1. Labyrinthitis, Tinnitis, Menieres Disease

2. Labyrinthitis
A balance disorder involving inflammation of the labyrinths, housing the vestibular system
May be caused by either a viral infection or a bacterial infection
Head trauma, allergies, and upper respiratory tract infections have also been known to cause labyrinthitis
Symptoms: Rapid undesired eye movement, nausea, chronic dizziness, general ill feeling associated with vertigo, patient may not be able to keep balance
May lead to permanent hearing loss and tinnitis
Even after treatment, patient may overcompensate for years to life, causing balance issues

3. The Vestibular System Vestibular System: 3 semicircular canals
Senses change in rotational movement
Otoliths
Senses change in linear movement
The body combines sensory information from the eyes with information from the vestibular system to make adjustments to balance and movement
Vestibulo-ocular reflex: Information on head movement is relayed to the eye muscle to coordinate visual focus during motion
Labyrinthitis causes the vestibular to improperly sense changes in direction

4. Connection to Anxiety
Labyrinthitis can lead to anxiety and anxiety can lead to dizziness
Psychosomatic: dizziness caused by anxiety
Somatopsychic: Vestibular dysfunction causes the body to feel a sense of imminent physical danger
Network Alarm Theory: Involves noradrenergic, serotonergic, and other neural systems which are stimulated by increased sensitivity in locus ceruleus

5. Pre-hospital Treatment
Nothing can be done outside the hospital concerning the actual disease
Benzodiazepines can be used to treat acute anxiety
Zofran can be used to treat vomiting
One may reassure the patient that treatment is effective... Studies show that patients who believed that their symptoms were out of control did not recover as well even after the physical damage had healed
Doctors may administer antibiotics and chronic anxiety medication to treat patient

6. Tinnitis Tinnitis is not a disease but a symptom
From Latin, means “ringing”
Patients may hear any persistent sound: music, tones, whistling, ticking, crickets, ringing, buzzing, whining, roaring, beeping, etc.
May be caused by ear infections (including labyrinthitis), foreign objects, wax, nose allergies, injury from loud noises, aspirin, low levels of serotonin
Since most people have minor tinnitis, it is usually only diagnosed in cases where it causes problems with normal activities such as sleep
The world's largest bell (Tsar Bell): tons; cast in 1655; hoisted into a tower 19 years later; fell to the ground and shattered in the fire of 1701

7. Tinnitis Study
In 1953, 80 tinnitis-free university students participated in a study
They were placed inside an anechoic chamber
93% reported hearing a buzzing, whistling, or pulsing sound
Study did not report differences in race
All students lived in an industrial nation
Similar studies report higher levels of tinnitis in industrialized nations

8. Disconcerting News
Tinnitis that pulsates with heartbeats indicate abnormal blood flow near the ear
May indicate atherosclerosis
May indicate life-threatening problems such as: carotid artery aneurysm or carotid artery dissection
Could also be a phenomenon in which the patient has a heightened sense of blood flow through the ear
Can be objective (audible by someone other than the patient)
Tinnitis can result in the place of some hearing loss... the frequency heard in the tinnits will no longer be heard by the patient from outside the ear. In other words, after a rock concert, a patient will lose some of the receptors (deafness) or they will falsely relay information (tinnitis)‏

9. Notable People with Tinnitis
Ludwig van Beethoven
Martin Luther

10. Moby
Steve Martin

11. William Shatner Ted Nugent
Lars Ulrich

12. Meniere's Disease
Caused by increased volume and pressure of the endolymph in the inner ear
Classic symptoms include: Bouts of dizziness, vomiting, tinnitis, hearing loss (one ear or both), and a feeling of fullness in affected ears
Patients may have any number of the symptoms as well as many others associated with the inner ear (such as nystagmus) Nystagmus: uncontrolled movement of eyes
Patients usually suffer these symptoms in “attacks”
Can lead to permanent hearing loss and balance problems
Unknown cause

13. Possible Causes
Endolymphatic Hydrops: excessive fluid buildup in the inner ear
Fluid may burst out of the normal pathways and damage parts of the inner ear, explaining the multiple and broad range of inner ear symptoms including a feeling of fullness
Endolymph: the fluid that flows through the inner ear
Over time, damage from swelling can cause more severe hearing loss and balance problems
Herpes virus is another possible cause since it is dormant in many people until the immune system is suppressed, as in trauma or infections. Symptoms develop after the virus erodes the inner ear

14. Exacerbation of Symptoms
Excessive sodium intake
Caffeine
Alcohol
Tobacco
Aspartame
Allergies
Pregnancy
Menstruation
Fluorescent Lighting

15. “Drop Attacks” Some patients report a sudden feeling of vertigo
If not seated or lying, the patient usually falls to the ground
Some patients are unable to stand until medication takes effect or the attack subsides
Often patients feel as though they are being pushed or pulled
Be suspicious of trauma related injuries in these cases

16. Prehospital Treatment
Treatment is limited outside of the hospital
Treat the symptoms of the patient
Zofran
Use dim lighting inside the ambulance
Treat trauma related problems if necessary
Doctors may use a multitude of treatments ranging from diet changes to surgery and medication

17. Alan B. Shepard First American astronaut
Diagnosed with Meniere's Disease in 1964
Performed only one spaceflight before being grounded as a result of the disease
Participated in an experimental surgery to correct the disease
After a successful surgery, he flew to the moon on Apollo 14

18. Sources
“Labyrinthitis.” 16 May Wikipedia. 20 May
“Tinnitis.” 24 May Wikipedia. 27 May
“Menieres Disease.” 20 May Wikipedia. 27 May
Heller, Morris F. M.D.. Bergman, Moe Ed.D.. “Tinnitus Aurium in Normally Hearing Persons.” Ann Otol, vol : Pg
The Merck Manual of Diagnosis and Therapy Eighteenth Edition. Merck Research Laboratories, Merck and Co., INC. Whitehouse Station, NJ