Intratympanic steroid injection for vertigo

Endolymphatic sac decompression has probably polarized the otolaryngology community more so than any other aspect of MD treatment. Following the publication of the Danish Sham study, 18 the procedure was largely abandoned in Europe. However, the study had methodological flaws leading many to question the validity of the results. The procedure remains popular in the United States at the present time. To do justice to this particular argument is well beyond the scope of this article. However, being Irish, I shall invoke an anecdote on the subject involving the consumption of alcohol. After a night with this author and another otolaryngologist of Polish extraction, one of the authors of the Danish Sham study conceded that the procedure might actually be effective in controlling vertigo symptoms. However, he felt that the improvement, rather than being mediated via decompression of the endolymphatic sac, was due to the surgery inflicting a degree of insult to the vestibular system, similar to the effect of low-dose gentamicin. I suspect that heated discussion on the subject of sac decompression will continue for some years to come.

Some reports maintain that a cold or other upper respiratory illness preceded the onset of SSNHL in as many as 40 percent of cases. Unfortunately, these reports lack corresponding data on the comparative frequency of upper respiratory illness in a matched control population. What about the evidence of blood examinations? In response to a virus, the immune system produces a temporary increase in the level of antibodies against the specific virus, and many case reports on patients with SSNHL show that they experience a brief, sharp rise in antibody levels against common viruses such as herpes, flu, mumps, or rubella. 

Depending on timing, intra-tympanic steroid injection is also offered (dexamethasone 10-24mg/cc). Intra-typmpanic steroid injection is performed by inserting a needle through the eardrum and injecting about of highly concentrated steroids directly into the middle ear space. The patient is than instructed to keep the affected ear up for 30 minutes without swallowing, yawning, or popping the ear. After injection, the patient is allowed to immediately resume normal activities. This steroid injection has also been used to treat Meniere's Disease flare-ups.

The dura mater and the mastoid or craniotomy are then closed with a variety of materials, and the patient is observed in the intensive care unit. Because the balance fibers are cut suddenly, the surgery causes intense vertigo and imbalance for a few days requiring supportive medical care, medications for nausea and eventually physical therapy. A cane or walker may be needed for a while, depending on the patient’s health and activity level prior to the surgery. Once the patient is able to ambulate safely, he may be discharged home, but vestibular and balance therapy is continued on an out-patient basis to speed the patient’s recovery as much as possible. A return to full function occurs in most patients, although many do feel imbalanced when tired or stressed.

Managing an acute attack involves preparation. This includes consulting with a physician about any appropriate drugs that can be taken when an acute attack occurs, and deciding ahead of time when it is appropriate to go to a hospital. During an attack, it is helpful to lie down in a safe place with a firm surface, and avoid any head movement. Sometimes keeping the eyes open and fixed on a stationary object about 18 inches away is helpful. In order to control dehydration, a doctor should be called if fluid intake is not possible over time due to persistent vomiting.

Intratympanic steroid injection for vertigo

intratympanic steroid injection for vertigo

The dura mater and the mastoid or craniotomy are then closed with a variety of materials, and the patient is observed in the intensive care unit. Because the balance fibers are cut suddenly, the surgery causes intense vertigo and imbalance for a few days requiring supportive medical care, medications for nausea and eventually physical therapy. A cane or walker may be needed for a while, depending on the patient’s health and activity level prior to the surgery. Once the patient is able to ambulate safely, he may be discharged home, but vestibular and balance therapy is continued on an out-patient basis to speed the patient’s recovery as much as possible. A return to full function occurs in most patients, although many do feel imbalanced when tired or stressed.

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