Ménière’s Disease: Vertigo - Hearing Loss - Tinnitus: A Psychosomatically Oriented Presentation

304 Pages·2021·4.984 MB·English

by  Helmut Schaaf

Ménière’s Disease
Vertigo - Hearing Loss - Tinnitus:
A Psychosomatically
Oriented Presentation
Helmut Schaaf
123
Ménière’s Disease
Helmut Schaaf
Ménière’s Disease
Vertigo - Hearing Loss - Tinnitus: A Psychosomatically
Oriented Presentation
Helmut Schaaf
Tinnitus-Klinik
Bad Arolsen, Germany
The translation was done with the help of artificial intelligence (machine translation by the
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ISBN 978-3-662-63609-1 ISBN 978-3-662-63610-7 (eBook)
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V
Preface to the 1st English edition
Menière’s disease with its mostly unpredictable attacks of vertigo can confound peo-
ple’s bodies as well as their souls. Those who lose their balance, which they previously
regarded as being secure and stable, very often also lose their overall assurance and
confidence in other fundamental pillars of daily life which they had taken “for
granted” until then.
When I began my study on Meniere’s disease in 1987 due to my own desperation
as a patient, I was looking for helpful information and research that would give me
some reliable orientation. What I found were numerous, scholarly articles and some
abstracts from symposiums. They presented the state of current, approximate knowl-
edge in diverse and often speculative ways. What was missing was a reliable orienta-
tion for dealing with the disease and taking care of those suffering from Meniere’s
disease.
After a few tolerable years, in 1993, “Meniere’s disease and its accompanying
symptoms” threw me off track. I then had no choice but to deal intensively with the
illness myself. In this way, the disease had found an author rather than an author
finding a disease to study and write about.
This had its effect on my – somewhat personal – approach and style of presenta-
tion.
Therefore, this book is written for patients with Meniere’s disease in the hopes of
giving them an understanding of the essentials of the disease and its consequences,
but also of the available possibilities and chances for compensating for these conse-
quences.
At the same time, I have made it a point to support the medical aspects with refer-
ence to important and current scholarly publications in such a way that colleagues in
the fields of medicine and psychotherapy can also find a coherent and comprehensive
presentation.
Altogether, the neurotological and psychosomatic foundations should show
clearly what is known, what can be implemented, and what needs to be questioned
critically. I have incorporated the experience of dealing with my own suffering from
Meniere’s disease and decades of experience with Meniere’s patients in a specialty
hospital in Germany, which offered neurological as well as psychosomatic-based
treatment, into this book.
The better we understand the disease and the better we can reduce the uncertainty,
the more possibilities of dealing with vertigo will become apparent. Then the subse-
quent problems become smaller. This is especially true for the phenomena of reactive
psychogenic dizziness and of the escalation of anxiety components.
This means that Meniere’s disease is not a “terminal diagnosis” and not a (central)
disease of the brain, as Prosper Meniere already suspected more than 160 years ago.
Even if the disease itself cannot be cured, many of the effects of M. Menière can be
largely compensated for or at least influenced favorably. Medical science can lay the
foundation for such a therapy in this individually complex and interwoven puzzle of
an illness with its various physical and psychological components.
V I Preface to the 1st English edition
These foundations include:
1. Diagnosis, which has been improved by the possibilities of mobile recording of
nystagmus and hearing test in acute cases. The range of vestibular diagnostics has
also been expanded considerably including visualization of endolymphatic
hydrops in MRI-findings.
2. Education and counseling.
3. Effective mitigation of acute attacks.
4. Medical therapy between attacks, including intratympanic cortisone injections.
5. Vestibular training for rehabilitation and compensation.
6. Providing technical aids to compensate hearing loss ranging from hearing aids to
cochlear implants.
7. Reduction or elimination of the function from the affected vestibular organ as a
final option to stop vertigo spells.
It should be noted that false or “inadequately substantiated” promises may increase
the confidence of those seeking help in the short term, but the resulting disappoint-
ment represents a serious side effect. For this purpose, the book includes a lengthy
chapter on Betahistine, which is still prescribed too often as a kind of reflex action,
even though it has been shown in a well-structured research by Betahistine advo-
cates(!) that this substance is no more effective than a placebo, whether with low or
high dosage.
At the same time, many questions remain unanswered, including what triggers
Meniere’s disease. What seems most significant to me when we look at the progres-
sion of the disease – in the absence of effective invasive intervention – is the effect of
time and duration. The longer the damage to the vestibular organ progresses with the
duration of the disease, the less frequent and less severe the vertigo attacks usually
become. This also explains why therapeutic measures can appear more “effective” the
later they are administered.
I am grateful to Springer for making it possible for me to update this book with
current knowledge in Germany at foreseeable intervals and to align it with long-
standing practical approaches.
I have always been able to profit from the meetings and discussions with my col-
leagues in Germany:
5 in Arolsen, Prof. Dr. Gerhard Hesse, Dr. Georgis Kastellis, and Dagmar Beyrau;
5 in Mainz, Prof. Dr. Kai Helling; in Königstein/Sulzbach, Prof. Dr. Leif Walther;
and in Berlin, Prof. Dr. Thomas Lempert.
Once again, I would like to thank the staff at Springer, Monika Radecki (planning),
Hiltrud Wilbertz (project management/production), and Stephanie Kaiser- Dauer
(external editing) and the team of Snehal Surwade, namely Anamika Kumari and
Akshay Supalkar.
Helmut Schaaf
Bad Arolsen, Germany
2021
VII
Contents
1 Ménière’s Disease – The Clinical Picture ........................................................................ 1
1.1 Vertigo, Hearing Loss, Tinnitus ....................................................................................................... 2
1.2 An Exemplary Case – The Classical Case ...................................................................................... 4
1.3 Forms of Appearance ......................................................................................................................... 6
1.4 Uncertainty and (Reactive) Psychogenic Dizziness ................................................................. 8
1.5 Insecurity in the Partnership ........................................................................................................... 10
1.6 Swindle in the Therapeutic Relationship .................................................................................... 10
1.7 Suddenly One Is Affected Oneself ................................................................................................. 11
1.8 Is Ménière’s Disease a Psychosomatic Disease? ........................................................................ 12
1.9 Perspective ............................................................................................................................................ 14
Literature ................................................................................................................................................ 14
2 Physiological and Anatomical Basics. .............................................................................. 17
2.1 The Vestibular Organ ......................................................................................................................... 21
2.1.1 Orientation Via Gravity .............................................................................................................................. 21
2.1.2 O tolith Organs – Utricule and Saccule ................................................................................................ 22
2.1.3 Semicircular Canals ..................................................................................................................................... 24
2.1.4 T he Saccus Endolymphaticus and the Sinus Endolymphaticus ................................................. 27
2.2 Auditory Part ........................................................................................................................................ 28
2.2.1 F rom Sound to Nerve Impulse ............................................................................................................... 28
2.2.2 F rom the Otolithic Organs to the Cochlea ......................................................................................... 31
2.2.3 Organ of Corti ............................................................................................................................................... 33
2.3 Vestibular Nerve .................................................................................................................................. 34
2.4 Vestibulo-Ocular Reflex (VOR) ........................................................................................................ 34
2.4.1 S uppression of the VOR – a Central Achievement .......................................................................... 36
2.5 Oculomotor System ............................................................................................................................ 36
2.6 Nystagmus ............................................................................................................................................. 37
2.7 Who Is Able to Do What! ................................................................................................................... 38
2.8 Other Conditions for Equilibrium .................................................................................................. 39
2.8.1 I nformation from the Skin, Hands and Feet ...................................................................................... 39
2.8.2 The “Belly Feeling” ....................................................................................................................................... 40
2.8.3 H eart, Lungs, Food and Drink ................................................................................................................. 40
2.8.4 Implementation in Motion ...................................................................................................................... 40
2.9 Interface Points in the Brain ............................................................................................................ 41
2.9.1 Advantages and Disadvantages ............................................................................................................ 41
2.10 Balance of the Soul ............................................................................................................................. 42
Literature ................................................................................................................................................ 44
3 Pathophysiology of Ménière’s Disease ........................................................................... 47
3.1 Vertigo from the Inner Ear................................................................................................................ 49
3.1.1 S tadium Classification According to Jahnke (1994)........................................................................ 54
3.2 Eye Tremor (Nystagmus) During an Acute Attack .................................................................... 54
3.3 Impaired Balance After Vertigo Attacks ...................................................................................... 55
3.4 Hearing Loss .......................................................................................................................................... 57
V III Contents
3.5 Dysacusis (Distorted Hearing) ........................................................................................................ 57
3.6 Lack of Loudness Compensation and Noise Sensitivity (Hyperacusis) ............................. 58
3.7 Hearing Impressions Without External Sound Source – Tinnitus ....................................... 59
3.7.1 Forms of Tinnitus ......................................................................................................................................... 59
3.7.2 Psychological Conflicts .............................................................................................................................. 61
3.7.3 T innitus in Endolymphatic Diseases Such as Ménière’s Disease ................................................ 61
3.8 Feeling of Pressure in and Behind the Ear .................................................................................. 62
3.9 Sensory Sensations (Paresthesia) .................................................................................................. 63
3.10 Lack of Compensation and Double Inhibition .......................................................................... 63
3.11 Reactive, Psychogenic Vertigo ........................................................................................................ 67
3.11.1 H ow Can Organic Vertigo Become Psychogenic Dizziness in Ménière’s Disease? ............... 68
3.11.2 M aintenance of Vertigo in Cases of Previous Mental Illness........................................................ 74
3.11.3 C an Fear and Panic Cause Ménière’s Attacks? ................................................................................... 79
Literature ................................................................................................................................................ 81
4 Special Forms of Meniere’s Disease .................................................................................. 85
4.1 Lermoyez Syndrome .......................................................................................................................... 86
4.2 Tumarkin Drop ..................................................................................................................................... 86
4.3 Cochlear Form ...................................................................................................................................... 87
Literature ................................................................................................................................................ 87
5 Differentiation from Other Clinical Pictures ............................................................... 89
5.1 A Misdiagnosis and its Treatment .................................................................................................. 93
5.1.1 F rom Body to Soul and Back Again ....................................................................................................... 93
5.2 Fluctuating Hearing with Low Tone Tinnitus Without Vertigo ............................................. 96
5.2.1 Diagnosis ........................................................................................................................................................ 100
5.2.2 Therapy ........................................................................................................................................................... 100
5.3 Migrainous Vertigo (Basilar Migraine) ......................................................................................... 101
5.3.1 Symptomatology ........................................................................................................................................ 102
5.3.2 Pathophysiology .......................................................................................................................................... 103
5.3.3 Diagnostics .................................................................................................................................................... 103
5.3.4 Treatment ....................................................................................................................................................... 103
5.4 Benign Paroxysmal Positional Vertigo (BPPV)........................................................................... 105
5.4.1 Diagnostics and Therapy .......................................................................................................................... 105
5.5 Vestibular Neuritis – Acute Unilateral (Idiopathic) Vestibulopathy ................................... 107
5.5.1 Possible Causes ............................................................................................................................................ 107
5.5.2 D iagnostics: Complete or Partial Failure? ........................................................................................... 108
5.5.3 Therapy ........................................................................................................................................................... 109
5.5.4 Balance Training ........................................................................................................................................... 110
5.5.5 Lack of Compensation ............................................................................................................................... 111
5.5.6 P ossible Functional Reduction for Too Fast Movements .............................................................. 111
5.5.7 H earing Impairment and Ringing in the Ears ................................................................................... 112
5.5.8 A Subsequent Paroxysmal Positional Vertigo ................................................................................... 112
5.5.9 Confusion in Experience ........................................................................................................................... 112
5.6 Perilymph Fistula ................................................................................................................................. 113
5.6.1 Diagnostics .................................................................................................................................................... 115
5.6.2 Therapy ........................................................................................................................................................... 115
IX
Contents
5.6.3 E xcursus: Influences of Air Pressure on the Ear (Tullio Phenomenon) ..................................... 116
5.6.4 Tube Ventilation Disorder......................................................................................................................... 116
5.7 Vestibular Paroxysmia ....................................................................................................................... 116
5.8 Isolated Otolith Dysfunction ........................................................................................................... 117
5.9 Psychogenic Dizziness ....................................................................................................................... 118
5.9.1 D izziness Instead of Unpleasant Feelings .......................................................................................... 118
5.9.2 T he Problem of Understanding.............................................................................................................. 120
5.9.3 W here Does the Psychogenic Dizziness Take Place? ...................................................................... 121
5.9.4 F rom the “Phobic Postural Vertigo” (PPV) to “Persistent Perceptual
and Postural Dizziness” (3P-D) ................................................................................................................ 121
5.9.5 D izziness in Sociophobia (Social Phobia) ........................................................................................... 128
5.10 Multiple Sclerosis ................................................................................................................................ 129
5.11 Central Vestibular Vertigo Syndrome ........................................................................................... 130
5.11.1 Diagnostics .................................................................................................................................................... 130
5.11.2 Prevention ...................................................................................................................................................... 131
5.12 Blood Pressure Fluctuations ............................................................................................................ 131
5.13 Acoustic Neuroma ............................................................................................................................... 132
5.13.1 Diagnostics .................................................................................................................................................... 132
5.14 Bilateral Loss of Vestibular Function. ............................................................................................ 132
5.15 Head-Extension Vertigo: Cervicogenic? ...................................................................................... 133
5.15.1 Diagnostics .................................................................................................................................................... 134
5.15.2 Therapy ........................................................................................................................................................... 134
5.16 Drug-Induced Dizziness .................................................................................................................... 135
5.16.1 G entamycin for the Elimination of Ménière’s Disease ................................................................... 136
Literature ................................................................................................................................................ 137
6 Diagnostics and Examination Methods ......................................................................... 141
6.1 Medical History .................................................................................................................................... 144
6.2 Balance Examination (Vestibular Examination)........................................................................ 147
6.2.1 Standing and Walking Examination ..................................................................................................... 147
6.3 Examination of Eye Movement ....................................................................................................... 149
6.3.1 Suppression of the VOR ............................................................................................................................ 150
6.3.2 H ead Impulse Test – Testing von the Vestibulo-Ocular-Reflex (VOR) ....................................... 151
6.3.3 Positioning Maneuvers.............................................................................................................................. 152
6.3.4 O verall Evaluation of the Investigation ............................................................................................... 152
6.4 Apparative Examination of the Semicircular Canals ............................................................... 153
6.4.1 Caloric (Thermal) Test ................................................................................................................................ 153
6.4.2 R otational Testing: Examination in a Swivel Chair ........................................................................... 154
6.5 Examination of the Otolith Organs ............................................................................................... 155
6.5.1 E xamination of the Sacculus ................................................................................................................... 155
6.5.2 E xamination of the Utricle ....................................................................................................................... 158
6.6 Hearing Tests ......................................................................................................................................... 162
6.6.1 Pure Tone Audiogram ................................................................................................................................ 162
6.6.2 Speech Audiogram ..................................................................................................................................... 165
6.7 Tinnitus Determination ..................................................................................................................... 165
6.8 Otoacoustic Emission and Distortion Products ........................................................................ 166
6.9 Electrocochleography ........................................................................................................................ 166
6.10 Brain-Evoked-Response Audiometry (BERA) ............................................................................. 167
X Contents
6.11 Glycerol Load Test (Klockhoff Test) ................................................................................................ 167
6.12 Manual Examination of the Vertebral Segments ..................................................................... 168
6.13 Imaging Techniques ........................................................................................................................... 168
6.14 Psychological-Psychosomatic Diagnostics ................................................................................. 169
6.15 Psychological Questionnaires/Test Diagnostics ....................................................................... 172
6.15.1 D izziness Handicap Inventory (DHI) ..................................................................................................... 172
6.15.2 H ospitality Anxiety and Depression Score (HADS) ......................................................................... 173
6.15.3 P atient Health Questionnaire (PHQ-D) ................................................................................................ 173
6.15.4 University Research .................................................................................................................................... 174
6.16 The Most Important Thing at the End: Evaluating and Assigning ...................................... 175
Literature ................................................................................................................................................ 177
7 Therapy of Ménière’s Disease ............................................................................................... 179
7.1 Enlightenment and Counselling .................................................................................................... 182
7.1.1 A ttention: Interactions Between Patient and Doctor –
The Doctor–Patient Relationship .......................................................................................................... 183
7.2 Acute Therapy. ...................................................................................................................................... 187
7.2.1 E mergency Medical Assistance: First and Second Vertigo Attack ............................................. 187
7.2.2 Own Emergency Preparation .................................................................................................................. 189
7.3 Therapy Between Vertigo Attacks ................................................................................................. 192
7.3.1 H ow Can Therapeutic Success Be Determined?............................................................................... 192
7.3.2 Proven Therapies ......................................................................................................................................... 195
7.3.3 Non-proven Conservative Therapies .................................................................................................... 213
7.3.4 S urgical Interventions – without Proven Effect ................................................................................ 221
7.4 Basic Outline of Psychosomatic Treatment ................................................................................ 226
7.4.1 Relaxation Techniques ............................................................................................................................... 226
7.4.2 Psychotherapy .............................................................................................................................................. 227
7.4.3 Psychodynamic Psychotherapy ............................................................................................................. 228
7.4.4 Behavioral Therapy Approaches ............................................................................................................ 229
7.4.5 Systematic Desensitization ...................................................................................................................... 229
7.4.6 Psychotropic Drugs .................................................................................................................................... 238
7.4.7 Inpatient Psychosomatic Treatment ..................................................................................................... 240
7.5 Alternatives/Outsiders: Opportunities and Threats ................................................................ 242
7.5.1 Homeopathy ................................................................................................................................................. 243
7.5.2 Acupuncture ................................................................................................................................................. 243
Literature ................................................................................................................................................ 244
8 B ilateral Disease ............................................................................................................................ 249
8.1 Consequences ...................................................................................................................................... 250
8.1.1 For Therapy .................................................................................................................................................... 250
8.1.2 I n Case of Bilateral Vestibular Loss ........................................................................................................ 251
8.2 Perspectives .......................................................................................................................................... 252
Literature ................................................................................................................................................ 253
9 What Might Make a Good Therapist? ............................................................................... 255
9.1 Careful Diagnostics ............................................................................................................................. 257
9.2 Comprehensible Enlightenment .................................................................................................... 257
9.3 Therapeutic Measures ....................................................................................................................... 258