February 26, 2014
Lately it seems hard to escape the constant flow of pharmaceutical commercials and print ads for a seemingly endless list of maladies. In our own office we see many patients whose medication lists span more than a full page. All of the drugs listed may be necessary and effective, however, do ALL disorders require medications, and can drugs (or surgery) cure or improve all conditions?
In our work diagnosing balance/dizziness disorders, we often find problems caused by the “vestibular system”, or the inner ear balance center. The ear is a balance organ first, a hearing organ second. Our VNG (videonystagmography) test battery provides clues about the origin of the “lesion”. The eyes, it turns out, are not only the “windows to the soul”, they are the windows to the inner ear. When eye movements follow a particular pattern, we may discover one ear is weakened in its ability to send nerve impulses to the brain when the head changes position. This may be due to conditions such as labyrinthitis or vestibular neuronitis, and dizziness are the result of mismatched messages from the ears. Normally the ears work as equal partners, however, if one is damaged and sending weaker signals, the brain may not be sure which ear to “listen to”.
Research has shown that medications given to ease symptoms by suppressing the vestibular system cannot strengthen the weaker ear, but can actually delay improvement in symptoms. Vestibular rehabilitation therapy can promote a “recalibration” of the brain to mismatched signal strengths and improve patients’ symptoms without medications.
A very common vestibular problem is positional vertigo (BPPV), in which tiny bits of debris (“ear stones”) block one of the semicircular canals. Again, this disrupts the signals the brain has become accustomed to for information about the position of the head, resulting in intense, brief spinning dizziness. When this is discovered, treatment involves a specific series of movements designed to clear the debris from the canal. It is not reasonable to assume a drug can seek out calcium crystals and physically move them.
Finally, it has been mentioned here and elsewhere that tinnitus (phantom noises in the ears) should not be treated with medications. Drugs such as antidepressants should be taken only for their intended purpose. For some patients, an underlying psychological condition may exacerbate the reaction to tinnitus. This should be discussed with a psychologist or psychiatrist, however, tinnitus on its own does NOT require medications. Strategies such as Tinnitus Retraining Therapy and/or amplification can be very effective without changing your blood chemistry or causing side effects.
Modern-day medications can improve or alleviate many ailments, however, medications are not always the best option for all conditions. An otologist or audiologist can help you select the most effective treatments.