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Disorders of Hearing
Published in Anthony N. Nicholson, The Neurosciences and the Practice of Aviation Medicine, 2017
Linda M. Luxon, Ronald Hinchcliffe
A recent low-pressure pulse generator (Meniett device) has been advocated as a non-invasive effective treatment for Ménière’s disease, but there is no definite evidence available (Gates, 2005). Chemical labyrinthectomy using intratympanic gentamicin has been popularized as a method of controlling severe vestibular symptoms, although no clear treatment protocol has been established and cochleotoxicity is a significant risk (Sajjadi and Paparella, 2008). Surgical treatment is considered when medical management has failed to control vertigo and is not an intervention advocated for control of progression of hearing impairment. ‘Therapeutic’ procedures such as endolymphatic sac decompression continue to be undertaken despite the lack of evidence of efficacy, while destructive procedures may control vertigo by section of the vestibular nerve if good hearing is preserved, or, in cases of severe/profound hearing loss, labyrinthectomy may be undertaken (Van de Heyning et al., 2005). Chronic symptoms of dizziness due to vestibular dysfunction and hearing impairment may be treated with auditory and vestibular rehabilitation.
A computational framework to simulate the endolymph flow due to vestibular rehabilitation maneuvers assessed from accelerometer data
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Carla F. Santos, Jorge Belinha, Fernanda Gentil, Marco Parente, Bruno Areias, Renato Natal Jorge
Vestibular rehabilitation is becoming an interesting treatment option for a patient with dizziness and balance problems, because such therapy can improve symptoms, functioning, and compliance (Boyer et al. 2008). The vestibular rehabilitation exercises stimulate the brain to use visual clues and proprioceptive alternatives to maintain balance and gait, and there is evidence that it improves nystagmus, control postural dizziness and all other vertigo symptoms, making it the definitive treatment for most patients (Swartz & Longwell 2005). Specific methods include maneuvres to repositioning otoliths, adaptation or substitution exercises that can be vestibular-ocular, vestibular-cervical, or vestibular-spinal, spatial-orientation. Non-specific methods consist generally in rehabilitating overall endurance and strengthening specific muscle groups to sustain posture or balance. The fact that good results can be obtained without drug side effects and that the treatment is both convenient and targeted leads to a gain in confidence by the patient in carrying out its daily activities (Herdman 2013). The first empirical vestibular rehabilitation programs were developed for subjects presenting brain injuries, and later on, the hypothesis of canalithiasis (when the otoconia are loose within the fluid pathways of the inner ear) in the SCD was validated by the success of dislodging maneuvers (Boyer et al. 2008). Physical therapists play a central role in vestibular rehabilitation, not only as care providers but also in helping advance new research in the field. The next wave of vestibular rehabilitation approaches could include virtual reality feedback and training, vestibular implants, and even stem cell techniques (Pavlou 2010; Herdman 2013). With the ultimate goal of improving the quality of life of persons with vestibular disorders, it is important to study the problem from a multi-disciplinary point of view, such that physical therapists, engineers, and physicians all contribute to better understand how the vestibular system works to improve rehabilitation techniques.