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Tinnitus

Definition:   Tinnitus is noise or ringing in the ears.It may be a the sensation of hearing ringing, buzzing, hissing, chirping, whistling, or other sounds. The noise can be intermittent or continuous, and can vary in loudness. It is often worse when background noise is low, so you may be most aware of it at night when you’re trying to fall asleep in a quiet room. In very rare cases, the sound beats in sync with your heart (pulsatile tinnitus)……..CLICK & SEE THE PICTURES 

A common problem, tinnitus affects about 1 in 5 people. Tinnitus isn’t a condition itself — it’s a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

Although bothersome, tinnitus usually isn’t a sign of something serious. Although it can worsen with age, for many people, tinnitus can improve with treatment. Treating an identified underlying cause sometimes helps. Other treatments reduce or mask the noise, making tinnitus less noticeable.

There are two kinds of tinnitus:

Subjective tinnitus is tinnitus only one can hear. This is the most common type of tinnitus. It can be caused by ear problems in the outer, middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).

Objective tinnitus is tinnitus the doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, an inner ear bone condition or muscle contractions.
Symptoms:
Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise but, in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, roaring, “crickets” or “tree frogs” or “locusts (cicadas)”, tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test and, in some cases, pressure changes from the interior ear. It has also been described as a “whooshing” sound because of acute muscle spasms, as of wind or waves. Tinnitus can be intermittent or it can be continuous: in the latter case, it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw or eye movements.

Most people with tinnitus have some degree of hearing loss: they are often unable to clearly hear external sounds that occur within the same range of frequencies as their “phantom sounds”. This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.

The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one’s own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one’s ear, changes within the canal of one’s ear or issues related to blood flow of the neck or face.

Causes:
Prolonged exposure to loud sounds is the most common cause of tinnitus. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. Carpenters, pilots, rock musicians, street-repair workers, and landscapers are among those whose jobs put them at risk, as are people who work with chain saws, guns, or other loud devices or who repeatedly listen to loud music. A single exposure to a sudden extremely loud noise can also cause tinnitus...CLICK & SEE : 

A variety of other conditions and illnesses may lead to tinnitus and they are as follows:
*Blockages of the ear due to a buildup of wax, an ear infection, or rarely, a benign tumor of the nerve that allows us to hear (auditory nerve)

*Certain drugs — most notably aspirin, several types of antibiotics, anti-inflammatories, sedatives, and antidepressants, as well as quinine medications; tinnitus is cited as a potential side effect for about 200 prescription and nonprescription drugs.

*The natural aging process, which can cause deterioration of the cochlea or other parts of the ear

*Meniere’s disease, which affects the inner part of the ear

*Otosclerosis, a disease that results in stiffening of the small bones in the middle ear

*Other medical conditions such as high blood pressure, cardiovascular disease, circulatory problems, anemia, allergies, an underactive thyroid gland, and diabetes

*Neck or jaw problems, such as temporomandibular joint (TMJ) syndrome

*Multiple sclerosis

*Injuries to the head and neck

*External ear infection

*Acoustic shock

*Cerumen (earwax) impaction

*Middle ear effusion

*Superior canal dehiscence

*Sensorineural hearing loss

*Acoustic neuroma*Mercury or lead poisoning

*Neurologic disorders

*Temporomandibular joint dysfunction

*Giant cell arteritis

*Metabolic disorders like thyroid disease, hyperlipidemia, vitamin B12 deficiency, iron deficiency anemia, psychiatric disorders,diabetis

*Psychiatric disorders like depression, anxiety
Tinnitus can worsen in some people if they drink alcohol, smoke cigarettes, drink caffeinated beverages, or eat certain foods. For reasons not yet entirely clear to researchers, stress and fatigue seem to worsen tinnitus.

Diagnosis:
The basis of quantitatively measuring tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient’s tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which they hear. The volume of the tinnitus will always be equal to or less than that of the sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above). For example: if a patient has a pulsatile paraganglioma in their ear, they will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.

Objective tinnitus, however, is quite uncommon. Often, patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise, that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods. However, pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for bruits by a medical professional with auscultation over the neck, eyes and ears. If the exam reveals a bruit, imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.

The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week. However, people with chronic tinnitus often experience the noise more frequently than this and can experience it continuously or regularly, such as during the night when there is less environmental noise to mask the sound.

Treatment:
Psychological:
The best supported treatment for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) which can be delivered via the internet or in person. It decreases the amount of stress those with tinnitus feel. These benefits appear to be independent of any effect on depression or anxiety in an individual. Relaxation techniques may also be useful. A program has been developed by the United States Department of Veterans Affairs.

Medications:
There are no medications as of 2014 that are effective for tinnitus and, thus, none is recommended. There is not enough evidence to determine if antidepressants or acamprosate is useful. While there is tentative evidence for benzodiazepines, it is insufficient to support usage. Anticonvulsants have not been found to be useful.

Botulinum toxin injection has been tried with some success in cases of objective tinnitus (palatal tremor)

Others:
The use of sound therapy by either hearing aids or tinnitus maskers helps the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects, which makes them a reasonable option. There is some tentative evidence supporting tinnitus retraining therapy. There is little evidence supporting the use of transcranial magnetic stimulation. It is thus not recommended.

Alternative   Therapy :
Ginkgo biloba does not appear to be effective. Tentative evidence supports zinc supplementation and in those with sleep problems, melatonin. The American Academy of Otolaryngology, however, recommends against melatonin and zinc.

Doing YOGA EXERCISE daily with PRANAYAMA (specially Anuloma belome , Kapalabhati and Bhramari ) may help a lot to improve and sometimes cure totally.
Prognosis:
Most people with tinnitus get used to it over time; for a minority, it remains a significant problem.

Prevention:
Prolonged exposure to sound or noise levels as low as 70 dB can result in damage to hearing (see noise health effects). This can lead to tinnitus. Ear plugs can help with prevention.

Avoidance of potentially ototoxic medicines. Ototoxicity of multiple medicines can have a cumulative effect and can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Tinnitus
http://www.mayoclinic.org/diseases-conditions/tinnitus/multimedia/tinnitus/
http://www.webmd.com/a-to-z-guides/understanding-tinnitus-basics

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Palmar hyperhidrosis

Description:
Palmer hyperhidrosis is profuse perspiration (excessive sweating) of the palms.It is one form of focal hyperhidrosis, meaning profuse perspiration affecting one area of the body. Sweaty palms may be accompanied by profuse perspiration of the feet, forehead, ckeeks, armpits (axillae) or be part of general hyperhidrosis (profuse perspiration throughout the body). Hyperhidrosis refers to profuse perspiration beyond the body’s thermoregulatory (temperature control) needs.

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Palmer  hyperhidrosis is a common condition in which the eccrine (sweat) glands of the palms and soles secrete inappropriately large quantities of sweat. The condition may become socially and professionally debilitating. The condition usually is idiopathic  and  it begins in childhood and frequently runs in families.

Symptoms:
The intensity of symptoms may vary among sufferers and trigger factors should be carefully noted. Common symptoms  are :

*Perspiration of the hands can vary from mild clamminess to severe perspiration resulting in dripping sweat.
*Temperature differences of palmar surface compared to surface temperature of other parts of the body may be noted.
*Sloughing (peeling) of skin may be noted in profuse perspiration.
*Episodes of profuse perspiration may be followed by periods of extreme dryness on the palmar surface.
*Hyperhidrosis often starts in puberty, and family history is often reported.

The secondary effects of palmar hyperhidrosis can result in both psychosocial effects as well as difficulty in undertaking certain tasks or handling equipment. Sufferers of palmar hyperhidrosis are often reluctant to partake in socially expected actions like shaking hands or touching loved ones. The embarrassment of dealing with this condition can affect the level of interactivity in both social and work situations. Difficulties with holding objects, gripping equipment or soiling electronic devices like keyboards may affect functioning at work. Daily activities such as writing with a pen or counting cash notes is often difficult.

Causes:
Hyperhidrosis is either primary focal or secondary generalized.

1. Primary Palmar  Hyperhidrosis

Focal palmar hyperhidrosis is usually localized and is referred to as primary (essential, idiopathic), meaning no obvious cause, except strong family predisposition can be found (4,5), and affected persons are otherwise healthy . Sweating on other locations as feet, armpits and face may appear. Primary palmar hyperhidrosis is caused by overactivity of the sympathetic nervous system, primarily triggered by emotional causes including anxiety, nervousness, anger and fear .

There may be a significant reduction in perspiration during sleep or sedation.

2. Secondary Palmar Hyperhidrosis

In secondary palmar hyperhidrosis hands sweat due to an obvious underlying disorder like:

*Infections including local infections, tuberculosis and tinea ugunium.
*Neurological disorders like peripheral autonomic neuropathy
*Frostbite
*Arteriovenous Fistulas
*Acromegaly
*Acrodynia
*Complex Regional Pain Syndromes
*Pachyonychia Congenita
*Primary Hypertrophic osteoarthropathy
*Dyskeratosis Congenita
*Blue rubber-bleb nevus
*Glomus tumor

*Secondary palmar hyperhidrosis as part of generalized hyperhidrosis due to  several  hormonal causes (diabetes, hyperthyroidism, thyrotoxicosis, menstruation, menopause), metabolic disorders, malignant disease (lymphoma, pheochromocitoma), autoimmune disorders (rheumatoid arthritis, systemic lupus erythrematosus), drugs like hypertensive drugs and certain classes of antidepressants (list of medications causing hyperhidrosis), chronic use of alcohol, Parkinson’s disease, neurological disorders (toxic neuropathy), homocystinuria, plasma cell disorders. Detailed list of conditions causing generalyzed hyperhidrosis.

How Sweat Glands Work:
In eccrine glands, the major substance enabling impulse conduction is acetylcholine, and in apocrine glands, they are catecholamines.

Body temperature is controlled by the thermoregulatory center in the hypothalamus and this is influenced not only by  by core body temperature but also by hormones, pyrogens, exercise and emotions.

Diagnosis:
The first step in diagnosing  the  Palmar  hyperhidrosis is to differentiate between generalized and focal hyperhidrosis.

A thorough case taking and medical history is usually sufficient to diagnose palmar hyperhidrosis and any trigger factors (scheduled drugs, narcotics, chronic alcoholism).

Diagnostic criteria for primary focal (including palmar) hyperhidrosis  are:

*Bilateral and relatively symmetric sweating
*Frequency of at least 1 episode per week
*Impairment of daily activities
*Age at onset before 25 years
*Family history
*Cessation of sweating during sleep

Tests may include:
*Hematological studies may be necessary to identify thyroid disorders (thyroid function test for T3 and T4 as well as thyroid antibodies) and diabetes (fasting blood glucose or a glucose tolerance test).

*X-rays and MRI scans will assist for diagnosing tuberculosis, pneumonia and tumors.

*Superficial electroconductivity can be monitored as any hyperhidrosis reduces skin electrical resistance.

*Thermoregulatory sweat test uses moisture-sensitive indicator powder to monitor moisture. Changes in the color of the powder at room temperature will highlight areas of increased perspiration.

Treatment:
Conservative management should be coupled with prescribed treatment by the Doctor to reduce the symptoms.

*Counseling may be effective in managing primary palmar hyperhidrosis in cases of mental-emotional etiology.

*Trigger foods and aggravating factors should be noted if possible and relevant dietary changes should be implemented.

*Effective prevention of secondary palmar hyperhidrosis is difficult with conservative management and drug therapy or surgery may be required.

*Excessive physical activity and extremes of heat may be two trigger factors that should be avoided as far as possible.

*In cases of diabetes, a glucose controlled diet with low glycemic index may improve glucose tolerance which could assist with palmar hyperhidrosis.

*Abstinence from alcohol and narcotics is advisable if it is the causative factor for sweaty palms.

*Stimulants such as caffeine and nicotine may aggravate palmar hypehidrosis and should relevant dietary and lifestyle changes should be implemented.

*Anti-perspirant compounds like aluminum chloride can be applied on the palms to reduce moisture or palmar surfaces. Recent research on an aluminum sesquichlorohydrate foam has shown that it is effective in reducing sweat in palmar hyperhidrosis

Treatment remains a challenge: options include topical and systemic agents, iontophoresis, and botulinum toxin type A injections, with surgical sympathectomy as a last resort. None of the treatments is without limitations or associated complications. Topical aluminum chloride hexahydrate therapy and iontophoresis are simple, safe, and inexpensive therapies; however, continuous application is required because results are often short-lived, and they may be insufficient. Systemic agents such as anticholinergic drugs are tolerated poorly at the dosages required for efficacy and usually are not an option because of their associated toxicity. While botulinum toxin can be used in treatment-resistant cases, numerous painful injections are required, and effects are limited to a few months.

Standard therapeutic protocol may differ among cases of palmar hyperhidrosis depending on medical history and underlying pathology.

*Anticholinergic drugs have a direct effect on the sympathetic nervous system although there are numerous side effects.

*Treatment should be directed at contributing factors.

*Ionophoresis involves the use of electrotherapeutic measures to reduce the activity of sweat glands.

*Botulinum injections at the affected area may be useful for its anticholinergic effects.

*Surgery should be considered if drug therapy proves ineffective. Endoscopic transthoracic sympathectomy involves resection of the sympathetic nerve supply to the affected area. This prevents nerve stimulation of the sweat gland of the palms. However surgery has a host of complications including exacerbating the problem or increasing generalized hyperhidrosis.

Surgical sympathectomy should be reserved for the most severe cases and should be performed only after all other treatments have failed. Although the safety and reliability of treatments for palmoplantar hyperhidrosis have improved dramatically, side effects and compensatory sweating are still common, potentially severe problems.

Ayurvedic Treatment ..click & see…>…….…(1) :....(2)

Home Remedies. click & see….>…....(1) :…(2) :.…...(3) :..

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.aafp.org/afp/2004/0301/p1117.html

Causes and Treatment of Palmar Hyperhidrosis – Sweaty Palms/Hands

Lumbar Spondylosis

 

Definition:
Lumbar Spondylosis is a condition associated with degenerative changes in the intervertebral discs and facet joints. Spondylosis, also known as spinal osteoarthritis, can affect the lumbar, thoracic, and/or the cervical regions of the spine. Although aging is the primary cause, the location and rate of degeneration is individual. As the lumbar discs and associated ligaments undergo aging, the disc spaces frequently narrow. Thickening of the ligaments that surround the disc and those that surround the facet joints develops. These ligamentous thickening may eventually become calcified. Compromise of the spinal canal or of the openings through which the spinal nerves leave the spinal canal can occur.

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Lumbar spondylosis encompasses lumbar disc bulges, herniations, facet joint degeneration, and vertebral bony overgrowths (osteophytes). Degenerative changes, including osteophyte formation, increase with age but are often asymptomatic. Disc herniation is symptomatic when it causes nerve root compression and spinal stenosis. Common symptoms include low back pain, sciatica, and restriction in back movement. Treatment is usually conservative, although surgery is indicated for spinal cord compression or intractable pain. Relapse is common, with patients experiencing episodic back pain.

Symptoms:
Symptoms of lumbar spondylosis follow those associated with each of the various aspects of the disorder: disc herniation, sciatica, spinal stenosis, degenerative spondylolisthesis, and degenerative scoliosis. Pain associated with disc degeneration may be felt locally in the back or at a distance away. This is called referred pain, as the pain is not felt at its site of origin. Lower back arthritis may be felt as pain in the buttock, hips, groin, and thighs. As with spinal stenosis or disc herniation in the lumbar region, it is important to be aware of any bowel or bladder incontinence, or numbness in the perianal area. These signs and symptoms could represent an important massive nerve compression needing surgical intervention (cauda equina syndrome).

Causes:
Spondylosis is mainly caused by ageing. As people age, certain biological and chemical changes cause tissues throughout the body to degenerate. In the spine, the vertebrae (spinal bones) and intervertebral discs degenerate with ageing. the intervertebral discs are cushion like structures that act as shock absorbers between the vertebral bones.

One of the structures that form the discs is known as the annulus fibrosus. The annulus fibrosus is made up of the 60 or more tough circular bands of collagen fiber (called lamellae). Collagen is a type of inelastic fiber. Collagen fibers, along with water and proteoglycans (types of large molecules made of a protein and at least one carbohydrate chain) help to form the soft, gel-like center part of each disk. This soft, center part is known as the nucleus pulposus and is surrounded by the annulus fibrosus.

The degenerative effects of ageing can cause the fibers of the discs to weaken, causing wear and tear. Constant wear and tear and injury to the joints of the vertebrae causes inflammation in the joints. Degeneration of the discs leads to the formation of mineral deposits within the discs. The water content of the center of the disc decreases with age and as a result the discs become hard, stiff, and decreased in size. This, in turn, results in strain on all the surrounding joints and tissues, causing the sensation of stiffness. With less water in the center of the discs, they have decreased shock absorbing qualities. An increased risk of disc herniation also results, which is when the disc abnormally protrudes from its normal position.

Each vertebral body contains four joints that act as hinges. These hinges are known as facet joints or zygapophyseal joints. The job of the facet joins is to allow the spinal column to flex, extend, and rotate. The bones of the facet joints are covered with cartilage (a type of flexible tissue) known as end plates. The job of the end plates is to attach the disks to the vertebrae and to supply nutrients to the disc. When the facet joints degenerate, the size of the end plates can decrease and stiffen. Movement can stimulate pain fibers in the facet joints and annulus fibrosus. Furthermore, the vertebral bone underneath the end plates can become thick and hard.

Degenerative disease can cause ligaments to lose their strength. A ligament is a tough band of tissue that attaches to joint bones. In the spine, ligaments connect spinal structures such as vertebrae and prevent them from moving too much. In degenerative spondylosis, one of the main ligaments (known as the ligamentum flavum) can thicken or buckle, making it weaken.

Knobby, abnormal bone growths (known as bone spurs or osteophytes) can form in the vertebrae. These changes can also cause osteoarthritis. Osteoarthritis is a disease of the joints that is made worse by stress. In more severe cases, these bones spurs can compress nerves coming out of the spinal cord and/or decreased blood supply to the vertebrae. Areas of the body supplied by these nerves may become painful or develop loss of sensation and function.

Carrying around excessive weight can cause lumbar spondylosis. Spending much of the day seated can also be a contributing factor. An injury or trauma to the back can also contribute, as can genetic factors.

The main Risk Factors:
• Age: As a person ages the healing ability of the body decreases and developing arthritis at that time can make the disease progress much faster. Persons over 40 years of age are more prone to developing lumbar spondylosis.

• Obesity: Overweight puts excess load on the joints as the lumbar region carries most of the body’s weight, making a person prone to lumbar spondylosis.

• Sitting for prolonged periods: Sitting in one position for prolonged time which puts pressure on the lumbar vertebrae.

• Prior injury: Trauma makes a person more susceptible to developing lumbar spondylosis.

• Heredity or Family history
Diagnosis:
Physical Examination:
A thorough physical examination reveals much about the patient’s health and general fitness. The physical part of the exam includes a review of the patient’s medical and family history. Often laboratory tests such as complete blood count and urinalysis are ordered. The physical exam may include:

*Palpation (exam by touch) determines spinal abnormalities, areas of tenderness, and muscle spasm.

*Range of Motion measures the degree to which a patient can perform movement of flexion, extension, lateral bending, and spinal rotation.

*A neurologic evaluation assesses the patient’s symptoms including pain, numbness, paresthesias (e.g. tingling), extremity sensation and motor function, muscle spasm, weakness, and bowel/bladder changes. Particular attention may be given to the extremities. Either a CT Scan or MRI study may be required if there is evidence of neurologic dysfunction.

X-rays and Other Tests:
Radiographs (X-rays) may indicate loss of vertebral disc height and the presence of osteophytes, but is not as useful as a CT Scan or MRI. A CT Scan may help reveal bony changes sometimes associated with spondylosis. An MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve abnormalities. Discography seeks to reproduce the patient’s symptoms to identify the anatomical source of pain. Facet blocks work in a similar manner. Both are considered controversial.

The physician compares the patient’s symptoms to the findings to formulate a diagnosis and treatment plan. The results from the examination provide a baseline from which the physician can monitor and measure the patient’s progress.

Treatment:
Each patient is treated differently for arthritis depending on their individual condition. In the early stages lifestyle modifications or medicines are used for treatment and surgery is needed only if these measures are ineffective.

Yoga:
A few yoga poses and sequences can help lumbar spondylosis. Sun salutations, also known as Surya Namaskar A and B, are good for back strengthening and flexibility. The cobra pose, or Bhjangasana, stretches the lower back. The locust pose, or Shalabhasana, strengthens the lower back because it requires lifting one’s upper and lower body off the ground from a prone position on the floor. Meditation & pranayam 

Exercises:
Physical therapy is often prescribed to relieve problems caused by lumbar spondylosis. Back extensions are used on patients who can tolerate them. The patient lies face down on her stomach and then slowly lifts only her upper body off the floor. The arms may be placed palms down under her chest to take some strain off the back muscles. If lying down is too painful, this exercise can also be done against a wall. The patient puts her hands against a wall, standing about a foot away, and bends back, using a combination of lower back muscles and arms.

Stretches to Avoid:
Lying on the back and bringing the knees into the chest is an example of a common lower back stretch that flexes the spine. This is not recommended for people with lumbar spondylosis. Bending down to touch one’s toes from a standing position is also not recommended. Reaching for the toes while sitting can be problematic, too.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.ehow.com/about_5039006_lumbar-spondylosis-exercises.html
http://www.physiotherapy-treatment.com/lumbar-spondylosis.html

 

BALANCE DISORDER

Definition:
A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness or wooziness, or having a sensation of movement, spinning, or floating. Balance is the result of several body systems working together: the visual system (eyes), vestibular system (ears) and proprioception (the body’s sense of where it is in space). Degeneration or loss of function in any of these systems can lead to balance deficits
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Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.

Our sense of balance is primarily controlled by a maze-like structure in our inner ear called the labyrinth, which is made of bone and soft tissue. At one end of the labyrinth is an intricate system of loops and pouches called the semicircular canals and the otolithic organs, which help us maintain our balance. At the other end is a snail-shaped organ called the cochlea, which enables us to hear. The medical term for all of the parts of the inner ear involved with balance is the vestibular system.

Symptoms:
When balance is impaired, an individual has difficulty maintaining upright orientation. For example, an individual may not be able to walk without staggering, or may not even be able to stand. They may have falls or near-falls. The symptoms may be recurring or relatively constant. When symptoms exist, they may include:

*Dizziness or vertigo (a spinning sensation)
*Falling or feeling as if you are going to fall
*Lightheadedness, faintness, or a floating sensation
*Blurred vision
*Confusion or disorientation

Some individuals may also experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety, or panic. Some reactions to the symptoms are fatigue, depression, and decreased concentration. The symptoms may appear and disappear over short time periods or may last for a longer period.

Cognitive dysfunction (disorientation) may occur with vestibular disorders. Cognitive deficits are not just spatial in nature, but also include non-spatial functions such as object recognition memory. Vestibular dysfunction has been shown to adversely affect processes of attention and increased demands of attention can worsen the postural sway associated with vestibular disorders. Recent MRI studies also show that humans with bilateral vestibular damage undergo atrophy of the hippocampus which correlates with their degree of impairment on spatial memory tasks

Causes:
Problems with balance can occur when there is a disruption in any of the vestibular, visual, or proprioceptive systems. Abnormalities in balance function may indicate a wide range of pathologies from causes like inner ear disorders, low blood pressure, brain tumors, and brain injury including stroke.

Many different terms are often used for dizziness, including lightheaded, floating, woozy, giddy, confused, helpless, or fuzzy. Vertigo, Disequilibrium and pre-syncope are the terms in use by most physicians and have more precise definitions.

*Vertigo: Vertigo is the sensation of spinning or having the room spin about you. Most people find vertigo very disturbing and report associated nausea and vomiting.

*Disequilibrium: Disequilibrium is the sensation of being off balance, and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting.

*Pre-syncope (links to syncope, which is different): Pre-syncope is a feeling of lightheadedness or simply feeling faint. Syncope, by contrast, is actually fainting. A circulatory system deficiency, such as low blood pressure, can contribute to a feeling of dizziness when one suddenly stands up.

Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, may also cause balance problems.

Related to the ear:
Causes of dizziness related to the ear are often characterized by vertigo (spinning) and nausea. Nystagmus (flickering of the eye, related to the Vestibulo-ocular reflex [VOR]) is often seen in patients with an acute peripheral cause of dizziness.

*Benign Paroxysmal Positional Vertigo (BPPV) – The most common cause of vertigo. It is typically described as a brief, intense sensation of spinning that occurs when there are changes in the position of the head with respect to gravity. An individual may experience BPPV when rolling over to the left or right, upon getting out of bed in the morning, or when looking up for an object on a high shelf.  The cause of BPPV is the presence of normal but misplaced calcium crystals called otoconia, which are normally found in the utricle and saccule (the otolith organs) and are used to sense movement. If they fall from the utricle and become loose in the semicircular canals, they can distort the sense of movement and cause a mismatch between actual head movement and the information sent to the brain by the inner ear, causing a spinning sensation.

*Labyrinthitis – An inner ear infection or inflammation causing both dizziness (vertigo) and hearing loss.

*Vestibular neuronitis – an infection of the vestibular nerve, generally viral, causing vertigo

*Cochlear Neuronitis – an infection of the Cochlear nerve, generally viral, causing sudden deafness but no vertigo.

 

*Trauma – Injury to the skull may cause either a fracture or a concussion to the organ of balance. In either case an acute head injury will often result in dizziness and a sudden loss of vestibular function.

*Surgical trauma to the lateral semicircular canal (LSC) is a rare complication which does not always result in cochlear damage. Vestibular symptoms are pronounced. Dizziness and instability usually persist for several months and sometimes for a year or more.

   *Ménière’s disease – an inner ear fluid balance disorder that causes lasting episodes of vertigo, fluctuating hearing loss, tinnitus (a ringing or roaring in the ears), and the sensation of fullness in the ear. The cause of Ménière’s disease is unknown.

    *Perilymph fistula a leakage of inner ear fluid from the inner ear. It can occur after head injury, surgery, physical exertion or without a known cause.

    *Superior canal dehiscence syndrome – a balance and hearing disorder caused by a gap in the temporal bone, leading to the dysfunction of the superior canal.

  *Bilateral vestibulopathy – a condition involving loss of inner ear balance function in both ears. This may be caused by certain antibiotics, anti-cancer, and other drugs or by chemicals such as solvents, heavy metals, etc., which are ototoxic; or by diseases such as syphilis or autoimmune disease; or other causes. In addition, the function of the semicircular canal can be temporarily affected by a number of medications or combinations of medications.

 

Related to the brain and central nervous system:
Brain related causes are less commonly associated with isolated vertigo and nystagmus but can still produce signs and symptoms, which mimic peripheral causes. Disequilibrium is often a prominent feature.

*Degenerative: age related decline in balance function
*Infectious: meningitis, encephalitis, epidural abscess, syphilis
*Circulatory: cerebral or cerebellar ischemia or hypoperfusion, stroke, lateral medullary syndrome (Wallenberg’s syndrome)
*Autoimmune: Cogan syndrome
*Structural: Arnold-Chiari malformation, hydrocephalus
*Systemic: multiple sclerosis, Parkinson’s disease
*Vitamin deficiency: Vitamin B12 deficiency
*CNS or posterior neoplasms, benign or malignant
*Neurological: Vertiginous epilepsy
*Other – There are a host of other causes of dizziness not related to the ear.

*Mal de debarquement is rare disorder of imbalance caused by being on board a ship. Patients suffering from this condition experience disequilibrium          even when they get off the ship. Typically treatments for seasickness are ineffective for this syndrome.

*Motion sickness – a conflict between the input from the various systems involved in balance causes an unpleasant sensation. For this reason, looking          out of the window of a moving car is much more pleasant than looking inside the vehicle.

*Migraine-associated vertigo
*Toxins, drugs, medications

Pathophysiology:
The semicircular canals, found within the vestibular apparatus, let us know when we are in a rotary (circular) motion. The semicircular canals are fluid-filled. Motion of the fluid tells us if we are moving. The vestibule is the region of the inner ear where the semicircular canals converge, close to the cochlea (the hearing organ). The vestibular system works with the visual system to keep objects in focus when the head is moving. This is called the vestibulo-ocular reflex (VOR).
Click & see :
Movement of fluid in the semicircular canals signals the brain about the direction and speed of rotation of the head – for example, whether we are nodding our head up and down or looking from right to left. Each semicircular canal has a bulbed end, or enlarged portion, that contains hair cells. Rotation of the head causes a flow of fluid, which in turn causes displacement of the top portion of the hair cells that are embedded in the jelly-like cupula. Two other organs that are part of the vestibular system are the utricle and saccule. These are called the otolithic organs and are responsible for detecting linear acceleration, or movement in a straight line. The hair cells of the otolithic organs are blanketed with a jelly-like layer studded with tiny calcium stones called otoconia. When the head is tilted or the body position is changed with respect to gravity, the displacement of the stones causes the hair cells to bend.

click & see
The balance system works with the visual and skeletal systems (the muscles and joints and their sensors) to maintain orientation or balance. For example, visual signals are sent to the brain about the body’s position in relation to its surroundings. These signals are processed by the brain, and compared to information from the vestibular, visual and the skeletal systems.
Diagnosis:
Diagnosis of a balance disorder is complicated because there are many kinds of balance disorders and because other medical conditions — including ear infections, blood pressure changes, and some vision problems — and some medications may contribute to a balance disorder. A person experiencing dizziness should see a physiotherapist or physician for an evaluation. A physician can assess for a medical disorder, such as a stroke or infection, if indicated. A physiotherapist can assess balance or a dizziness disorder and provide specific treatment.

The primary physician may request the opinion of an otolaryngologist to help evaluate a balance problem. An otolaryngologist is a physician/surgeon who specializes in diseases and disorders of the ear, nose, throat, head, and neck, sometimes with expertise in balance disorders. He or she will usually obtain a detailed medical history and perform a physical examination to start to sort out possible causes of the balance disorder. The physician may require tests and make additional referrals to assess the cause and extent of the disruption of balance. The kinds of tests needed will vary based on the patient’s symptoms and health status. Because there are so many variables, not all patients will require every test.

Diagnostic testing:
Tests of vestibular system (balance) function include electronystagmography (ENG), Videonystagmograph (VNG), rotation tests, Computerized Dynamic Posturography (CDP), and Caloric reflex test.

Tests of auditory system (hearing) function include pure-tone audiometry, speech audiometry, acoustic-reflex, electrocochleography (ECoG), otoacoustic emissions (OAE), and auditory brainstem response test (ABR; also known as BER, BSER, or BAER).

Other diagnostic tests include magnetic resonance imaging (MRI) and computerized axial tomography (CAT, or CT).

Treatment and Prevention:
There are various options for treating balance disorders. One option includes treatment for a disease or disorder that may be contributing to the balance problem, such as ear infection, stroke, multiple sclerosis, spinal cord injury, Parkinson’s, neuromuscular conditions, acquired brain injury, cerebellar dysfunctions and/or ataxia. Individual treatment will vary and will be based upon assessment results including symptoms, medical history, general health, and the results of medical tests. Additionally, tai chi may be a cost-effective method to prevent falls in the elderly.

Many types of balance disorders will require balance training, prescribed by an occupational therapist or physiotherapist. Physiotherapists often administer standardized outcome measures as part of their assessment in order to gain useful information and data about a patient’s current status. Some standardized balance assessments or outcome measures include but are not limited to the Functional Reach Test, Clinical Test for Sensory Integration in Balance (CTSIB), Berg Balance Scale and/or Timed Up and Go The data and information collected can further help the physiotherapist develop an intervention program that is specific to the individual assessed. Intervention programs may include training activities that can be used to improve static and dynamic postural control, body alignment, weight distribution, ambulation, fall prevention and sensory function. Although treatment programs exist which seek to aid the brain in adapting to vestibular injuries, it is important to note that it is simply that – an adaptation to the injury. Although the patient’s balance is restored, the balance system injury still exists

Benign Paroxysmal Positional Vertigo (BPPV):
It is caused by misplaced crystals within the ear. Treatment, simply put, involves moving these crystals out of areas that cause vertigo and into areas where they do not. A number of exercises have been developed to shift these crystals. The following article explains with diagrams how these exercises can be performed at the office or at home with some help: The success of these exercises depends on their being performed correctly.

The two exercises explained in the above article are:

*The Brandt-Daroff Exercises, which can be done at home and have a very high success rate but are unpleasant and time consuming to perform.

*The Epley’s exercises are often performed by a doctor or other trained professionals and should not be performed at home. Various devices are available      for home BPPV treatment.

Ménière’s disease:
  *Diet:
Dietary changes such as reducing intake of sodium (salt) may help. For some people, reducing alcohol, caffeine, and/or avoiding nicotine may be               helpful. Stress has also been shown to make the symptoms associated with Ménière’s worse.

 *Drugs:
#Beta-histine (Serc) is available in some countries and is thought to reduce the frequency of symptoms
#Diuretics such as hydrochlorothiazide (Diazide) have also been shown to reduce the frequency of symptoms
#Aminoglycoside antibiotics (gentamicin) can be used to treat Ménière’s disease. Systemic streptomycin (given by injection) and topical gentamicin         (given directly to the inner ear) are useful for their ability to affect the hair cells of the balance system. Gentamicin also can affect the hair  cells of the cochlea, though, and cause hearing loss in about 10% of patients. In cases that do not respond to medical management, surgery may be indicated.

      *Surgery for Ménière’s disease is a last resort.
#Vestibular neuronectomy can cure Ménière’s disease but is very involved surgery and not widely available. It involves drilling into the skull and  cutting the balance nerve just as it is about to enter the brain.
#Labyrinthectomy (surgical removal of the whole balance organ) is more widely available as a treatment but causes total deafness in the affected ear.

Labyrinthitis:
Treatment includes balance retraining exercises (vestibular rehabilitation). The exercises include movements of the head and body specifically developed for the patient. This form of therapy is thought to promote habituation, adaptation of the vestibulo-ocular reflex, and/or sensory substitution. Vestibular retraining programs are administered by professionals with knowledge and understanding of the vestibular system and its relationship with other systems in the body.

Bilateral vestibular loss:
Dysequilibrium arising from bilateral loss of vestibular function – such as can occur from ototoxic drugs such as gentamicin – can also be treated with balance retraining exercises (vestibular rehabilitation) although the improvement is not likely to be full recovery

Medication:
Sedative drugs are often prescribed for vertigo and dizziness, but these usually treat the symptoms rather than the underlying cause. Lorazepam (Ativan) is often used and is a sedative which has no effect on the disease process rather helps patients cope with the sensation.

Anti-nauseants, like those prescribed for motion sickness, are also often prescribed but do not affect the prognosis of the disorder.

Specifically for Meniere’s disease a medication called Serc (Beta-histine) is available. There is some evidence to support it is effective to reduce the frequency of attacks. Also Diuretics, like Diazide (HCTZ/triamterene), are effective in many patients. Finally, ototoxic medications delivered either systemically or through the eardrum can eliminate the vertigo associated with Meniere’s in many cases, although there is about a 10% risk of further hearing loss when using ototoxic medications.

Treatment is specific for underlying disorder of balance disorder:

#anticholinergics
#antihistamines
#benzodiazepines
#calcium channel antagonists, specifically Verapamil and Nimodipine
#GABA modulators, specifically gabapentin and baclofen
#Neurotransmitter reuptake inhibitors such as SSRI’s, SNRI’s and Tricyclics

Research:
Scientists at the National Institute on Deafness and Other Communication Disorders (NIDCD) are working to understand the various balance disorders and the complex interactions between the labyrinth, other balance-sensing organs, and the brain. NIDCD scientists are studying eye movement to understand the changes that occur in aging, disease, and injury, as well as collecting data about eye movement and posture to improve diagnosis and treatment of balance disorders. They are also studying the effectiveness of certain exercises as a treatment option.

Other projects supported by the NIDCD include studies of the genes essential to normal development and function in the vestibular system. NIDCD scientists are also studying inherited syndromes of the brain that affect balance and coordination.

The NIDCD supports research to develop new tests and refine current tests of balance and vestibular function. For example, NIDCD scientists have developed computer-controlled systems to measure eye movement and body position by stimulating specific parts of the vestibular and nervous systems. Other tests to determine disability, as well as new physical rehabilitation strategies, are under investigation in clinical and research settings.

Scientists at the NIDCD hope that new data will help to develop strategies to prevent injury from falls, a common occurrence among people with balance disorders, particularly as they grow older.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Balance_disorder
http://www.medicinenet.com/vestibular_balance_disorders/article.htm#what_is_a_balance_disorder

Yuan Zhi

Botanical Name : Polygala tenuifolia
Family: Polygalaceae
Genus: Polygala
Species: P. tenuifolia
Kingdom: Plantae
Order: Fabales

Common Names : Chinese Senega, Yuan Zhi,polygala, Chinese senega root,Thinleaf Milkwort Root,Polygala root,thin-leaf milkwort root

Other Names:Chinese Senega, Flax, Klapperschlangen, Milkwort, Mountain Polygala, Polygalae radix, Rattlesnake Root, Senaga Snakeroot, Seneca, Seneca Snakeroot, Senega, Senega Snakeroot, Seneka, Snake Root. Polygala glomerata; Polygala japonica; Polygala reinii; Polygala senega, synonym Polygala senega latifolia; Polygala tenuifolia.

Habitat : Polygala tenuifolia is native to  E. Asia – Korea, Mongolia, Manchuria. Grows in the  Hillsides, roadsides and meadows. Dry meadows and stony slopes.

Description:
Polygala tenuifolia is a perennial herb,  growing to 0.2 m (0ft 8in) by 0.2 m (0ft 8in).  It is hardy to zone 6. The flowers are hermaphrodite (have both male and female organs)

CLICK & SEE THE PICTURES

The plant prefers light (sandy), medium (loamy) and heavy (clay) soils and requires well-drained soil.The plant prefers acid, neutral and basic (alkaline) soils..It can grow in semi-shade (light woodland) or no shade.It requires moist soil.

Cultivation:
Prefers a moderately fertile moisture-retentive well-drained soil, succeeding in full sun if the soil remains moist throughout the growing season, otherwise it is best in semi-shade. Dislikes shade according to another report. Plants are hardy to at least -15°c.

Propagation  :
Seed – sow spring or autumn in a cold frame. When they are large enough to handle, prick the seedlings out into individual pots and grow them on in the greenhouse for their first winter. Plant them out into their permanent positions in late spring or early summer, after the last expected frosts. Division. Cuttings of young shoots in a frame in late spring.

Edible Uses
Edible Parts: Leaves;  Root.

Young leaves – cooked. Root – cooked. The core is removed and the root is boiled in several changes of water.

Medicinal Uses :
Cardiotonic;  ExpectorantHaemolytic;  Kidney;  Sedative;  Tonic.

Yuan Zhi is used primarily as an expectorant. It is one of the 50 fundamental herbs used in traditional Chinese medicine, where it is called yuan zhi .

Yuan Zhi contains triterpenoid saponins, these promote the clearing of phlegm from the bronchial tubes. The plant is used mainly as an expectorant and stimulant to treat bronchial asthma, chronic bronchitis and whooping cough. The root is antibacterial, cardiotonic, cerebrotonic, expectorant, haemolytic, hypotensive, sedative and tonic. It acts mainly as a tonic for the heart and kidney energies. It is taken internally in the treatment of coughs with profuse phlegm, bronchitis, insomnia, palpitations, poor memory, anxiety, depression and nervous tension. Externally it is used to treat boils and carbuncles. The root is harvested in the autumn and dried for later use. The leaves are used as a tonic for the kidneys.

Medical study:
A randomized, double-blind, placebo-controlled, parallel-group study of the extract of dried roots of Polygala tenuifolia in healthy adults produced memory-enhancing effects. A similar trial with elderly humans also found significant cognitive improvement.

A number of in vitro experiments have examined the use of the herb in Alzheimer’s disease, memory disorder, depression, amnesia, cognitive defects, neurotoxicity, degenerative disease,and dementia among others. Results have been encouraging

Known Hazards : Although no specific mention has been seen for this species, at least one member of this genus is said to be poisonous in large quantities.

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider

Resources:
http://www.pfaf.org/user/Plant.aspx?LatinName=Polygala+tenuifolia
http://www.plantsystematics.org/imgs/mmy8/r/Polygalaceae_Polygala_tenuifolia_25750.html
http://www.mdidea.com/products/new/new09801.html
http://en.wikipedia.org/wiki/Polygala_tenuifolia

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