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The following are excerpts from an as of yet unfinished
chapter Dr. Li has been working on. If it seems choppy, it is because it has been cut
and pasted into this page. Hope it is understandable. …….The balance system is extremely complex and is influenced by many factors. It is a delicately tuned system that can easily derailed. When it works flawlessly, It is very transparent. You don't need to think about balance, it just happens. Your body knows exactly where to place the foot for each step. You make minor position corrections to stay balanced on a bicycle without being conscious of these movements. It is so basic that you don't have to think about it. ….Dizziness is usually the result when that system breaks down. Everyday tasks become tiresome and difficult. …..There are many components to maintaining your balance. Intricate brain connections and nerve pathways are involved. These pathways can be left to the Neuroanatomists. …..We are mostly concerned with the components that matter. The 3 main components are the Eyes, Ears, and The whole rest of the body. (so much for narrowing things down.) …..In order for us to know where we are at any given time, we need at least 2 of the three components. One to tell us where we are, and another for cross reference confirmation. Of course things work best if all the senses are working and correlate correct information. When one sense works improperly, it gives conflicting
signals. Hence dizziness. Dr. Li's Twin Engine Airplane Analogy. The inner ears have to give equal impulses to the brain to give the perception of balance. If both engines of a twin engine airplane are running at 100%, they will keep the plane flying straight. Imagine if suddenly one engine failed completely, the airplane would swing wildly! Similarly, if suddenly one inner ear organ is damaged, you feel extremely dizzy and feel as though you were spinning wildly. This brings us to the concept of compensation. With
compensation, the brain does a phenomenal job in readjusting for the problem.
Likewise, the pilot, when faced with an engine flameout, works on maintaining
flight with the rudder and steering wheel. Although it sure is nice to have two
engines, the plane can run on one. Patients can also run on one inner ear. Treatment If the engine is out, the best thing to do is to fix it. = directed therapy - surgery, CRP etc. Antivert (a inner ear tranquilizer) is like giving morphine for pain. It doesn't solve the problem, but it sure does soothe the pain. It is OK for short term use, but don't get dependent on it. -- If the pilot (the patient) is upset and nervous about flying the plane sideways because one engine is out, you can give him tranquilizers. Obviously this is not a particularly good option, especially in the long run. But if you must, a little scotch on the rocks and a calm pilot is better than one in a total nervous breakdown or no pilot at all. Remember, our brains don't come equipped with co-pilots. Think of tranquilizers as a stop-gap measure-- not something to use long term. Vestibular rehab. Is like pilot instrument training It teaches the pilot how to compensate for bad balance situations. It helps him learn to perform well with what he has whether it be an engine out, a bad compass or foggy visual conditions. …………Fixed vs. Variable lesion vs. Complete A fixed lesion is one that doesn't change (fixed as in static, stuck, unchanging, not repaired) Variable lesions change without warning. Symptoms come and go, vertigo attacks are episodic. Complete means all the way out If a one of the engines is malfunctioning, for example at 50% capacity. As long as it stays working At 50% capacity, the pilot can make adjustments to keep the plane going straight. If the bad engine fluctuates without warning, then smooth sailing is out of the question. The plane may yaw and spin without warning leaving the pilot to play catch-up to salvage each episode. In these cases, if the engine can't be repaired, it is better to shut that engine down permanently rather than endure sudden violent attacks of vertigo. This may be accomplished through surgery. The idea is to shut off all impulses coming from the damaged ear to the brain. This may be accomplished through vestibular neurectomy, labyrithectomy or aminoglycoside perfusion. |
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Questions or problems regarding this web site should be directed to Dr-Li@Dr-Li.net.
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