These symptoms are due to an opening in the bone overlying one of the inner ear balance canals. We have identified a syndrome in which vertigo and imbalance are triggered by loud noises or pressure in the affected ear. VERTIGO DUE TO AN OPENING IN THE BONE OVERLYING THE SUPERIOR SEMICIRCULAR CANAL They give the brain information related to linear movements of the head and to the orientation of the head relative to gravity. The otolith organs (utriculus and sacculus) are the other balance organs in the inner ear. They function somewhat like a gyroscope in an airplane. These balance canals give the brain information related to the angular motion of the head. The inner ear balance organs consist of three semicircular canals (the horizontal, posterior, and superior canals) that are located at roughly right angles to one another. The diagram above shows the structures of the inner ear. Most importantly, the incidence of hearing loss has been reduced substantially. In more than 100 patients we’ve treated during the last eight years with the low-dose version of the therapy, we’ve seen vertigo cured 90 percent of the time, results that equal the effectiveness of surgery. Through work in the lab, our team has improved that treatment, known as intratympanic gentamicin, by determining that a lower dose of the drug can also be effective. Though the treatment worked well to eliminate the debilitating spells of dizziness, it had the drawback of causing hearing loss in ten percent of patients. By reducing or destroying residual vestibular hair cell function, gentamicin Adapted for use in treating Meniere’s disease, the medication is give by small injection directly into the ear. Key to this concept is that the vertigo of intractable Meniere’s is due to fluctuation in vestibular function in the affected ear. Several years ago, doctors realized that gentamicin, an antibiotic commonly used for systemic infections has the side effect of knocking the vestibular structure out of commission by damaging hair cells.Īlthough gentamicin toxicity can itself be a cause of vestibular disorders, hearing loss and vertigo, this drug can be used to effectively and safely treat Meniere’s disease. In extreme cases, surgery to cut the vestibular nerve or remove the vestibular part of inner ear solves the problem, but at the cost of major surgery and a chance or certainty of hearing loss. Endolymphatic sac surgery was offered by many centers, but results have been inconsistent. Many patients with Ménière’s disease are treated with dietary changes and diuretics to eliminate excess fluid, but that therapy doesn’t work for all patients.
As of today, no one knows why people with Ménière’s disease accumulate fluid in the inner ear, but the effects are clear: fluctuating hearing loss, lack of balance and periods of terrible vertigo. Our lab has made great strides in improving the treatment of another balance disorder known as Ménière’s disease, which affects as many as 5,000,000 people worldwide. Then, we took our findings a step further and established a treatment for patients who suffer from the condition. We named the condition superior canal dehiscence syndrome (a “dehiscence” is a hole). After assembling a range of clues, we determined that the condition, which involves a tear in the uppermost canal of the vestibule of the inner ear, occurs because the bony surface of the canal never grew to proper thickness during development. One of the early achievements of our lab was defining a particular balance disorder that had never been described before, a discovery that took place in 1995. Until recently, these complaints were often considered psychosomatic. Their hearing for internal noises (like a heartbeat and the grating of knee joints) is much better than normal. Some patients note a strange set of symptoms: Loud noises cause them to suffer sudden vertigo and blurred vision. Our Publications SUPERIOR CANAL DEHISCENCE SYNDROME