigo that lasts for minutes to hours to days is likely to be caused by Ménière's disease or vestibular neuronitis. It is common for inner ear diseases to be accompanied by other associated symptoms such as hearing loss, aural pressure, or tinnitus. Meniere's disease causes severe dizziness/vertigo, ringing in the ears, hearing loss, and a feeling of fullness or congestion in the ear. Episodes of vertigo occur without warning and usually last 20 minutes to several hours, and severe vertigo can cause nausea and vomiting. Hearing loss in Meniere's disease comes and goes, particularly early on. Eventually, most people have some permanent hearing loss even though Ménière's disease usually affects only one ear. The symptoms of Ménière's disease are caused by the buildup of fluid in the compartments of the inner ear, called the labyrinth (Meniere's Disease, 2010, para.7).


Symptoms of vestibular neuritis are the same as those for Meniere’s disease. The symptoms of both vestibular neuritis and labyrinthitis typically include dizziness or vertigo, disequilibrium or imbalance, and nausea. Acutely, the dizziness is constant. “After a few days, symptoms are often only precipitated by sudden movements” (Iwasaki, 2014, para.11). A sudden turn of the head is the most common problem when it comes to sudden movements. For certain conditions, exposure to chemotherapy for cancer treatment or exposure to certain antibiotics if you have a severe infection can predispose to to loss of vestibular function and also general health can, like vascular disease, diabetes, hypertension also inheriting blank can result in loss of vestibular function” (Agrawal, p.3).


Treatment options for Meniere’s disease and vestibular neuritis range from various surgeries and steroids. Endolymphatic sac surgery for Meniere's disease is an effective option. From a study published in the laryngoscope, it was concluded that endolymphatic sac surgery is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation (Kozin, 2014, para.13). This paper is about emerging evidence for endolymphatic sac surgery in the treatment of Meniere’s disease. Surgery options for Meniere’s disease include a vestibular neurectomy, labyrinthectomy, and endolymphatic sac surgery. endolymphatic sac surgery is the most common option because it enables both the hearing and balance functions of the ear to be preserved (Lim, para. 4-7).


Medication is one of the only treatments recommended for vestibular neuritis. This specific treatment involves the injection of medication through the eardrum. This medication then passes into the inner ear through the round window membrane. This procedure Is performed in patients in whom vertigo from vestibular neuritis is uncontrolled with standard medical therapy,and behavioral lifestyle changes. Studies have demonstrated up to an 80-90% response rate to dexamethasone perfusion (Meniere’s Surgeries, Para. 9).


Treatment options for otitis media include surgery and antibiotic medication. Surgery for otitis media can help lower the chances of developing another infection. If the infections keep coming back and antibiotics are not helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve airflow air flow and prevent fluid backup in the middle ear (Ear Infections, 2017, para. 7). “Bilateral myringotomy and tubes is a surgery in which a small opening is made in each eardrum and a small tube is placed in the opening on each side, and it is usually an outpatient surgery” (Ear Infections, 2017, para. 12). This surgery is needed to treat children who have otitis media or middle ear infections that will not go away with medication. When air is able to get behind the eardrum through the tubes inserted inserted in the ear, the fluid inside the ear can dry up and take away the pain or pressure that the child may have been feeling. It can also reduce the risk of future infections. (Bilateral, 2017, para.8).
A study was conducted with the medical records of all the patients who had undergone myringotomy with tympanostomy tube insertion surgery between February 2000 and March 2001 at the two general hospitals of the Isfahan University. “It was concluded that considering the low risk of serious complications after 10 years, tympanostomy tube insertion is a safe and effective treatment option in the treatment of otitis media with effusion” (Behrouz, 2012, para.1-4). Tympanocentesis is the trans-tympanic needle aspiration of the middle ear contents. Aspiration of fluid reduces middle ear pressure and is very effective in relieving pain. Tympanocentesis can be performed on infants using restraints, local or mild sedation. Older children will be more comfortable if a local or general anesthesia is used (Surgical Treatments, para.4).


Antibiotic medication is usually prescribed for the treatment of acute otitis media. “Amoxicillin at a dosage of 80 to 90 mg per kg per day should be the first-line antibiotic for most children with acute otitis media” (Kalyanakrishnan, Para.11). Patients with otitis media who fail to respond to the initial treatment option within 48 to 72 hours should be reassessed to confirm the diagnosis (Kalyanakrishnan, Para.14). “Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days” (Ear Infections, 2007, para.11). Doctors may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain (Ear Infections, 2007, para. 11-12).


Research conducted by Dr. Agrawal showed that vestibular loss is actually prevalent in the population, and in fact, in 50 percent of older adults, so it actually is an issue of public health. Meniere's disease, common in the elderly, can be combated with surgery or medicine use, while for vestibular neuritis, steroid use is one of the only clinically effective treatments to alleviate symptoms. Otitis media, which is diagnosed after recurrent ear infections are not responding to antibiotics, can be treated with several different surgical variations of inserting draining tubes. The ears not only help us hear and perceive the world, they also control our balance, which one needs to go about their day and complete daily tasks. This is why it is so important that ear disorders are treated in the proper manner, so that the quality of life for those who live with these condition is improved.


 






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