Maintenance of Balance

The balance mechanisms in the inner ear are one of the main sources of input for the central nervous system, although the eyes, the neck muscles, and the muscles of the joints in the limbs also play key sensory roles in maintaining balance.  The central nervous system coordinates all of the input to maintain balance for the patient.  Distrubances in any of these sensory areas may result in the subjective sensation of dizziness or unsteadiness.  True vertigo most commonly results from disturbances in the inner ear balance organs, but may result from central nervous system problems as well.  General disturbances in the metabolism of the body may lead to dizziness by interfering with coordination of impulses in the brain.

The brain, reacting to normal or abnormal impulses, may respond in such a way that the individual has a false feeling of movement resulting in staggering or falling.  The brain’s influence on the body’s glands and muscles may result in the individual breaking out in a cold sweat, having nausea and vomiting, or feeling very faint. 



Dizziness:  Surgical Treatment

Surgery is indicated when medical treatment fails to control vertigo, or in special cases when it is used to prevent further hearing loss.  The type of operation selected depends on the degree of hearing impairment in the affected ear, the life circumstances of the individual, and the status of the individual’s disease.  In some operations the hearing may be occasionally improved following surgery, and in others it may become worse.  In most cases it remains the same.  Head noise may or may not be relieved, and in some cases may become even more marked.  In most cases it is not relieved.

Surgery is most successful in relieving acute attacks of dizziness in the majority of patients.  Some unsteadiness may persist over a period of several months until the opposite ear and the central nervous system are able to compensate and stabilize the balance system.  In the event that a conservative operation does not relieve the attacks of dizziness, a second operation may be necessary.

In your case we recommend:

Endolymphatic Shunt- With or Without Gentamicin

This operation drains excess endolymph from the inner ear.  It is usually performed under general anesthesia and is done as an outpatient.

An incision is made behind the ear.  A mastoid operation is performed and a tube is inserted into the endolymphatic sac of the inner ear to control the abnormal fluid pressure. Gentamicin may be perfused at the same time depending on other hearing and balance factors.

A shunt operation usually is advised when hearing is relatively good in the involved ear.  Further loss of hearing may occur in 25% of cases due to progression of the disease.  Total loss of hearing in the operated ear following surgery is uncommon, but does occur in about 2% of operations.

Translabyrinthine labyrinthectomy and section of the vestibular (balance) nerve-

The operation is performed under general anesthesia and requires hospitalization for approximately two to four days.  Through an incision behind the ear a mastoidectomy is performed, the inner ear balance chambers are removed, and the balance nerve endings destroyed. 

In cases selected for labyrinthectomy and section of the vestibular nerve, hearing is severly impaired.  The operation results in total loss of hearing in the operated ear, and frequently, a temporary increase in dizziness.  Fortunately, the attacks of dizziness are eliminated in nearly every instance.  Persistent unsteadiness, however, may continue for a period of weeks or months until the control nervous system stabilizes the balance system.  When necessary, this operation can be performed if other surgery is not successful.


Retrolabyrinthine section of the vestibular (balance) nerve-

This operation is performed in the hospital under general anesthesia and requires hospitalization for about two to four days.  Through an incision behind the ear a mastoidectomy is performed and the balance nerve is cut between the brain and the inner ear. 

This procedure allows examination of the anatomy between the inner ear and the brain, particularly, the vessels.  This operation may be advised when the hearing is good in the involved ear, and the patient is somewhat older.  Up to 15% of patients may develop a severe hearing impairment in the operated ear after surgery.  Fortunately, the attacks of dizziness are eliminated in nearly every instance.  Persistent unsteadiness may continue for several weeks to months until the central nervous system has stabilized the balance system.  Temporary paralysis of half the body has occurred following a retrolabyrinthine nerve section due to brain swelling.  Complications as for all ear surgeries include: bleeding, infection, menengitis, hearing loss, tinnitus, facial nerve paralysis and the loss of any and all neurological functions.

Summary

There are many causes of dizziness.  This dizziness may or may not be associated with hearing loss.  In most instances the distressing symptoms of dizziness can be greatly benefited or eliminated by medical or surgical management.