DizzyClear E-Book

Khalid Bashir

• Herausgeber: Grosvenor House Publishing
• Kategorie: Ratgeber
• Sprache: Englisch

Seitenzahl: 135

Veröffentlichungsjahr: 2011

Beschreibung

Do you feel dizzy when you get up too quickly, when you change position in the bed, after air or boat travel, following an injury, or when you turn your head suddenly? You are not alone! Millions of people suffer from dizziness, but few know that effective treatment is available. Dizzyclear provides easy explanation of the causes, symptoms and treatment. This book has been written by an experienced doctor who has successfully treated over a thousand dizzy patients. Dizzyclear will certainly benefit patients and their carers, doctors and nurses, physiotherapist, osteopath, manipulative and physical therapist.

Leseprobe

DIZZYCLEAR

Easy to understand dizziness and vertigo and their management, including home treatments.

Mr Khalid Bashir MD

Consultant and Head of Emergency Medicine Department

Bronglais General Hospital, Aberystwyth, United Kingdom

Specialist in otolaryngology, sports medicine and pre-hospital care

Fellow of College of Emergency Medicine (UK)

Fellow of Royal College of Surgeons (Edinburgh)

Fellow of Royal College of Surgeons (Glasgow)

Diploma in Immediate (pre-hospital) care, Royal College of Surgeons (Edinburgh)

Diploma in Sports Medicine (Cardiff)

Certificate in Aviation Medicine (London)

GMC Specialist register of emergency medicine and general practice

Chapters

Part 1

Understanding Dizziness and its Management

Chapter 1

What is dizziness?

Chapter 2

How does the balance system work?

Chapter 3

Meniere’s disease and dizziness

Chapter 4

Vestibular Neuritis (Labyrinthitis) and dizziness

Chapter 5

Perilymphatic fistula (PF) and dizziness

Chapter 6

Vitamin B12 deficiency and dizziness

Chapter 7

Motion sickness

Chapter 8

Mal de Debarquement Syndrome (MDS)

Chapter 9

Dizziness in multiple sclerosis (MS)

Chapter 10

Dizziness in Parkinson’s disease

Chapter 11

Fibromyalgia and dizziness

Chapter 12

Dizziness in children

Chapter 13

Dizziness after injury

Chapter 14

Dizziness in old age

Chapter 15

Microvascular compression (MVC)

Chapter 16

Psychogenic dizziness

Chapter 17

Acoustic neuroma (AN)

Chapter 18

Dizziness and air travel

Chapter 19

Exercise-induced dizziness

Chapter 20

Dizziness and sex

Chapter 21

Dizziness treatment using complementary and alternative medicine

Chapter 22

Vestibular rehabilitation therapy (VRT)

Part 2

Understanding Vertigo and its Management

Chapter 23

Benign Paroxysmal Positional Vertigo (BPPV)

Chapter 24

Cooksey-Cawthorne Exercises (CCE)

Chapter 25

Gaze stabilisation exercises (GSE)

Chapter 26

Dix-Halpike manoeuvre

Chapter 27

Modified Epley’s manoeuvre (MEM)

Chapter 28

Modified Brandt-Daroff Exercises (MBE)

Chapter 29

Frequently asked questions

Poem

I had dizziness for two years

This brought forth my tears

Someone said it is your ears

Depression was stated by my peers

Stroke was one of my fears

I spent money on pills for years

And then I discovered Dizzyclear

Then my dizziness stopped

By a dizzy patient

Dedication

I would like to dedicate this book to my parents, who have contributed significantly in my life and helped me achieving the highest position in my field.

Foreword

Doctors and other medical personnel commonly come across patients with dizziness. The incidence of dizziness increases as one gets older. Patients with dizziness can present with and without vertigo sensation. It is quite a disabling symptom, although mostly there is no serious underlying cause. In the past, people suffered and lived with this condition, as care providers found it difficult to deal with it properly; however, with recent advances in technology and proper management of this condition, most people can get very effective treatment. The treatments are usually provided by ear nose and throat specialists, GPs or physiotherapists in the form of various exercises and short term medication.

Dizzyclear has been written by Mr Khalid Bashir, who has vast experience in treating these patients. For the last eleven years, he has successfully treated many patients in Bronglais General Hospital, Aberystwyth. This book also contains many easy to understand illustrations. There is currently a research project being undertaken in this hospital to look into the effectiveness of Epley’s manoeuvre and home exercises for the treatment of benign paroxysmal positional vertigo. Initial results have shown significant benefit to these patients in this area of Wales. We feel this book, in simple format and basic structure on this subject, will benefit hospital doctors, GPs, practice nurses, medical students and physiotherapists dealing with dizzy patients on a regular basis.

Dr L Pandya MRCP (UK), MRCP (Ireland), Consultant Physician

Dr M Akram MRCP (UK), Specialty Doctor in Medicine

Important note

Every effort has been made to check the drugs and their doses. The readers are encouraged to consult the drug company’s literature before administering any drugs listed in this book. The exercises recommended in this book should be performed in a safe environment, preferably supervised by a clinician or at least in the presence of a relative or a carer.

Directory of Terms

■ BPPV (Benign paroxysmal positional vertigo). This is a type of dizziness where surroundings appear to spin. It is associated with nausea with various head and neck movements (chapter 23).

■ Dix-Halpike manoeuvre This is a test for diagnosing BPPV. The head is brought in to various positions to induce dizziness (chapter 26).

■ Proprioception This is a subconscious sense that enables us to know where our limbs are in space with out having to look. The proprioceptive system consists of nerve receptors in muscles, ligament and tendons around the joints.

■ Nystagmus A repetitive and involuntary movement of the eyes. If it is present during vertigo diagnostic tests, then the vertigo is very likely due to an inner ear problem.

■ Grommet A grommet is a small tube inserted into the eardrum, mainly to prevent accumulation of mucus in the middle ear. However, one rare indication of grommet insertion is vertigo due to Meniere’s disease.

■ Inner ear Called labyrinth due to its complex shape, the inner ear is situated in the bone behind the ear (petrous part of the temporal bone). It consists of a bony part, called osseous labyrinth and a membranous part, called membranous labyrinth. The labyrinth consists of three parts: 1) cochlea is the anterior part of the labyrinth. It is coil-shaped and is responsible for hearing 2) vestibule is the central part 3) semi-circular canals are the posterior part of the labyrinth. There are three semi-circular canals named according to their position: superior, posterior and horizontal. The semicircular canals and vestibule are concerned with balance.

■ Vestibular system The part of the inner ear concerned with balance is called the vestibular system. It consists of semi-circular canals and otolith organs. Otolith organs are fluid-filled pouches that lie between the semicircular canals and the cochlea. They are called the utricle and the saccule. These inform the brain when our body is moving in a straight line, such as when standing up or riding in a car. They also inform the brain about the position of our head in relation to the ground, for example, whether we are lying down or sitting

■ Vestibular rehabilitation therapy (VRT) This is an exercise-based treatment offered to patients for both acute and chronic dizziness. The following exercises are most commonly used:

• Cooksey-Cawthorne Exercises (chapter 24)

• Gaze Stabilisation Exercises (chapter 25)

• Canalolith repositioning manoeuvres, such as Epley’s manoeuvre, Semont’s manoeuvre and Brandt Baroff’s home exercises (chapters 27&28)

■ CT scan (Computerised tomogram) This is a special type of X-ray using a scanner and a computer to take pictures and analyse them. It produces scans in cross-sections. Some scanners are able to turn images into 3-D images.

■ MRI scan (Magnetic resonance imaging This is a special type of scan which uses strong magnetic field and radio waves and computers to take and analyse detailed pictures of the brain and spine. It is excellent in differentiating between normal and abnormal soft tissues. There is no radiation exposure to the patient, hence, it is.

Introduction

Do you ever feel dizzy when you get up too quickly, when you change position in the bed, following travel by air, boat or road, or a head injury, or when you turn your head suddenly? You are not alone! Millions of people suffer from dizziness, but few know that effective treatment is available. There are many books available in the market about dizziness that deal with various aspects of dizziness and vertigo. Some of them are difficult to understand by non-medical personnel and others provide much more detail. Dizzyclear has been written by an experienced doctor who has successfully treated over 1,100 dizzy patients in the last eleven years. It provides a simple explanation of the causes and symptoms of dizziness and also provides suggestions for relief and self-treatment. Dizzyclear will mainly benefit non-specialist medical staff such as GPs, practice nurses, physiotherapists and physical therapists. However, it may also help dizziness and vertigo sufferers.

The book is divided into two parts. The first part of the book covers various causes of dizziness and their management; the second part explains the diagnosis and management of vertigo. Part 2 contains a flow chart which explains how to diagnose and treat vertigo at a GP’s surgery or at home. This is supplemented by various easy to understand illustrations.

I used to suffer from recurrent attacks of vertigo for a long time. In spite of being a medic myself and with many of my colleagues being doctors, I did not find any clear, effective treatment. During my training in ear, nose, throat and head and neck surgery, I learned the assessment and treatment of vertigo patients. This helped me significantly in treating my own symptoms. The Dizzyclear clinic opened in February 2001, and is based in the Emergency Department of Bronglais Hospital, Aberystwyth, Wales, UK. I am the lead doctor responsible for running this clinic. Patients sometimes refer themselves privately, and we also treat National Health Service patients who are referred by their GP or other specialists.

This clinic was started initially to treat patients suffering from vertigo. However, following successful treatments, we also started seeing patients with dizziness with or without vertigo. We have seen people in our clinic from ages 14 to 94. The duration of symptoms appears to vary from a few months, in the majority, to years, in a few. The longest sufferer was a 60-year-old woman who suffered for nearly 20 years; she was seen in the Dizzyclear clinic. Her symptoms completely settled after a treatment in the clinic (Epley’s manoeuvre which involved moving head and neck in some positions) and some days of home exercises. Over 95% of our patients have improved within three weeks of the treatment.

Every effort has been made to provide up to date information in a clear, simple language that is assessable by a wide range of audiences. The first two chapters are dedicated to understanding balance, and how abnormalities in balance can affect our daily life. The remaining chapters cover the wide range of causes of dizziness, providing practical advice for the sufferer, their family members and the relevant health-care professional.

Each chapter begins with a case study outlining the symptoms of real patients; most of them have visited the Dizzyclear clinic over the years. Every effort has been made to disguise the identities of these patients. Following each case study, a brief introduction to each condition is presented, which outlines the symptoms and diagnosis for each condition. This is followed by treatment and advice for health care professional and also for patients. Towards the end there are further reading options which will help if you wish to explore about topics further.

Part 1

Understanding Dizziness and its Management

Chapter 1

What is dizziness?

Dizziness is a feeling that may be hard to describe, and can mean many different things. Some people say that they are “dizzy” when they have light-headedness, or they feel “giddy”, or they may experience vertigo or balance problems, or simply feel confused. Vertigo is one very common type of dizziness where you get a sense of movement, or the surroundings appear to spin when you are standing or sitting still. There are various causes of dizziness. Mostly these are minor problems. However, although rare, there could be a serious underlying cause. If you frequently feel dizzy without an obvious cause, then you should see your doctor for further advice.

The exact number of people suffering from dizziness is difficult to quantify, as the diagnostic criteria varies in different places. However, in the United States, from 2001 to 2004, 69 million Americans aged 40 and over were diagnosed with dizziness. The majority of patients over 70 who experience falls have associated dizziness. People with chronic balance problems usually have difficulty in performing one or more daily living tasks, such as bathing, moving about in the house, getting in and out of bed, or dressing.

WHEN TO GET URGENT HELP

You should seek help from your General Practitioner initially, or the nearest emergency department, if you have dizziness along with the following symptoms:

1.Severe headaches, or a different kind of headache than you typically experience

2.High temperature – more than 38°C (100.5°F)

3.Sudden deafness or visual problems such as loss of vision or double vision

4.Weakness or numbness in the body, arm or legs

5.Collapse (passing out)

6.Speech problems

7.Chest pain or a shortness of breath

8.Frequent vomiting (for an hour or more)

9.Irregular pulse rate (i.e. very slow, below 50 bpm, or high, above 100 bpm)

10.Any other concerns

Your doctor would likely examine you and in most cases, there will be clear cause of dizziness after examination. However, sometimes the cause may not be clear and further tests may be required to gain a diagnosis.

CAUSES OF DIZZINESS

Following are the common causes of dizziness. Most causes are discussed in detail in this book:

1.Dizziness due to inner ear problems

• BPPV (benign paroxysmal positional vertigo) – this is the most common cause of dizziness

• Menier’s disease

• Vestibular labrynthitis

• Perilymph fistula

• Superior canal dehiscence

• Tumours, such as acoustic neuroma

• Microvascular compression syndrome

2.Dizziness due to neurological problems

• B12 deficiency

• Brain stem strokes

• Basilar invagination

• Epilepsy

• Cervical vertigo

• Chiari malformation

• Migraine associated dizziness

• Motion sickness

• Mal de Debarquement

• Multiple sclerosis

• Parkinson’s disease

• Stroke

3.Dizziness due to medical problems

• Low blood pressure

• Side effect of medications

4.Dizziness caused by psychological problems

• Anxiety disorder

• Phobias

• Malingering

5.Dizziness caused by various activities

• Post traumatic dizziness

• Dizziness due to flying

• Motion sickness

• Dizziness due to sexual activity

• Dizziness due to loud sound (Tullio’s)

• Positional vertigo

6.Other causes of dizziness

• Post-partum (pregnancy-related)

• Fibromyalgia

• Medication used for epilepsy, high blood pressure, Parkinson’s disease, antidepressants, sedatives, and some antibiotics can all cause dizziness

SUMMARY

Dizziness, with or without spinning sensations, is a common complaint. Most causes are simple and easily treatable; however occasionally, there may be a serious underlying illness. With an appropriate examination of a patient’s past history and treatment, most people can recover from dizziness. Dizziness has been known to recur, but it can be safely treated at home.

FURTHER READING

1.Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. “Disorders of balance and vestibular function in US adults”. Arch Intern Med. 200; 169 (10):938-944

2.Neuhauser HK, Radtke A, Von Brevern M, Lezius F, Feldmann M, Lempert T. “Burden of dizziness and vertigo in the community”. Arch Intern Med 2008; 168(19): 2118-2124

Chapter 2

How does the balance system work?

Case study: A thirty-five-year old acrobat was referred to a neurology clinic as he had not been able to perform his act of walking on a tight wire for nearly four months. He described a feeling of unsteadiness while practicing his act. This difficulty presented itself after an episode of flu-like illness. His hearing was normal and there were no other concerning sign and symptoms following a thorough examination. He was diagnosed with labrynthitis and was referred for vestibular (inner ear) rehabilitation therapy. Within two months of treatment, he was able to complete his practice session successfully.

The acrobat’s vestibular system sends constant signals to the muscles required for this act. The sensory receptors from his eyes, ears, and muscle and joints are constantly sending information to keep him informed of the position of the entire body at every movement. At the same time, the brain is sending signals to the appropriate muscles to contract.

INTRODUCTION

The balance system of our body is quite complex and it is maintained automatically. It does not require conscious control. We only realise when it is not working properly how much we are dependent on this balance system. A balance disorder will make you feel as if you are moving, spinning or floating, even though you are either standing still or lying down. Balance disorders can be caused by various medical conditions involving the inner ear, brain, heart, and lungs, and also as a side effect of certain medications.