Coping with Vestibular (Inner-Ear) Trauma

Tagged:  

What would you do if you woke up one morning and found that you were seasick? Not just queasy, but horribly - wanting the boat to sink so you could die - seasick? How would you deal with a world where spatial reality became unpredictable and you could hear and then not hear and what you heard might not always be.… real? Would you think you were going crazy?

Or would your physician have the good sense to ask if, at any time in your life, you'd injured your head, had severe allergies or had a very bad ear infection or been listening to too much loud music? If your physician recognizes vestibular trauma, you are one of the few people presenting with these symptoms to be correctly diagnosed.

Much attention is being given to returning veterans with brain injury and tinnitus. Posters are going up in gymnasiums to alert coaches about brain injury among sports enthusiasts, especially young athletes. Victims of car crashes are being checked and shelter personnel and social workers are well aware of brain injury in battered wives and abused children. But nothing is being said about the other life-long debilitating trauma which always accompanies brain injury - Vestibular Trauma.

Generally, the popular assumption, even in the medical field, has been that the ear is for hearing sounds, and somehow the little bones and thingy-ma-bobs deeper inside help with how we keep our balance. Would it surprise you to know that the vestibular system is one of the most complex nerve structures in the body? That we determine our place in space with these little structures and their attached nerves? Our urge to flee often originates from signals the vestibular system generates and even our stomach and intestines receive, and send information on whether to go on with the business of digestion.… or, heave-ho! get rid of the contents.

The balance system works with the visual and skeletal systems to maintain orientation. Visual signals are sent to the brain and compared to information from the vestibular systems and muscles and joints.

An organ in the inner ear, the labyrinth, is a central player in the vestibular or balance system. Inside the labyrinth are three semicircular canals which are filled with fluid. As the head moves, the fluid inside the semicircular canals signals to the brain its relative motion. Each semicircular canal has a bulged end that contains hair cells. Rotation of the head causes the fluid to flow, which in turn causes displacement of the top portion of the hair cells. The endolymphatic sac is a fluid reservoir that keeps the fluids in a constant volume in the semicircular canals.

Two other organs which are also part of the vestibular system, the utricle and saccule, are responsible for detecting linear acceleration, or movement in a straight line. The hair cells in theses organs are blanketed with a jelly-like layer which contains tiny calcium stones called otoconia. When the head is tilted or the body position is changed with respect to gravity, the displacement of the stones causes the hair cell to bend, providing proper balance

Several famous people suffered from the effects of vestibular damage, Beethoven being top of the list. Van Gogh showed all the signs of Meniere's disease which causes vertigo, tinnitus and an agonizing fullness in the ears. So agonizing, the sufferer might try to punch out the afflicted ear with a sharp object … or cut it off. Then, Van Gogh's addiction to absinthe (a potent liqueur) probably didn't help either.

So, being as complicated as a computer program, if the vestibular system is damaged in any way, it's like putting a glitch or a virus in that program. Luckily, unlike the fussy computer that shuts down, the brain will do its very best to find a way to fix the problem, to compensate and keep us on our feet. Or adjust to microgravity in space!

A child who falls off a swing might not show symptoms until adulthood.
What Causes Inner-ear Damage?

One of the most dramatic injuries can come from shaken baby abuse. These whiplash injuries are also sustained by car wreck victims, battered spouses, boxers. In addition, quite a few medications and some foods can be highly toxic to the otological (ear) system. SSRIs (anti-depressants) and anti-psychotic drugs are notorious for leaving a person with permanent tinnitus, as can some antibiotics and other medications. As for food, some of the worst culprits are soy products processed with a chemical called hexane, a by-product of gasoline. Watch closely when you buy soy baby formula. Much of it uses hexane processed soy. That soy burger or energy bar may be loaded with the stuff.

More infamous for creating vestibular damage are sustained loud noises and pressure changes from being in a rock band or listening to music plugged directly into the ear. Young people aren't the only ones culpable in causing their own ear injuries. Many workers in deafening jobs are "way too casual about using protectors for their ears. Mention might be made of MRI exams." The loud banging can definitely contribute to tinnitus.

Dramatic injury can occur also from an illness. A bad case of flu, a high fever especially in infants, ear infections and sinus infections, teeth that aren't cared for, can bring on awful pain in the ears and eyes. Some peoples, like Native Americans, are highly susceptible to ear infections and the generation of Indian children who were carted off to boarding schools in the early 20th century where white-men's diseases hit them full force, faced adulthood with partial deafness and vestibular disorders.

Luckily, the vestibular system usually recovers from bacterial and viral illnesses if … and this is an important IF.… the infection is dealt with properly. Which does not include antibiotics except in extreme cases. Go to the Coping Section below for recommendations on how to deal with sinus and ear infections.

A nasty episode of real sea-sickness can be a life-changer as well. Some poor individuals seem to be born with an inability to adjust their vestibular system to life at sea. Take the famous character Hornblower, fashioned after the real Admiral Nelson who spent the first week of any voyage in his cabin, heaving. It is not unknown for sea-sickness to affect scuba divers also which can be life-threatening.

For most of us, mal-de-mer comes on because of already stuffy ears. Same with air sickness or car sickness and not only humans react to windy roads as Rover can demonstrate.
What are the Symptoms of Vestibular - Inner-ear Damage and Why do they Express in such Dramatically Different Ways?

It wouldn't be fair to criticize medical personnel too much for not picking up on the signs and symptoms of damage to the inner ear as the underlying cause of a presenting malady. First of all, the original trauma to the vestibular system could have occurred years before the patient comes to the doctor and since the range of symptoms is vast, rule number one should be: Look Deeper.

For example, if a fifty year old man comes in complaining of poor memory, wobbliness and constant fatigue, ask if the fellow works with loud noise and strong vibrations such as in a lumber mill.

Although organizations such as the American Tinnitus Association are working hard to get information out on tinnitus, little is being done on an international scale to educate the medical profession about how trauma to the balance system in the brain affects someone's health and emotions. Furthermore, even if the doctor realizes his patient is presenting with vestibular damage, there is not a lot that can be done medically other than prescribe remedies for sea-sickness like Meclizine (Dramamine).

Then, to determine vestibular damage or disease, there are numerous tests, which in the United States, insurance will not cover. The doctor is left with advising the patient to develop life-changing coping skills and every MD knows how very difficult that message is to get across to patients.

Yes, coping with vestibular damage requires serious re-structuring of behaviours.
Dizziness and Nausea

The entire body develops coping strategies to deal with dizziness and vertigo. For example, you find yourself not being able to ride in a car, especially in the back seat any more and only feeling comfortable, safe, driving.

Finding you can no longer fly in an airplane is common. Pilots and astronauts dread any diagnosis of vestibular disorder since it means instant disqualification from flying and, no surprise, NASA has a big investment in finding solutions to vestibular problems.

Another coping strategy, long overlooked, is the sufferer's strong desire for numbing drugs or alcohol. The unremitting symptoms make a person want only to find escape. That tell-tale unsteady gait of someone with severe vestibular damage is exacerbated by alcohol.

Age brings deterioration to the intricate inner-ear mechanisms, as well as vision, and if an older person has not done the kind of exercises needed to maintain balance without the use of the inner-ear mechanism, she will fall or be easily knocked down.

One more excellent example is feeling totally miserable in the mall or big department store. Too much going on, so many colours and sounds, kids screaming, you get lost, you forget what you came for and all you want is to leave and then you can't remember where you parked the car!

Having tinnitus just adds to the misery.
Tinnitus

One of the primary symptoms of vestibular damage is noise in the ears, usually a steady ringing or humming or the susurrus of ocean waves. For years, tinnitus was considered a hearing problem but research is showing that the damage is more intrinsic. The central auditory system in the brain itself has been affected by whatever injury was sustained which is why hearing aids generally don't help. In fact, since hearing aids pick up all sounds, they often make the situation worse. Recently certain kinds of hearing aids are used to mask the tinnitus noise bringing a level of welcome relief for some people.

The American Tinnitus Association (ATA - www.ata.org) is doing yeoman work in campaigning for research and treatment grants to help military veterans. As mentioned, the most frequent complaints from soldiers coming home are tinnitus and brain injury meaning vestibular damage. Sadly, when vets go to the VA with dizziness, nausea and 'walking on the moon' gait or outright panic attacks and suicidal thoughts, they are consistently diagnosed with PTSD. The vet is put on an SSRI.

Two-thirds of Afghan war veterans are suffering from hearing damage -The intense noise of the battlefield is afflicting British troops 20 Dec 2009 More than two-thirds of British troops returning from Afghanistan are suffering severe and permanent hearing damage, according to the most comprehensive study reported in The Observer in 2009 into one of the less well-known side-effects of the conflict in Helmand. Internal defence documents reveal that of 1,250 Royal Marine commandos who served in Afghanistan, 69% suffered hearing damage due to the intense noise of combat.

Now comes the hard part. SSRIs bring about permanent tinnitus and are useless in compensating for emotional pain, highly dangerous during withdrawal and for months afterward can contribute to suicidal and possible homicidal thoughts.[ 1]

Another form of hearing loss, always accompanied by tinnitus, is called variously 'cocktail party deafness' or 'crowd deafness'. You can hear a bird across the street, but a noisy party dazes you. If you can't lip read, you're lost, and asking the person talking to you to speak up is useless. 'Crowd deafness' makes going to movies or the symphony distressing and shopping at a big-box store is like walking into a carnival fun-house, without the fun.[ 2]
Memory Loss

There is a much higher chance that you have vestibular damage than Alzheimers. Get tested for both. Oh, yes - the little issue in the US of insurance not covering testing for inner ear damage but covering the tests for Alzheimers, plus the doctor in the US can instantly prescribe medication for Alzheimers.

Check yourself out first. If you are rested and in a quiet place, does your brain function just fine? You can recall words, organize thoughts, figure out where you're going and how to program the DVR to catch your favourite TV show? Center yourself and relax, take things one step at a time.
Agoraphobia and Obsessive-Compulsive Behaviors

Directly related to the loss of balance and sense of where you are in space, is the gradual unwillingness to go out in public and leave the comforting surrounding of one's home. The stress of having to face a noisy, confusing situation can make you feel desperately unsure of yourself and you go over and over the routine for departing. Is the stove turned off? Did you unplug the toaster?

Planning ahead and putting items in predictable places really helps. Often, once you've gotten on the road, you'll be fine. It's as if the brain realizes all is okay and you have the next place to be, and driving or riding the train can be comforting.
Panic Attacks

The most devastating symptom of inner ear damage can literally mark you as mentally ill. Panic attacks. For some unknown reason, your entire sense of reality can go into melt down.[ 1] Be aware of the approaching signals (increased tinnitus, nausea, diarrhoea and chills, increased heart rate and blood pressure, visual changes) and begin doing calming exercises like deep breathing, WREMS or EMDR, walking, hot bath or shower, ginger tea or pills, or if all that fails, remember you are simply seasick and take a remedy for seasickness.
Life Style Changes

Vestibular damage is permanent. Before age adds to the problem, there are steps that can be taken to successfully cope.
Tai Chi

Certain exercises have been shown in study after clinical study to make dramatic differences in the lives of those with vestibular damage, as well as the elderly. Number one, with no contest, is Tai Chi. Slow stretching movements, often done to music, Tai Chi brings on a relaxed, meditative state. The easiest form to learn is the Yang 24 movement, but any of the thousands of Tai Chi styles offers the exact same benefits. They are all performed in a set pattern done over and over with accompanying breathing techniques and centring skills, Students change the way they move, the way they balance, the way they breathe.

For sufferers of vestibular damage, the first several weeks of class can be tough but stick with it. The reward will be worth every moment of dizziness and clumsiness at the beginning..
Working Out with Weights

Not surprisingly, just as studies show the benefits for seniors of working out in a gym, or at home with weights, so should someone with vestibular damage maintain their strength. Interestingly enough young men with severe vestibular damage, including partial deafness, often become body builders. One famous example: Arnold Schwarznegger, now governor of California.
A Healthy Diet

Mention has already been made about the effects of some soy products which are processed using the chemical hexane. Also, it is wise to avoid eating meat because of the hormones, antibiotics and pesticides used on the animals. This includes factory-farmed fish and chicken. They're all treated the same way. If meat must be on the menu, buy organic - make sure it's organic - and eat less of it.

A vegetarian diet helps you to lose weight, so why not?

Avoid too much caffeine. Sort of a no-brainer there. Quit drinking soda with artificial sweeteners. Asparatame, an artificial sweetener used in many foods, was originally invented for use as a nerve gas to be used in killing on the battlefield. MSG should also be avoided.

Wine in moderation is probably good for you, but be warned - persons with vestibular damage cannot handle alcohol well at all.
Relief from Dizziness and Nausea

Here are a few suggestions which have been proven to help.

Ginger in any form works a charm for most people. Ginger tea, ginger pills, ginger candy, ginger with chocolate - yummy! Recent studies show ginger to be highly effective in quelling the nausea of cancer patients. Persons with vestibular disorder might consider carrying ginger pills with them for use when needed.

Ginkgo biloba extract, sometimes combined with zinc have proven to work for any form of vertigo. The combination was tested on patients with Meniere's disease in France. NOTE: This is a powerful tool for relief, but be careful if you happen to be allergic to it.

Feverfew, a little plant related to the marigold can be used for headaches and body aches instead of Tylenol products.

Neti Pot users rave over the way this tiny teapot clears out the sinuses. Highly recommended by more and more natural healers and physicians, and surprisingly, dentists and optometrists, to speed the recovery from sinus, ear and dental-gum infections.

Ear candling is the newest craze for clearing away too much ear wax. Candling involves putting a hollow wick into the ear canal and lighting it to create negative pressure in the ear canal, melting the wax in the process. Quite a few injuries to the ear have been reported, say Folimer and Shi and they are very much against the practice.[ 3]

For panic attacks, explore the use of Eye Movement Desensitization procedures such as WREMS (www.wakingrem.com) which is a self-help technique, and EMDR which is a clinical procedure. Both are highly effective at giving relief from all kinds of emotional trauma.

DIAGRAM: The internal ear. The blue area comprises the bony labyrinth; the pink area belongs to the membranous labyrinth

PHOTO (COLOR)
References

[1.] Stuart Shipko. Panic disorder in otolaryngologic practice: A brief review - Special Contribution Ear, Nose & Throat Journal. Dec 2001. http://bit.ly/6y5Jqt

[2.] Vernon Jack PhD. Questions and Answers, tips on dealing with tinnitus. Tinnitus Today (ATA publication) 12/06.

[3.] Robert Folimer & Yongbing Shi, Reducing your risk of complications during ear wax removal. Tinnitus Today (ATA publication) 6/05.
Further Information

American Tinnitus Association. PO Box 5, Portland, OR 97207-0005. Tel:: 800-634-8978; Fax:: 503-248-0024. Jennifer DuPriest Associate Executive Director American Tinnitus Association PO Box 5 Portland, Oregon 97207 TF: (800) 634-8978 x215; Tel:: (503) 248-9985 x215. www.ata.org For excellent tips on coping with tinnitus www.ata.org/tinnitus-tips
Arches Tinnitus Formulas

www.tinnitusformula.com/infocenter/articles/conditions/menieres.aspx

Kathleen Cullen and Soroush Sadeghi. Vestibular System. Scholarpedia 3( 1):3013. 2008. www.scholarpedia.org/article/Vestibular%5fsystem

~~~~~~~~

By Ann Fillmore

For many years, during her long career Ann Fillmore PhD was an international consultant dealing with victims of violence. As a behavioural scientist, she served as expert witness, worked as a therapist and before retiring, invented the self-help technique: WREMS (www.wakingrem.com). Now retired, she is busier than ever, teaching Tai Chi at a local college and writing. Her latest mystery novel: Way of Escape is the first about rescuing women in danger and the sequel is on its way. www.amazon.com/Way-Escape-Ann-Fillmore/dp/0917990986 Ann was diagnosed with severe vestibular trauma back in 1987. She did not take the doctors' advice and start on medications, but rather learned Tai Chi. Recently, after a bout with flu, the symptoms worsened and she began the personal quest to keep going - change in diet, research into natural methods of help, which produced this article. She lives on the central Oregon coast, is an ardent gardener, bird watcher and painter. Her two dogs and several cats allow her to share the old house and garden. She may be contacted via UUzul@aol.com

Share this with your friends