The impact of Primary Sjogren's syndrome (PSS) on a patient's health and quality of life can be tremendous. Some people end up changing not only their life styles, read Venus Williams' example [1], as well as their professional careers or the way their perform professionally, again and to a certain extent, Venus Williams. Some symptoms associated with autoimmune diseases are quite devastating and can drive the body immune responses to lengths that are known to be quite compromising to the physiological system itself. Other issues are mild, moderate, temporary, infrequent or just somewhat annoying. But one known affliction related to autoimmune diseases and that is also quite present in roughly 22 to 46% [2] of Sjogren's syndrome patients is the involvement of audiovestibular symptoms. These can derive in severity and result in compromising lack of balance, vertigo, nausea, dizziness or even, in some more grave cases, chronic audiovestibular neuronitis.
There are many factors that do participate in the sense of lacking balance, prevalence of vertigo, occurrence of nausea and dizziness. And well before your healthcare professional can assume there is something affecting your inner ear fluid, a battery of blood and urine tests might be requested to rule out certain deficiencies or health issues that indeed also, directly or indirectly, promote/generate the aforementioned symptoms. Multiple components can participate in triggering audiovestibular symptoms; take for example lack of vitamin B12 [3] that indirectly promote audiovestibular imbalance due to possibility of pernicious anaemia, paraesthesia, the umbrella 'ataxia' set of conditions that is comprised by lack of balance, coordination and speech. Also the calcium-vitamin D bridge for vitamin D is involved in the regulation of calcium and phosphorus in the human body for maintaining adequate bone structure, but ultimately is also recognised as a risk factor in idiopathic benign paroxysmal positional vertigo [4] [5]. Also and for example, peaks of hypertension (increased blood pressure) might eventually reveal the presence of underlying audiovestibular symptoms [6], even though high blood pressure (recognised as a silent killer) is known to be generally asymptomatic. And even endocrine factors can contribute to these audiovestibular aspects.
Before all PSS patients deliver themselves to tears of commiseration with the possibility of yet another serious health affliction, it is important to understand that these tend to have a higher prevalence of sensorineural hearing loss (SNHL) in comparison to the general population [2], HOWEVER there aren't presently reports of damage to the central auditory pathways that I know. In the past, bilateral progressive SNHL in PSS would be treated with steroids and cytotoxic treatments [7], but I suspect nowadays clinicians are ever more aware of the possible presence of macroglia/macrophages in the inner ear of these patients, and treatments are likely to be progressing towards addressing the presence of such resident cochlear inflammatory macrophages.
When audiovestibular symptoms blossom, due to a chronic condition, it is very well possible that the inner ear will be compromised and permit entry to viral and bacterial agents. On its own a chronic condition can sensitise the spaces/vesicles/glands where bodily fluids sit, but it can also wear out the tissues that viral and bacterial infections may use to proliferate at. In that instance chronic vestibular neunorinits or infection of the vestibular nerve in the inner ear can potentiate more serious vertigo, severe lack of balance and grave dizziness symptoms as a result of chronic inflammation.
In all cases, be it mild or severe, visiting a healthcare professional is important for a good assessment on the causes that originate such afflictions. Where in more serious cases the clinical approach may consider prescribed medication with anti-emetics, anti-inflammatories and other products to control deriving situations, simpler cases can be resolved with two basic yet crucial measures, i.e., 1) the use of natural anti-emetics alongside natural anti-inflammatories, that for a viral infection and in time, will improve the patient's condition; 2) balance therapy (a specialised form of physiotherapy to alleviate primary and secondary problems that derive from vestibular disorders).
Natural anti-emetics and Balance Therapy:
Synthetic anti-emetics are known to potentiate, in some cases, a range of secondary effects that put people off using these products. Hence, natural plants with anti-emetic properties gain more relevance. For the sake of conciseness I won't be adding hereby any information on the several natural anti-emetics available in the market, leaving it for a subsequent post with depth on their method of action and on their nature. However, if you'd like to learn more about balance therapy for vestibular rehabilitation, there are so many different good sources of exercises that it was difficult for me to summarise in a simple paragraph how these can potentiate your recovery. I leave you with a few options for judgement according to your school of thought. Just visit the links and ask your doctor which he/she would consider the best alternative treatment for your specific case. In any case, rest assured that a future post will review how effective balance therapy can be, and also the promised post on the available natural anti-emetics.
Vestibular Rehabilitation Exercises by the Brain And Spine Foundation ACCESS HERE.
Vestibular Rehabilitation Exercises by the Northern Lincolnshire and Goole NHS Foundation Trust ACCESS HERE.
Basic Vestibular Rehabilitation Exercises by Salisbury NHS Foundation Trust ACCESS HERE.
Disclaimer: All links were functional as of 17th of July 2019. However, these are pages maintained by third-parties so I have no responsibility whatsoever on their content and functionality.
Before I go and if you want to know more about vestibular neuronitis there is a very good NHS page where relevant patient information is tremendously well summarised [8].
[2] Ralli, M., D’Aguanno, V., Di Stadio, A. et al (2018). "Review Article: Audiovestibular Symptoms in Systemic Autoimmune Diseases". Journal of Immunology Research, 18(1), pp. 1-14.
[3] Healton, E. B., Savage, D. G., Brust, J. C. (1991). "Neurologic aspects of cobalamin deficiency". Europe PMC, 70(4), pp. 229-245.
[4] Jeong, S-H., Kim, J-S., Shin, J-W. et al (2013). "Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo". Journal of Neurology, 260(3), pp. 832–838.
[5] Talaat, H.S., Kabel, A-M. H., Khaliel, L. H. et al (2015). "Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency". Auris Nasus Larynx, 43(3), pp. 237-241.
[6] Esparza, C. M., K. Jáuregui‐Renaud, K., Morelos, C. M. C. et al (2007). "Systemic high blood pressure and inner ear dysfunction: a preliminary study". Clinical Otolaryngology, 32(3), pp. 173-178.
[7] McCabe, B. F. (1979). “Autoimmune sensorineural hearing loss”. The Annals of Otology, Rhinology, and Laryngology, 88 (5), pp. 585–589.
[8] Vestibular neuronitis, NHS, [https://www.nhs.uk/conditions/vestibular-neuronitis/], last visited on the 17th of July 2019, last update on the 23rd of June 2016.
Post image by Guilherme Stecanella from Unsplash.
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