Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
We have a letter from Bnei Brak asking two questions. The
first concerns tinnitus. Tinnitus is basically activation of
the hearing system despite there being no noise at the
moment. This means often buzzing or ringing in the ears. This
troublesome disease is caused by many factors. The most
common remains hearing loss and malfunction that often comes
with age. However, this disease is a common component of many
tumors, and vascular problems (such as aneurysm) as well. A
treatable cause is serous otitis media which is fluid in the
eardrum.
Tinnitus is not preventable, and treatment in cases that are
not correctable is difficult. There is no screening test to
see who will be susceptible, but a simple hearing test by an
audiologist will tell if you have a hearing problem and
perhaps are at risk for tinnitus. There are devices that help
tinnitus, such as maskers and hearing aids that make more
pleasant noises that mask the buzzing. Sometimes medications
are used, but their success is limited.
Meniere's disease is vertigo and tinnitus. We do not know the
cause of this disease either, and treatments are with
medications that are of some help. As the middle ear is
involved in balance as well as hearing, it isn't surprising
that this disease will cause vertigo -- a sensation of room
spinning or being seasick -- and also causes tinnitus.
Vertigo can be caused by many things, including a virus,
trauma and stroke. What is interesting is that the best
treatments for at least traumatic causes are not medication
but physiotherapy. By putting the head through certain
maneuvers, the fluid in the balance system seems to
straighten out.
While we are on the subject, motion sickness is a variant of
these problems. In the USA there are scopolamine patches that
are very effective, but most antihistamines work well
also.
The second question also concerns a disease that is often
untreatable, unpreventable and unpredictable. It is dementia,
which comes in many variants. Dementia is called, in common
language, senility and it has affected many great people, who
were usually healthy physically and active as well, until
this struck. Dementia patients vary in their presentations,
but all have decline in mental functioning, confusion, and
eventually loss of continence, loss of speech, loss of
memory, and dependence on others for care and feeding.
The most common dementia is multi infarct dementia, which is
due to many small, often unnoticed strokes, which finally rob
a person of his functioning. Here prevention can help. It is
the usual: stop smoking, exercise, lose weight, treat
cholesterol problems. More next week.
A message from Glaxo, sponsor of this column. There
are many medications that are introduced every year, and few
are revolutionary. Avandia is one of them and it has improved
diabetes care. It controls the sugar levels exceedingly well
with little danger of dropping them too far.
