Motion Sickness

Vertigo And Dizziness Program

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Motion sickness is an abnormal response of an individual to the stimulus of prolonged motion. Usually it occurs in boats, automobiles, or airplanes. Those affected are prone to become dizzy, diaphoretic, and nauseated after an extended period of travel. Oddly, their dizziness is seldom actual vertigo, but more often a sense of imbalance and lightheadedness. These patients may show positional nystagmus on ENG testing and hip sway on posturography, even when symptoms are not present. Preventative treatment consists of oral Dramamine or Phenergan, or scopalomine skin patches.

Vestibular rehabilitation therapy (VRT) deserves mention as a therapeutic modality. Many medical centers have this capability within their rehabilitation departments. This treatment consists of a series of adaptive exercises for patients with chronic vestibular dysfunction or damage, including motion sickness. The exercises are not intended for patients

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with acute vertigo. They are also not very helpful for those with central (brainstem) causes for their dizziness.

In addition to motion sickness, vestibular rehabilitation has proven effective for benign positional vertigo and any chronic loss of vestibular inner ear function, either unilateral or bilateral. The exercise protocols vary from program to program, but in general, they are designed to "challenge" the dizzy patient to perform tasks of balance with the eyes closed or with the head moving. Initially, the tasks will exacerbate a patient's symptoms, but the intent is for eventual adaptation and compensation. Clinical improvement is often seen in motivated patients.

¡n closing this discussion of vestibular disorders, be reminded that other diseases discussed in Chapters 5 and 7 may cause true vertigo or dysequili-brium. These include spontaneous perilymph fistula, classic Meniere's disease, autoimmune inner ear disease, syphylis, and cerebellopontine angle tumors (e.g. acoustic neuroma).

Further Reading

Busis SN. Diagnostic evaluation of the patient presenting with vertigo. Otolaryngol

Clin North Am. 1973;6:1;3-23. Clemis JD, Becker GW. Vestibular neuronitis. Otolaryngol Clin North Am. 1973;6:1;139-156.

Coats AC, Martin GK, Lonsbury-Martin BL. Vestibulometry. In: Ballenger JJ, ed. Diseases of the Nose, Throat, Ear, Head, &Neck. 14th ed. Philadelphia: Lea & Fe-biger; 1991:1006-1028. Drachman DA. A 69-year-old man with chronic dizziness. JAMA. 1998;280:24;2111-2117.

Epley JM. Particle repositioning for benign paroxysmal positional vertigo. Otolaryngol Clin North Am. 1996;29:2;323-332. Hamid MA. Vestibular rehabilitation. In: Myers EN, Bluestone CD, Brackman DE, Krause CJ, eds. Advances in Otolaryngology—Head and Neck Surgery. Vol 6. St. Louis: Mosby Year Book; 1992. Morrison AW, Johnson KJ. Genetics (molecular biology) and Menieres disease. Otolaryngol Clin North Am. 2002;35:3;505-507. Parnes LS. Update on posterior canal occlusion for benign paroxysmal positional vertigo. Otolaryngol Clin North Am. 1996;29:2;333-342. Telian SA, Shepard NT. Update on vestibular rehabilitation therapy. Otolaryngol Clin North Am. 1996;29:2;359-371.

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