Vestibular Rehabilitation Essay

In the current health set up, Nurse Practitioners (NP) incidence of hearing loss is less prevalent non-communicable diseases both nationally and globally. High frequency of noise exposure and ageing are the duo contributing factors to Sudden Sensorineural Hearing Loss (SSNHL). The dawning of insidious is gradual but accompanied by multiple harmful effects and usually progresses months to years depending on the magnitude of damage. On the other hand, Medical Interventions usually of scientific innovation have developed electronic devices which act as sound amplifier specifically for hearing loss occurring due to advanced ageing. The fact is that Sudden Sensorineural Hearing Loss (SSNHL) associated with ageing is incurable.

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Early diagnosis of the hearing predicament has proven to be the primary life-saving initiative immediately after the 3days onset of the predicament. However, sudden Sensor neural Hearing Loss (SSNHL) is typically a unilateral form of hearing loss meaning some of the reported cases can be cured only if early diagnosis is initiated and the victim subjected to treatment within the shortest span possible after the onset of the hearing loss. On the other hand, Nurses practitioner being the forefront healthcare providers who usually walk with patients throughout the entire prognosis course of diseases they are often the initiators of the first line of treatment. Neurologists are responsible for the provision of diagnostic procedures and outlining treatment framework and hand it over to nurses who are responsible for outreaches, follow up care and supplementary evaluation (Colleen G. Le Prell, 2016).

Epidemiology

Contemporary research indicates that the annual morbidity of Sudden Sensorineural Hearing Loss (SSNHL) is 2-20/ 100,000 people while the mean lifetime of manifestation is averagely 43-53 years. However, loss of hearing is a common problem that affects almost every individual in a lifetime usually experienced when climbing high mountains and flying at high altitudes. Clinical features include a sensation of wanting to unblock the ears through air poping which usually results in a short-lived better hearing at that particular time. According to Beaver Dam cohort study results in the United States of America (USA), a 3 percent among 21-34 years of age and 6 percent among 35-44 years of age is the prevalence of Sudden Sensorineural Hearing Loss (SSNHL) defined b audiometry. The prevalence of hearing loss has been scientifically proven to have no significant influence on the occurrence of Sudden Sensorineural Hearing Loss (SSNHL). The mortality rate of hearing loss is almost equated to zero apart from their feasible connectivity with a stroke that has claimed a handful of life. Epidemiological, viral infections are the most leading contributing factor for Sudden Sensorineural Hearing Loss (SSNHL) followed by progressive ageing, cardiovascular diseases and finally the latency of positive antinuclear antibody.

Etiology

The occurrence of Sudden Sensorineural Hearing Loss (SSNHL) in individuals across all ages indicates damage to the nerve pathways originating from the inner year to the brain or hair cell in their inner ear. The cause of hearing loss is considered idiopathic. Additionally, hearing loss may also occur as a result of oedema at the eighth cranial which subsequently results in the confining of the internal auditory artery to the circulatory apparatus and the cochlea. Compression of the inner auditory artery is mainly caused by a viral infection which is manifested by an oedema of the auditory nerve circumscribed in the internal auditory meatus.

Many of the patients experiencing Sudden Sensorineural Hearing Loss (SSNHL) at early stages of the disease progression the victim have reported an apparent hearing ability but the failure to understand the speech which is evident in the existence of background noise. Acquired and congenital sensorineural hearing losses are the two type of sensorineural hearing defect. Acquired sensorineural hearing loss appears after birth. Underlying causes include:

• Ageing, hearing loss is the most prevalent condition associated with growing old. Since the defect progresses relatively within a long span, it may be difficult to notice since it affects both ears.
• Noise, statistics indicate that 15 percent of Americans between the age of 20 and 69 suffer from Sudden Sensorineural Hearing Loss (SSNHL).Noise-Induced Hearing loss (NIHL) is as a result of exposure to loud noise higher than 85 decibels (dB) explosive blast being a good example.
• Infection and diseases, viral infections such as meningitis, mumps and measles are the leading cause of sensorineural hearing defects.
• Acoustic trauma, a blow to the head caused by explosions from firearms and engine induce hearing loss

Medication, the American Speech-Language-Hearing Association (ASH) has scientifically proven that approximately more than 200 medications are ototoxic. Good examples are the cancer chemotherapy drugs like carboplatin and some antibiotics.

The congenital sensorineural hearing defect occurs during pregnancy and causes include maternal diabetes, prematurity, insufficient oxygen during birth, rubella and genetic.

Therapy Intervention

Vestibular disorder directly affects the victim's life merely by diminishing the life quality and impacts all facets of daily living. Vestibular disorders also elevate emotional complication such as depression and anxiety. As the disease progresses, victims often embrace a sedentary lifestyle with a principal intention of mitigating the imbalance state and dizziness which are usually the aggressive symptoms of the disorder. Decreased muscle flexibility and strength, reduce stamina and increased joint stiffness are usually associated with the adoption of the sedentary life by patients.

Vestibular Rehabilitation Therapy (VRT) is a unique form of therapy mainly exercise based designed to alleviate both primary and secondary clinical manifestations of vestibular disorders. For patients suffering from a vestibular disorder, Vestibular Rehabilitation therapy is an exercise based curriculum developed to reduce gaze instability, imbalances which result to fall, dizziness and vertigo (Reviews, 2016).

Despite multiple advantages of the exercise based program still, clinical results indicate that the amount of vestibular reclamation is small. However, compensation as part of the rehabilitation mechanism has repeatedly restored vestibular function, and patients can return to their daily activities. Compensation enables the brain to adapt and use the somatosensory and vision sensors to compensate for the impaired vestibular system. The present health state of visual, cerebellum, brain stem and somatosensory sensation which are the primary constitutes of the nervous system are the critical determinants of the degree of recovery that can be achieved through compensation.

Genetically, recovery natural occurs courtesy of brain and central nervous system adaptation usually prompt recovery among many patients, however, for patients whose symptoms persist and cannot attend to their daily activities Vestibular Rehabilitation Therapy (VRT) is of great significance since it will trigger recovery.

Therefore, Vestibular Rehabilitation Therapy (VRT) is fashioned in a manner that it incorporates the disorder related problems and generate a recovery approach that promotes compensation. In most cases, maximum compensation is attained by customising the exercise curriculum to suit each patient to individual specific problems. Comprehensive clinical examination of patients is vital before the designing and application of an exercise program to highlight complications identified with the vestibular disorder. A triple principal mechanism of exercise is often prescribed determined by the type and level of damage caused by the vestibular disorder.

1: Habituation is a form of exercise designed to treat dizziness induced by visual stimuli and self-motion. Habituation is significant to patients who experience high dizziness frequency which is experienced during physical movement from one place to another and when changing position example when bending over. Quick head movements may result in the patient falling due to a sudden drop in blood pressure. Also, dizziness caused by the visually stimulating environment such as watching horror movies and shopping malls are treatable through the adoption of habituation exercises. Never the less habituation exercise has any medical advantage to spontaneous dizziness symptoms since habituation is primarily designed to reduce and eventually eliminate dizziness through multiple exposures to the distinct visual and movement symptoms agitating dizziness in patients. The magnitude of the patient's dizziness always drops over time since the human brain can bypass all the abnormal signals encoded from the inner ear.

2: Gaze Stabilization exercise is usually designed to improve eye movement and control and enhance visual clarity during changing of posture that involves a rapid movement of the head. Gaze Stabilization exercise is advantageous to a patient experiencing vision blurredness when moving around to the extent that they cannot see clearly and recognise images. Two type of head and eye exercise are the primary components of Gaze stabilisation mechanism.

Therefore before application of any of the exercise, a clinical vestibular examination is critical to determine the description of vestibular disorder and the magnitude of damage the patient is suffering from. Infatuations of objects as the patient repeatedly sway the head up and down for some minute is one type of Gaze stabilisation exercise. Additionally, the second type of Gaze stabilisation exercise adopts the somatosensation and vision senses to supplement the impaired vestibular system. Patients with bilateral inner ear damage are the primary beneficiaries of the exercise since it boosts gaze stability.

3: Balance Training exercises have significantly improved patients condition by enhancing steadiness and enable most of the patients who comply with the program to once again successfully perform their daily activities such as work and self-care. Underlying factors of the vestibular disorders are comprehensively analysed to address individual problems specifically. It is crucial that the balance exercise should be designed to target on eliminating environmental obstacles and fall risk. Despite the fact that balancing training exercise has improved patients' ability to walk, stand, bend and turn still it is not practical to patients with Benign Paroxysmal Positional Vertigo (BPPV).

Lastly, along with physical exercises designed to improve the state of vestibular disorder and mitigate the magnitude of the effect of the disorder symptoms, it is vital that health care givers incorporate patients education as an integral part of Vestibular Rehabilitation Therapy (VRT) (Susan J Herdman, 2014).

Reference

Colleen G. Le Prell, E. L. (2016). Translational Research in Audiology, Neurotology, and the Hearing Sciences. New York: Springer.

Reviews, C. (2016). Vestibular Rehabilitation, 3rd Edition Contemporary Perspectives in Rehabilitation. Michigan: Cram101.

Susan J Herdman, R. C. (2014). Vestibular Rehabilitation. Carlifonia: F.A. Davis.