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Dizziness

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B Joseph Touma, MD
Dizziness

Dizziness afflicts people of all ages. It is the second most common complaint following lower back pain, in people over 50. It is described as unsteadiness, spinning, whirling, light-headedness, swimming in the head, and staggering, etc.

Cause of Dizziness

Dizziness can be caused by either inner ear problems or other general conditions:

Inner Ear Dizziness

Meniere’s Disease with episodic dizziness, fullness, hearing loss in one or both ears, ear noise, nausea, etc.

Viral Infection of the inner ear nerve with severe dizziness lasting for a few days without any hearing problem.

Benign Paroxysmal Vertigo with the dizziness occurring only when the head is in a specific position.

Acute Occlusion of the feeding blood vessel to the inner ear with or without hearing loss.

Other Disorders, such as head trauma, leak of the inner ear fluids, ototoxic drugs, and other rare conditions.

 

Central General Dizziness

Circulatory Problems, such as a stroke, occlusion or spasm of some arteries in the brain.

High or low blood pressure.

Abnormal Heart Rate: slow, fast, or irregular.

Medications, such as sleeping pills, antihistamines, blood pressure medications, ototoxic drugs, or nerve pills.

General Medical Condition, such as anemia, kidney problems, liver or visual problems, etc.

Neurological Problems, such as a brain tumor, stroke, spinal cord tumors, cerebral or cerebellar atrophy.

Allergies

Examination and Testing

In order to diagnose your problem, one or more of the following tests will be performed:

Hearing Test (Audiogram)
Since the hearing and the balance components of the inner ear are closely related, testing the hearing is very valuable.

Computerized Inner Ear Test (Electronystagmogram / ENG)
The computer monitors the eye movements that are elicited by the inner ear due to direct connection between them and centers that control the eye movement. The head electrodes will be pasted around the eyes and the head will be placed in various positions. The ears will be irrigated with slightly warm and cool water.

Computerized Rotary Chair
Your eye movements will be monitored as you turn around at different speeds in a darkened room. This test is helpful when the ENG results are inconclusive, checking children, or following head trauma.

Auditory Brain Stem Evoked Response Potential Test
This studies the transmission of the sound from the inner ear to the brain. It is helpful in ruling out tumors pressing on the nerve of hearing.

Allergy Testing
Either through computerized evaluation of a blood sample or skin testing.

X-rays, CT scan or MRI can be helpful.

Other tests such as blood tests, medical evaluation and other general or specialized studies may be needed to help determine the cause of imbalance.

Treatment

After the diagnosis is established, one or more of the following methods of treatment will be used. However, treatment can be lengthy and requires your patience and cooperation.

Inner Ear Suppressants
These drugs control the abnormal emission of stimuli from the inner ear and help keep you comfortable while the inner ear has a chance to recover.

Fluid Pills (diuretics)
Diuretics are helpful in Meniere’s Disease.

Vasodilators
These help improve the circulation in the inner ear.

Diet
Low salt diet is very helpful in Meniers’s Disease. Eliminating caffeine reduces stimulation of the inner ears. Balanced diet and good eating habits control fluctuations in blood sugar levels.

Physical Therapy and special exercises can also be helpful.

Surgery
Reserved only for those cases which do not improve with other measures. There are several surgical procedures, depending on the type and nature of the disease.

Treatment for Central Dizziness is directed toward the cause, such as high blood pressure, low blood pressure, low thyroid, neurological diseases, etc.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.

 


B. Joseph Touma, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Meniere’s Disease

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B Joseph Touma, MD
Meniere’s Disease

Meniere’s disease is an inner ear condition characterized by dizzy spells that last for a few hours at a time associated with nausea, vomiting, fullness, pressure in one ear, and fluctuating hearing loss. Some variations of these symptoms can exist.

There are several new developments in managing this incapacitating disease such as:

Medical Management with strict low salt diet, diurectics (fluid pills), anti-nausea medications, anti-dizziness medications, steroids and others.

Surgery is indicated when medical treatment fails: There are several kinds of surgical procedures:

a. The first procedure is to drain the sac that absorbs the inner ear fluids. This is an outpatient surgery that is done under general anesthesia.

b. Destruction of the inner ear, which is usually reserved to patients with severe hearing loss.

c. Other surgery on the balance nerve.

Chemical destruction of the inner ear. This is accomplished by injecting medicine in the middle ear that causes destruction of the area responsible for the dizziness. This is an office procedure and will be repeated weekly until satisfactory results are achieved.

With today’s advances in medicine, control of Meniere’s disease can be achieved, however it takes time and patience until such a favorable result is accomplished.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


B. Joseph Touma, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Laser in Ear Surgery

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B Joseph Touma, MD
Laser in Ear Surgery

The use of lasers allows the ear surgeon to perform microsurgery more accurately with less trauma. The advances in laser technology allow the beam to be extremely narrow, with versatility in duration and power.

The applications of lasers in ear surgery include the following:

1) Otosclerosis (fixation of the stirrup bone which prevents the sound from reaching the nerve of hearing):
Because of the accuracy of lasers and reduced trauma, dizziness is usually minimal, allowing an early return to work. The higher frequencies are better preserved with this technique.

2) The laser makes it possible to remove residual disease accurately and safely from the many important structures in the middle ear.

3) The laser is used to reduce the size of the benign tumors growing on the nerve of balance and makes it easier to dissect the growth and control bleeding.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


B. Joseph Touma, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Advances in Diagnosis & Treatment of Ear Diseases

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B Joseph Touma, MD
Advances in Diagnosis & Treatment of Ear Diseases

Many recent advances in diagnosing and treating ear diseases enable the ear specialist to make an early diagnosis of ear ailments and institute some of the most advanced technology and techniques to correct the disease and improve the hearing. The following is a list of some of these advances:

Otoacoustic Emissions Test

Hearing loss can be detected in a matter of a few seconds, which enables the specialist to institute early intervention, such as hearing aids and medical or surgical treatment.

Auditory Brain Stem Testing

This technology enables us to detect hearing loss even in a premature infant. Early amplification can give an infant a chance to acquire language and be mainstreamed with other children.

Cochlear Implants

Patients with severe nerve deafness were neglected before electrodes could be implanted directly in the cochlea where the nerve of hearing originates.

Laser in Ear Surgery

Lasers allow the specialist to perform certain kinds of ear surgery more accurately with less trauma, resulting in better hearing and less side effects

Endoscopic Middle Ear Surgery

With small endoscopic middle ear scopes, the ear specialist can detect the condition of the windows to the inner ear, the bones in the middle ear, and disease in the middle ear without elevating the eardrum and exposing the patient to a more invasive operation.

MRI

MRI has enabled us to early detect a growth on the nerve of balance, which usually causes some ringing in one ear and progressive hearing loss in the same ear, with some imbalance.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


B. Joseph Touma, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Acoustic Neuroma

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B Joseph Touma, MD
Acoustic Neuroma

Acoustic neuroma is a benign tumor that grows on the nerve of balance

Symptoms

Ringing (tinnitus) can be the only symptom when the tumor is small. However, as it gets larger, some balance problems will occur. Hearing progressively deteriorates as the tumor gets larger. Later, the patient will have numbness in the side of the face, more balance problems, and sometimes trouble swallowing.

Diagnosis

Patients with hearing loss and ringing in one ear should undergo Auditory Brainstem Testing (ABR) that monitors the conduction of the sound through the nerve of hearing, which can detect early pressure on the nerve. However, the definite diagnosis can be obtained with a MRI.

Treatment

There are several modalities in treating acoustic neuromas:

1) Observation: In older patients, patients with health problems, and in small tumors, the lesion can be observed with interval MRI’s, especially since this tumor is slow growing.

2) Surgery: There are several approaches to remove the tumor. Any technique poses some risk since the tumor is inside the skull and is surrounded with several important structures and nerves, such as the facial nerve and the cochlear nerve. The surgeon must be an experienced one and perform this kind of surgery routinely. In small tumors, an attempt should be made to preserve the hearing. In every case, the preservation of the facial nerve is important.

3) Radiation: Radiation using the gamma knife is performed in only a few centers and carries some risk of damage to the adjacent tissues from radiation.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


B. Joseph Touma, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Cochlear Implants

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B Joseph Touma, MD
Cochlear Implants

The severely hearing impaired patients now can achieve a substantial improvement in their hearing thanks to the recent technological advances by the use of the Cochlear Implant.

This technology has been evolving for several years and recently it became an outstanding way to help severely hearing handicapped people.

The principle of this technology is to introduce multichannel electrodes to the cochlea (where the nerve of hearing begins) connected to a processor fastened to the bone behind the ear and covered with skin. The sound will be delivered to the processor through a receiver that is coupled to it by a magnet.

This technology allows the signal to stimulate various areas of the cochlea that coincide with various pitches. Following surgery, a team consisting of an audiologist, a speech pathologist, and the ear surgeon will conduct rehabilitation that usually lasts for a few weeks of training and counseling.

The Huntington Ear, Nose and Throat Specialist, PLLC staff and Joseph B. Touma, M.D.,F.A.C.S. (Ear and Balance Specialist) have multidisciplinary teams to perform this exciting and promising service for the Tri-State’s severely hearing impaired patients.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277.


B. Joseph Touma, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277