Ménière’s Disease: Vertigo - Hearing Loss - Tinnitus: A Psychosomatically Oriented Presentation

Preface to the 1st English edition
Contents
About the Author
1: Ménière’s Disease – The Clinical Picture
	1.1	 Vertigo, Hearing Loss, Tinnitus
	1.2	 An Exemplary Case – The Classical Case
	1.3	 Forms of Appearance
	1.4	 Uncertainty and (Reactive) Psychogenic Dizziness
	1.5	 Insecurity in the Partnership
	1.6	 Swindle in the Therapeutic Relationship
	1.7	 Suddenly One Is Affected Oneself
	1.8	 Is Ménière’s Disease a Psychosomatic Disease?
	1.9	 Perspective
	Literature
2: Physiological and Anatomical Basics
	2.1 The Vestibular Organ
		2.1.1	 Orientation Via Gravity
		2.1.2	 Otolith Organs – Utricule and Saccule
		2.1.3	 Semicircular Canals
		2.1.4	 The Saccus Endolymphaticus and the Sinus Endolymphaticus
	2.2 Auditory Part
		2.2.1	 From Sound to Nerve Impulse
		2.2.2	 From the Otolithic Organs to the Cochlea
		2.2.3	 Organ of Corti
	2.3 Vestibular Nerve
	2.4 Vestibulo-Ocular Reflex (VOR)
		2.4.1	 Suppression of the VOR – a Central Achievement
	2.5 Oculomotor System
	2.6 Nystagmus
	2.7 Who Is Able to Do What!
	2.8 Other Conditions for Equilibrium
		2.8.1	 Information from the Skin, Hands and Feet
		2.8.2	 The “Belly Feeling”
		2.8.3	 Heart, Lungs, Food and Drink
		2.8.4	 Implementation in Motion
	2.9 Interface Points in the Brain
		2.9.1	 Advantages and Disadvantages
	2.10 Balance of the Soul
	Literature
3: Pathophysiology of Ménière’s Disease
	3.1 Vertigo from the Inner Ear
		3.1.1	 Stadium Classification According to Jahnke (1994)
	3.2 Eye Tremor (Nystagmus) During an Acute Attack
	3.3 Impaired Balance After Vertigo Attacks
	3.4 Hearing Loss
	3.5 Dysacusis (Distorted Hearing)
	3.6 Lack of Loudness Compensation and Noise Sensitivity (Hyperacusis)
	3.7 Hearing Impressions Without External Sound Source – Tinnitus
		3.7.1	 Forms of Tinnitus
			Outer Ear: Ear Plug
			Loss of External Auditory Perception
			Inner Ear
			Central: In the Hearing Processing System
		3.7.2	 Psychological Conflicts
		3.7.3	 Tinnitus in Endolymphatic Diseases Such as Ménière’s Disease
	3.8 Feeling of Pressure in and Behind the Ear
	3.9 Sensory Sensations (Paresthesia)
	3.10 Lack of Compensation and Double Inhibition
	3.11 Reactive, Psychogenic Vertigo
		3.11.1	 How Can Organic Vertigo Become Psychogenic Dizziness in Ménière’s Disease?
			Maintaining Factors
		3.11.2	 Maintenance of Vertigo in Cases of Previous Mental Illness
		3.11.3	 Can Fear and Panic Cause Ménière’s Attacks?
	Literature
4: Special Forms of Meniere’s Disease
	4.1	 Lermoyez Syndrome
	4.2	 Tumarkin Drop
	4.3	 Cochlear Form
	Literature
5: Differentiation from Other Clinical Pictures
	5.1	 A Misdiagnosis and its Treatment
		5.1.1	 From Body to Soul and Back Again
	5.2	 Fluctuating Hearing with Low Tone Tinnitus Without Vertigo
		5.2.1	 Diagnosis
		5.2.2	 Therapy
	5.3	 Migrainous Vertigo (Basilar Migraine)
		5.3.1	 Symptomatology
		5.3.2	 Pathophysiology
		5.3.3	 Diagnostics
		5.3.4	 Treatment
	5.4	 Benign Paroxysmal Positional Vertigo (BPPV)
		5.4.1	 Diagnostics and Therapy
	5.5	 Vestibular Neuritis – Acute Unilateral (Idiopathic) Vestibulopathy
		5.5.1	 Possible Causes
		5.5.2	 Diagnostics: Complete or Partial Failure?
		5.5.3	 Therapy
		5.5.4	 Balance Training
		5.5.5	 Lack of Compensation
		5.5.6	 Possible Functional Reduction for Too Fast Movements
		5.5.7	 Hearing Impairment and Ringing in the Ears
		5.5.8	 A Subsequent Paroxysmal Positional Vertigo
		5.5.9	 Confusion in Experience
	5.6	 Perilymph Fistula
		5.6.1	 Diagnostics
		5.6.2	 Therapy
		5.6.3	 Excursus: Influences of Air Pressure on the Ear (Tullio Phenomenon)
		5.6.4	 Tube Ventilation Disorder
	5.7	 Vestibular Paroxysmia
	5.8	 Isolated Otolith Dysfunction
	5.9	 Psychogenic Dizziness
		5.9.1	 Dizziness Instead of Unpleasant Feelings
		5.9.2	 The Problem of Understanding
		5.9.3	 Where Does the Psychogenic Dizziness Take Place?
		5.9.4	 From the “Phobic Postural Vertigo” (PPV) to “Persistent Perceptual and Postural Dizziness” (3P-D)
		5.9.5	 Dizziness in Sociophobia (Social Phobia)
	5.10	 Multiple Sclerosis
	5.11	 Central Vestibular Vertigo Syndrome
		5.11.1	 Diagnostics
		5.11.2	 Prevention
	5.12	 Blood Pressure Fluctuations
	5.13	 Acoustic Neuroma
		5.13.1	 Diagnostics
	5.14	 Bilateral Loss of Vestibular Function
	5.15	 Head-Extension Vertigo: Cervicogenic?
		5.15.1	 Diagnostics
		5.15.2	 Therapy
	5.16	 Drug-Induced Dizziness
		5.16.1	 Gentamycin for the Elimination of Ménière’s Disease
	Literature
6: Diagnostics and Examination Methods
	6.1	 Medical History
	6.2	 Balance Examination (Vestibular Examination)
		6.2.1	 Standing and Walking Examination
	6.3	 Examination of Eye Movement
		6.3.1	 Suppression of the VOR
		6.3.2	 Head Impulse Test – Testing von the Vestibulo-Ocular-Reflex (VOR)
		6.3.3	 Positioning Maneuvers
		6.3.4	 Overall Evaluation of the Investigation
	6.4	 Apparative Examination of the Semicircular Canals
		6.4.1	 Caloric (Thermal) Test
		6.4.2	 Rotational Testing: Examination in a Swivel Chair
	6.5	 Examination of the Otolith Organs
		6.5.1	 Examination of the Sacculus
		6.5.2	 Examination of the Utricle
	6.6	 Hearing Tests
		6.6.1	 Pure Tone Audiogram
		6.6.2	 Speech Audiogram
	6.7	 Tinnitus Determination
	6.8	 Otoacoustic Emission and Distortion Products
	6.9	 Electrocochleography
	6.10	 Brain-Evoked-Response Audiometry (BERA)
	6.11	 Glycerol Load Test (Klockhoff Test)
	6.12	 Manual Examination of the Vertebral Segments
	6.13	 Imaging Techniques
	6.14	 Psychological-Psychosomatic Diagnostics
	6.15	 Psychological Questionnaires/Test Diagnostics
		6.15.1	 Dizziness Handicap Inventory (DHI)
		6.15.2	 Hospitality Anxiety and Depression Score (HADS)
		6.15.3	 Patient Health Questionnaire (PHQ-D)
		6.15.4	 University Research
	6.16	 The Most Important Thing at the End: Evaluating and Assigning
	Literature
7: Therapy of Ménière’s Disease
	7.1	 Enlightenment and Counselling
		7.1.1	 Attention: Interactions Between Patient and Doctor – The Doctor–Patient Relationship
	7.2	 Acute Therapy
		7.2.1	 Emergency Medical Assistance: First and Second Vertigo Attack
		7.2.2	 Own Emergency Preparation
	7.3	 Therapy Between Vertigo Attacks
		7.3.1	 How Can Therapeutic Success Be Determined?
		7.3.2	 Proven Therapies
		7.3.3	 Non-proven Conservative Therapies
		7.3.4	 Surgical Interventions – without Proven Effect
	7.4	 Basic Outline of Psychosomatic Treatment
		7.4.1	 Relaxation Techniques
		7.4.2	 Psychotherapy
		7.4.3	 Psychodynamic Psychotherapy
		7.4.4	 Behavioral Therapy Approaches
		7.4.5	 Systematic Desensitization
		7.4.6	 Psychotropic Drugs
		7.4.7	 Inpatient Psychosomatic Treatment
	7.5	 Alternatives/Outsiders: Opportunities and Threats
		7.5.1	 Homeopathy
		7.5.2	 Acupuncture
	Literature
8: Bilateral Disease
	8.1	 Consequences
		8.1.1	 For Therapy
		8.1.2	 In Case of Bilateral Vestibular Loss
	8.2	 Perspectives
	Literature
9: What Might Make a Good Therapist?
	9.1	 Careful Diagnostics
	9.2	 Comprehensible Enlightenment
	9.3	 Therapeutic Measures
	9.4	 Support and Therapy Between Vertigo Attacks
	9.5	 Psychological Measures
	9.6	 What Might Make a Good Patient?
		9.6.1	 Factors that Can Be Influenced
		9.6.2	 Compensable Factors
		9.6.3	 And myself?
	Literature
10: Short Answers to Frequently Asked Questions
	10.1	 What Is Ménière’s Disease?
	10.2	 What Causes Ménière’s Disease?
	10.3	 How Common Is Ménière’s Disease
	10.4	 Are Hearing Fluctuations in the Low-Frequency Range with Low Tone Tinnitus a Sign of Ménière’s Disease?
	10.5	 Can Ménière’s Disease Be Bilateral?
	10.6	 Is There a Cure for Ménière’s Disease?
	10.7	 When Can Therapy Be Helpful for Ménière’s Disease?
	10.8	 Is There a Connection Between Migraine and Ménière’s Disease?
	10.9	 Are Ménière’s Sufferers Allowed to Drive?
	10.10	 Are Ménière’s Sufferers Allowed to Travel (Fly)?
	10.11	 Are Ménière’s Patients Allowed to Swim and What Do they Need to Be Aware of?
	10.12	 Are Ménière’s Sufferers Allowed to Dive?
	10.13	 Is Ménière’s Disease Hereditary?
	10.14	 Does Ménière’s Disease Affect Pregnancy?
	10.15	 Do Hearing Aids Help with Ménière’s Disease?
	10.16	 Can Anesthesia Influence Ménière’s Symptoms?
	10.17	 And What Other Use Is There?
	Literature
Self-help Groups
Glossary
Literature
	Recommended Books for Therapists
	M. Meniere
	Balance System and Dizzines
	Literature Cited
Index