Share:
Equilibrium causes and therapy
contents
- The organ of equilibrium
- Incoordination
- dizziness
- Balance disorders due to alcohol
- sunstroke
- Mental dizziness
- therapy
- Dissociate
- Benign paroxysmal positional vertigo
- Meniere's disease
- Neuropathia vestibularis and labyrinthitis
- Fistulas of perilymph fluid
- Vascular dementia
- The Creutzfeldt-Jakob disease
The organ of equilibrium
Our organ of balance lies in the inner ear and is called vestibular apparatus. Together with eyes it registers changes of position and movements. This is how we orient ourselves in the room. There are also receptors on the surface of the body that sense temperature, touch, vibration and pain.
The equilibrium organ has three semicircular canals. These are 90 degrees to each other and thus recognize the three dimensions of the room. The two atrial pouches capture the sensory fields with which we estimate velocities.
The sensory fields perceive the linear velocities, through hairs that protrude into a jelly-like mass. On it are the otoliths, crystals of calcite. As the zempo changes, the jelly moves, causing the hairs to bend and stimulate the sensory cells. The sensory cells then pass the information on to the cerebellum. This translates the information, for example, by the eyes changing their sight. This process can not be controlled deliberately.
In the arcades, on the other hand, there are sensory cells that recognize rotational speeds. The hairs also protrude into a gelatinous mass here. If we turn, the position of the jelly changes and the sensory hairs bend; this transmits to the sensory cells, and they also relay the signals to the cerebellum. This reacts reflexively, for example, by quickly moving the eyes.
By perceiving rotational movements, for example, we can see a roadside hitchhiker on a fast car ride.
Low blood pressure can be the trigger for balance disorders. Picture: Picture-Factory - fotolia Incoordination
If the organ of balance is damaged, these reflexes will not work anymore. Balance disorders are dizziness, confusion, or dissociation. The affected person can not stand on his feet, he stumbles and falls, he does not know where up and down is. The triggers are often harmless: Someone has drunk too much alcohol, on a ship, the ground fluctuates, or the ride in a roller coaster brings the interaction between body, nerves and brain off track.
But if such factors fail, serious diseases can be behind the balance disorder:
- high blood pressure
- Metabolic disorders and low blood sugar
- Cardiovascular disease
- Low blood pressure
- Concussion and brain trauma
- sunstroke
- Inner ear inflammation
- hyperventilation
- Disease of the inner ear
- Side effects of antibiotics
- Eye diseases
- Meningitis
- stroke
- Tumors in ear and eye
- neurological diseases
- Parkinson
- multiple sclerosis
Physical balance is influenced by the integration of sensual information into the nervous system. Any conflict between this information, that is, any blockage, causes changes in the physical balance.
With age, the sensory systems suffer from an accumulation of degenerative, infectious, and traumatic processes that hinder their functioning. Although isolated alteration in one part of the nervous system does not result in overall balance instability, a combination of these neurological disorders is the key factor for balance problems in the elderly.
dizziness
Dizziness is one of the most common ailments people go to the doctor for. These include fake movements of the environment as well as problems standing and walking, the feeling of fainting, but also swaying, stumbling and falling.
These dizziness feelings have a variety of causes: disorders of the organ of balance as well as visual disturbances, circulatory problems, inflammation of the nervous system, diseases of the metabolism, and, very often, mental problems.
The dizziness affects the affected considerably, even if the trigger is harmless. They can no longer carry out a lot of physical work, for example climbing scaffolding or driving certain vehicles, and mental workers suffer from their concentration.
Persistent dizziness can also become psychologically anchored, which is difficult to define diagnostically. Balance disorders are often difficult to detect with modern methods such as computed tomography, ultrasound and magnetic resonance - in 80% of all dizziness symptoms.
The doctor himself is in demand: his knowledge of the clinical pictures of balance disorders, his detailed analysis of the patient's complaints and his history make the right diagnosis.
Further investigations show dysfunctions of the sensory organs, which carry the equilibrium system, thus the equilibrium system, the eyes, the cerebellum and the nervous system, more precisely, the movement, strain and pressure transducers located in the joints, tendons and muscles, above all in the arms and legs.
Physical balance is important because a weakened balance increases the risk of falling and contracting brain injuries or broken legs. Keeping the balance while sitting or standing is necessary for daytime activity, and this includes elementary ones such as personal hygiene or walking. A weak balance suffers many physical actions such as sports, driving and working.
Medications affect the organ of balance as well as infections of the inner ear, head injuries or anything else that affects the inner ear and cerebellum. For example, low blood pressure can cause dizziness if someone gets up quickly. The cerebellum will not be supplied with blood fast enough in this case. But also bone diseases such as rickets or eye diseases such as weakness of the eye muscles can disturb the balance. In the case of arthritis, information from the cerebellum no longer reaches the bony nerves; if the eye muscle weakens, the information reaches the eye, but it can no longer react to it. Unfortunately, many disorders of balance begin suddenly and without obvious cause.
Balance disorders are generally associated with problems of the vestibular system in the inner ear. However, they can also hang together with the cerebellum, with the eyes or the skeleton. A lack of vitamin B 12 can lead to balance disorders.
Balance disorders due to alcohol
Anyone who has ever drunk too much alcohol knows the alcohol-related loss of balance: The glass falls out of his hand, if he wants to sit down on a chair, he sits down, he stumbles, and, when he is very drunk he can not walk anymore. He sees things twice, can not estimate distances and loses his orientation. Arrived at the front door, he does not manage to put the key in the lock, and when he finally lies in bed, his head "Karusell".
Alcohol causes two different types of dizziness. First, drunk people suffer directly from the outlined acute disorder, which is directly associated with the intoxication. Second, permanent imbalance disorders occur in alcoholics and people who abuse chronic alcohol.
The acute disturbance caused by a frenzy is that the alcohol briefly disturbs the interplay of structures in the equilibrium system. The "Karusell-driving" in bed, however, also belongs to the acute alcohol intoxication and is called "alcoholic lageschwindel".
The semicircular canal in the organ of equilibrium responds to rotational movements of the head, because its hairs are bent. These hairs usually have the same weight as the endo-muscles that activate them and respond only to rotational movements.
Alcohol is lighter than water, the hair is now lighter, and the organ reacts to static changes in position of the head - from a blood alcohol content of 30 mg per 100 ml. Namely, the alcohol lamiert first in the hair. If the drunk now lowers or raises his head, he becomes dizzy.
But this happens when the alcohol reaches the endolymph and the weight recovers. But with the "hangover" the second alcoholic attitude fraud sets in. The alcohol in the inner ear sinks, first in the cupula.
Now the initially lighter cupula becomes heavier than the endolymph, it bends down, and again the drinker suffers from dizziness.
Chronic alcoholics, on the other hand, permanently damage their balance system. The nerves are not working as they should, and so are the nerves and nerve centers that regulate balance. Even without drinking, the patient now stumbles, has always "blackouts", that is, problems to orient themselves in the room, forget important, stumbles and falls.
sunstroke
Sunstroke refers to a disturbance caused by excessive sun heat. The meninges are exposed to strong stimuli, and the person suffering from nausea, headaches and dizziness attacks.
If we move too long in too strong sunlight, then we run the risk of getting a sunstroke. In contrast to sunburn, but not the whole body "problem zone", but the uncovered neck, neck, and especially the head. The broad-brimmed sombrero of the Mexicans is suitable to protect this problem zone because it covers the entire head-neck-shoulder area.
While sunburn damages the skin with first-degree burns, sunstroke affects the meninges. Those who walk around in the Sonoran Desert without a hat or "tan" uncovered on the beach of the Persian Gulf increase the risk, and those who are naturally fair-skinned and have little head hair should consider a heat stroke as a serious danger.
Who suffers from a sunstroke, feels this, in contrast to a sunburn, only hours after sun exposure. Most of the time the sunstroke disappears when we cool our heads, put us in the shade or cover our heads.
However, in a few cases, a sunstroke has serious consequences: the worst is brain edema, which increases brain dryness, which can lead to respiratory arrest, convulsions and even coma. An emergency doctor is in demand - and he is rarely present in risky areas such as the inner Sahara or the interior Tanasania.
Other symptoms of a "normal" sunstroke are taken by outdoor travelers on their own, not life threatening, but can trigger a dangerous domino effect. Typical for a sunstroke are orientation problems and dizziness. The affected person loses the orientation in the room in the short term, and in the short term means, until he finds shade.
The sunstroke is soon followed by dehydration. Lack of water also causes the person concerned to black out, pain in his temples, he gets dizzy, he finally gets stomach cramps and breaks down. Sunstroke and thirst are not the same, but often occur together and show the same symptoms.
These orientation problems can cost your life in an emergency. In the Grand Canyon, for example, there is a scorching heat in the middle of summer, which in the US is probably surpassed only by Death Valley. In addition, only one of several paths through the bottom of the canyon leads past a waterhole.
First, if you suffer a sunstroke here, secondly find no shade, thirdly because of the sunstroke loses its orientation, and so fourth, neither water nor can seek help, is a candidate for death.
In desert areas there are therefore two iron laws: First, carry enough water, and secondly wear at least a headgear, but better additionally carry a shade dispenser like a poncho, a blanket or a tent wall with him.
In a sunstroke, small children also easily contract meningitis. Therefore, infants should always be protected from direct and prolonged exposure to the sun.
Mental dizziness
Many dizzy spells are psychological, and in young adults, this is even the most common complaint of dizziness.
These are not easy to recognize because they often "imitate" the vestibular dizziness, that is, they act as a disruption of the organ of balance: a tendency to fall, the feeling that everything is spinning, and disorientation.
However, most mental dizziness complaints are clearly undirected, so they are more diffuse than disorders of the organ of equilibrium: They occur neither regularly, nor are they limited in time or occur in specific situations, such as getting up or rapid head movements.
Rather, it marks a general feeling of falling or sinking, "losing the ground underfoot," accompanied by sweats and palpitations, anxiety attacks, a general oppression, and, above all, the feeling of drowsiness.
While disturbances of the organ of equilibrium are characteristically triggered by movements of the head, mental dizziness usually occurs in anxiety-filled situations: in crowds, in conversations, in confined spaces, ie always where the person concerned is particularly afraid. Doctors therefore speak of situational-phobic dizziness.
These dizziness attacks have nothing to do with simulantism: they range from a disorderly malaise to fatal attacks of fainting.
Mental dizziness symptoms have negative consequences for those affected as well as purely physical ones. Often the sufferers no longer dare to leave their homes, they can no longer practice their profession, and the vertigo can develop into a full-blown depression.
therapy
Mental dizziness requires treatment other than a disorder of the organ of balance. In the case of everyday problems, such as the fear of an existing exam, the victim will already be helped if the doctor informs him of the cause of the physical symptoms.
Exercise, and especially endurance sports, always helps with mental dizziness. Although the symptoms are psychologically conditioned, a physical training strengthens the psyche and helps to overcome the challenges facing dizziness as an "emergency brake".
In case of serious problem, the person concerned should consult a neurologist. If mental illness is underlying dizziness, psychotherapy is also appropriate.
Dissociate
Balance disorders may also be part of a traumatizing and / or underlying mental disorder. Post Traumatic Stress Disorder and Borderline Disorder mark phases in which the person in question dissociates.
Then he loses the sense of space and time and his own identity. Post-traumatized people remember drunks in these phases. They have problems standing straight, they need to breathe fresh air to inhale oxygen, their head is "driving carousel".
On the one hand, traumatized people experience a flashback, that is, the memories of the traumatic event return unchecked. This includes tachycardia, sweating and muscle tension. The affected person acts as if he "stood next to him". Dizziness is just one of many symptoms that the sufferer suffers from.
Benign paroxysmal positional vertigo
This disease manifests itself in vertigo attacks. The crystals in the inner ear have come loose through external force or chemical processes in the body. Because the crystals now move freely in the fluid, the brain perceives a pseudo-movement.
An ear, nose and throat specialist makes the diagnosis by checking the location of the crystals. In therapy, the crystals are returned to their previous position.
Those affected feel their balance particularly when they turn around in bed, get into bed or get out of bed, when they climb high steps or turn their heads back under the shower.
When they get out of bed, they are black in the face, they even stumble and fall. Sometimes they feel extra and have to vomit. Because of this, sufferers often confuse the disease of the inner ear with a flu infection.
The symptoms often show up abruptly, terrifying the patients. Whenever they move their heads or taps their temples, they feel irritated and often even fall out of bed.
When they stand and move their heads forward or backward, they often fall to the ground. Usually the symptoms diminish in a few weeks or months, sometimes lasting years.
The most common cause of this illness is a head injury. In older people, however, the equilibrium system in the inner ear frequently degenerates, and the crystals then dissolve without external influence. This is the case in half the cases where the doctors then diagnose: cause unknown.
Meniere's disease
In Meniere's disease, tinnitus, hearing problems, and giddiness usually occur together, and these symptoms can last for hours, and then the patient is completely exhausted. The fluid in the inner ear is insufficient in this disease, and the membranes that connect the spaces of this fluid are slowed down in their function. Between the attacks, the affected person usually has no symptoms. This disease can lead to permanent hearing damage. In addition to ear, nose and throat doctors, neurologists, ophthalmologists and internal physicians are also consulted.
Meniére's disease was discovered by the French physician Prosper Meniére in the early 1860s. The cause of the disease is as unknown today as in his time, doctors suspect allergies that affect the inner ear. It is also unclear why the disease sometimes progresses and often does not. The disease runs in three stages.
The first stage features sudden phases of dizziness. The patient feels dizzy in these attacks and vomits. Such a phase lasts from 20 minutes to 24 hours. In the meantime, hearing is difficult for the person concerned, but the hearing then returns to its normal state. The ear hurts and feels clogged, as if pressure is on it.
In the second stage, the dizziness weakens, but the hearing loss gets worse. Some people say the disease will stop completely, but then the symptoms come back after months.
In the third stage dizziness almost ceases, and sometimes it ends forever. But the balance disorders remain. Those affected feel uneasy when it is dark and can hardly translate visual signals into the orientation in the room in low light. The hearing deteriorates more and more.
Neuropathia vestibularis and labyrinthitis
Neuropathia vestibularis overrides the organ of balance without doctors knowing the exact cause. The sufferer suffers from a spontaneous onset of vertigo that lasts for days or even weeks.
A so-called labyrinthitis is usually caused by a viral infection, for example, by herpes. Bacterial labyrinthitis often begins with untreated middle ear inflammation or as a result of meningitis.
The infections can, if they are recognized, treat in a few weeks. However, if the inner ear is permanently damaged by the infection and the cerebellum can not repair this damage, the symptoms become chronic. These include: Chronic confusion, fatigue, disorientation, tinnitus and hearing loss.
Balance disorders can be caused by disturbances in the inner ear. Therefore, it is always advisable to consult an ENT doctor. Picture: Elvira Gerecht - fotolia Fistulas of perilymph fluid
A fistula of the perilymph (English PLF) is an abnormal opening in the fluid of the inner ear. A tear or a defect in the small, thin membranes between the middle and inner ear. These membranes are called oval window and round window.
Changes in the air pressure that weighs on the middle ear, we know as the "pop" when we rise in an airplane in the air. Usually these have no effect on the inner ear. However, if a fistula affects the inner ear, such changes in the middle ear directly affect the inner ear, stimulating balance and hearing.
Most of the symptoms caused by PLF are similar to those of Meniere's disease. Therefore, the difference between the two disorders is important: There are two different fluids in the inner ear, the endolymph and the perilymph. Meniere's disease occurs when the endolymphic fluid is under pressure and blocks the membranes in which it is located. This pressure shifts the perilymph fluid.
In PLF, however, the perilymphatic fluid flows into the middle ear. This also leads to uneven pressure between the two fluids and therefore to similar symptoms, even if the cause of the imbalance is different.
Various tests distinguish both diseases. For example, a fistula can be detected by noting the eye movements while applying pressure to each ear canal - for example, with a small piece of gum.
Head trauma is the most common cause of PLF, usually caused by a direct blow to the head or ear. However, PLF is also the result of a rigid change in the pressure of the atmosphere, be it freediving, acrobatic flying maneuvers, childbirth or bungee jumping. Very rarely such fistulas are innate.
Controversial are "spontaneous PLFs" - without obvious triggers. Doctors who deny such "inexplicable" fistulas assume that head trauma or a rapid change in atmospheric pressure is the cause, but that the patient does not associate with the condition.
Vascular dementia
Vascular dementia shows by way of example that in many diseases the disturbance of the balance is only one symptom among many. In this multi-infarct dementia, the brain is no longer adequately supplied with blood. The sufferer loses most of the mental abilities he developed before.
Dementia suffer from balance disorders in memory lapses, orientation problems, concentration disorders, speech disorders, emotional disorders and constipation.
Twenty percent of all dementia patients suffer from the vascular form of the disease. Characteristic is her forgetfulness, especially in short-term memory. This dementia mainly affects old people, who already suffer from diseases that damage the brain, especially heart problems or arteriosclerosis. The constricted blood vessels in the brain no longer supply the organism with the oxygen it needs. The cells die.
Arteriosclerosis, a pre-existing disease of vascular dementia, is also caused by smoking, cholesterol, blood, diabetes or cardiac arrhythmias.
Dementia begins slowly, so that the patient often does not recognize it or perceives it as a normal concomitant of aging. It starts with the person forgets things. At first he does not know where the car key is, sometimes he forgets that his grandchildren wanted to visit him - soon he destroys essential parts of everyday life, and the forgetful becomes so forgetful that he can forget about forgetfulness Problem: He forgets that he is forgetful, and he forgets what he has forgotten. In the on-going process, he no longer recognizes his friends and relatives, his mental ability diminishes - he falls back to the level of a toddler.
The affected person, as in the case of a disturbance of the organ of equilibrium, has problems in orienting himself in space. The patient loses his motor skills, the limbs become stiff, he nipples, shuffles and walks wide-legged.
He falls down again and again, he gets visual hallucinations that confuse him. He becomes dizzy, he feels threatened by his environment and reacts aggressively.
When older people forget, they should consult a doctor. He clarifies the cause after an in-depth questioning of the background. At a minimum, vascular dementia, if detected early, can be slowed down by taking medication that inhibits blood clotting and improves blood flow.
An underlying cardiac arrhythmia can be controlled by vitamin K antagonists, which promote blood thinning.
The consequences of progressive dementia, on the other hand, are dramatic: The patients lose their social contacts, they also lose their feelings to the people who are close to them. They can no longer practice their profession and no longer pursue their hobbies because they forget their patterns of thinking and acting stored as memories. This is another reason why they are becoming increasingly apathetic.
Demented people wander around aimlessly, they also eat inedible food because they lose their memories of tasty food, they suffer from insomnia, they are irritable and at other times depressed, anxiety attacks are accompanied by delusional states, they are as euphoric as they are uninhibited.
They become indifferent. Even going to the toilet does not matter to them, going for a walk loses its appeal, and even basic hygiene must be taken care of by nurses.
The Creutzfeldt-Jakob disease
Creutzfeldt-Jakob Disease (CJD) damages the brain. More precisely, it changes its protein structure into a spongy mass. This very rare disease is easily confused with dementia because the symptoms are similar. The disease is incurable.
It is triggered by prion proteins, which are to some extent put on healthy proteins. The healthy proteins take over the structure of the infectious, and the brain is, to put it bluntly, provided with holes like a Swiss cheese.
Sometimes the disease occurs without any external cause, in old people. This form is the most common of this extremely rare disease. Creutzfeldt-Jakob can also be hereditary or triggered by an infection. In particular, human growth hormones injected to those affected promoted the disease; The transplantation of human brain and cornea is one of the safe suspects.
Young people suffered Creutzfeldt-Jakob in a form that corresponds to the cattle disease BSE.
The disease is characterized by memory lapses, orientation problems, balance disorders, difficulty concentrating, tremors, paralysis, depression and anxiety attacks.
As with dementia, the patient first loses slowly, then rapidly loses his mental and physical abilities. He complains about depression as well as dizziness, then gradually loses his memory-
Typical are involuntary muscle twitches. The affected person can no longer control his movements, he stumbles and falls and at the same time no longer knows where he is. Not the organ of balance, but the brain is damaged here and can no longer process information from the equilibrium system. The disease leads to death after a few months. She does not slow down or treat herself.
Only the symptoms can be treated to give the patient a little bit more quality of life in his last time. Suitable antidepressants against depression, neuroleptics against hallucinations, and antiepileptic drugs against muscle twitches. (Somayeh Ranjbar)