Our inner ear is a marvel. The labyrinthine vestibular system within it is a delicate, byzantine structure made up of tiny canals, crystals and pouches. When healthy, this system enables us to keep our balance and orient ourselves. Unfortunately, a study in the Archives of Internal Medicine found that 35 percent of adults over age 40 suffer from vestibular dysfunction.
A number of treatments are available for vestibular problems. During an acute attack of vertigo, vestibular suppressants and antinausea medications can reduce the sensation of motion as well as nausea and vomiting. Sedatives can help patients sleep and rest. Anti-inflammatory drugs can reduce any damage from acute inflammation and antibiotics can treat an infection.
If a structural change in the inner ear has loosened some of its particulate matter—for instance, if otolith (calcareous) crystals, which are normally in tilt-sensitive sacs, end up in the semicircular canals, making the canals tilt-sensitive—simple repositioning exercises in the clinic can shake the loose material, returning it where it belongs. After a successful round of therapy, patients no longer sense that they are tilting whenever they turn their heads.
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If vertigo is a recurrent problem, injecting certain medications can reduce or eliminate the fluctuating function in the affected ear. As a last resort, a surgeon can effectively destroy the inner ear—either by directly damaging the end organs or by cutting the eighth cranial nerve fibers, which carry vestibular information to the brain. The latter surgery involves removing a portion of the skull and shifting the brain sideways, so it is not for the faint of heart.
Patients who receive either surgery trade freedom from disabling vertigo for permanent loss of vestibular function and, in many cases, hearing in one ear. Such patients often then benefit from vestibular rehabilitation therapy, which helps the patients adapt by making optimal use of any remaining vestibular sensation or substituting information from other senses such as vision and kinesthetic receptors in the body.
