Intratympanic steroid injection

In essence, vestibular rehabilitation aims to minimize and ultimately eliminate the central vestibular asymmetry underlying persistent symptoms of imbalance and unsteadiness. It is different from traditional physical therapy of gait and balance disorders arising from biomechanical or central movement disorders such as Parkinson disease or multiple sclerosis. Vestibular rehabilitation can be performed by patients at home using tailored exercises that focus on challenging the main vestibular reflexes (VOR, VSR) and visual interaction with both reflexes.

Although from the name of the procedure one would expect that the entire vestibular nerve would be cut, in reality this is not always possible. According to Eisenmen (2001) there is evidence for retained vestibular function in about half of patients following nerve section or labyrinthectomy. Some of the fibers of the vestibular nerve run very close to the cochlear (hearing nerve), and because of this they may be spared. Saccule derived nerve fibers may be purposefully spared because they tend to run close to the cochlear nerve (Silverstein et al, 1994). Sometimes there is an attempt to cut these fibers at another site with a singular neurectomy. Singular neurectomies, however, are somewhat difficult and unreliable even in very experienced hands.

Based on this now I'd like to go this way, as 1 time and done.....I'm having some success on the Triamterene and Hydrodhlorothiazide as the Diamox didn't seem to work quite as well for me (both diuretics).  But I don't want to be on these the rest of my life i'm 58.  Seems after several more days of thought the injections of Gentamicin don't necesarily cause additional hearing loss and with the high percentage of success with this procedure given my 70% hearing loss already, seems to be the best/hopefully permanent long term "fix".  

The remaining two procedures, vetibular neurectomy and labyrinthectomy, are ways of eliminating the balance function of the faulty ear. It is known that individuals will function better with one normal balance system than with one normal and one faulty system. The labyrinthectomy is a procedure in which the mastoid bone is removed and the inner ear is eliminated. This procedure is for patients that have lost usable hearing in the affected ear, as it entails removing all function of the inner ear, including hearing and balance. The change from having two balance systems to having one balance system alone does require a recovery or "compensation" period. It takes the brain a period of weeks to figure out that only one system is active and that it is no longer receiving information from the faulty system which it had come to expect. The second procedure, the vestibular neurectomy, is a good option if the hearing is good in the ear with the failing balance system. In this surgical procedure, the balance nerve (vestibular nerve) is cut between the inner ear and the brain. The inner ear is completely preserved but the faulty balance information is not able to reach the brain and cause the vertigo. Like the labyrinthectomy, this procedure requires a recovery period while the brain "figures out" the new situation.

Remember, proponents of the vascular theory are seeking a smoking gun: a direct linkage between some vascular event such as ischemia or infarction and definite changes associated with hearing loss. Changes in the temporal bones, such as labyrinthine ossification, if consistently found in patients with SSNHL, would be such a smoking gun. Saumil N. Merchant, ., and his colleagues at my institution, the Massachusetts Eye and Ear Infirmary, recently reviewed specimens of temporal bone in the Infirmary’s collection from 17 cases of SSNHL. 3 Only one specimen showed any evidence of new bone formation—the vascular theorists’ hoped-for smoking gun. Another strike against the vascular theory is the relationship of SSNHL prognosis to the site of cochlear injury. The cochlear artery runs from the base of cochlea, where high-frequency sounds are detected, to the apex, where low-frequency sounds are detected. Since there is no collateral blood supply to the cochlear apex, blockage of the cochlear artery should cause the most severe damage to low-frequency hearing. But clinical reports show exactly the opposite: SSNHL affecting low-frequency hearing of the cochlear apex actually has a better prognosis than SSNHL affecting high-frequency hearing in the cochlear base. Another difficulty is that if the labyrinthine artery itself were affected by some vascular event, both auditory and balance functions should be impaired, but only a few patients with SSNHL experience severe or sustained vertigo.  

Intratympanic steroid injection

intratympanic steroid injection

The remaining two procedures, vetibular neurectomy and labyrinthectomy, are ways of eliminating the balance function of the faulty ear. It is known that individuals will function better with one normal balance system than with one normal and one faulty system. The labyrinthectomy is a procedure in which the mastoid bone is removed and the inner ear is eliminated. This procedure is for patients that have lost usable hearing in the affected ear, as it entails removing all function of the inner ear, including hearing and balance. The change from having two balance systems to having one balance system alone does require a recovery or "compensation" period. It takes the brain a period of weeks to figure out that only one system is active and that it is no longer receiving information from the faulty system which it had come to expect. The second procedure, the vestibular neurectomy, is a good option if the hearing is good in the ear with the failing balance system. In this surgical procedure, the balance nerve (vestibular nerve) is cut between the inner ear and the brain. The inner ear is completely preserved but the faulty balance information is not able to reach the brain and cause the vertigo. Like the labyrinthectomy, this procedure requires a recovery period while the brain "figures out" the new situation.

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