Treatment for Disequilibrium
Medications
Several medications, for example, Valium, meclizine and dramamine, are available to help reduce the effects of disequilibrium. Most doctors do not advise taking these medications for more than a few months, since they may hinder the ability of the brain to compensate for (adjust to) the loss of vestibular function.
Vestibular Therapy
Vestibular therapy can be quite effective in treating loss of vestibular function by accelerating the body’s adaptation to such loss. The basic premise of vestibular therapy is to have the patient perform motions that induce dizziness while at the same time making him/her focus on body position and coordination. This helps the brain learn to compensate for lost vestibular function. The therapy, in the form of exercises, can be performed at a vestibular therapy center or at home. It is important to keep safety of the patient in mind. For this reason, any of the exercises which could lead to falls should not be performed while alone.
Treatment for Facial Paralysis
Acupuncture
Acupuncture has not been scientifically proven to be of benefit in cases of Ramsay Hunt syndrome except to relieve shingles pain or post herpetic neuralgia.
Botox
Botox* (botulinum toxin) has proven useful in the treatment of severe hypertonia (spasticity) of the facial muscles resulting from RHS. Hypertonia in RHS is one form of synkinesis, marked by an abnormal increase in the tightness of muscle tone and a reduced ability of a muscle to stretch (i.e. an increased stiffness). The connection between nerve and muscle may be blocked temporarily, without surgery, by injecting botulinum toxin into the muscle, resulting in relaxation of the muscle. It is difficult to determine the exact amount of the toxin to inject and where to inject it to optimize its effect without causing unnecessary paralysis. For this reason, it is important to have the procedure performed by a qualified board-certified physician who has extensive experience with using botulinum toxin for this purpose. * Botox is produced by and a trademark of Allergan Pharmaceuticals.
Corticosteroids
Corticosteroids are often prescribed to reduce inflammation of the facial nerve. Their effectiveness is a matter of contention due to the difficulty of judging how well a patient would have recovered without treatment. This has lead to a situation where the decision to prescribe Corticosteroids has been left to the personal opinions of the Doctor and the patient.
Electrical Stimulation
We strongly recommend against electrical stimulation of the facial nerves. Some doctors and physical therapists recommend using a TENS unit (electrical stimulator) to aid the healing process or prevent muscle atrophy. However, the latest thinking is that electrical stimulation can encourage synkinesis and that the risks outweigh the possible benefits.
Facial Therapy
We strongly recommend that any facial exercises be deferred until the healing of the nerves is complete, a process that takes about two years. Some doctors and physical therapists recommend forcing the facial muscles to move to aid the healing process or prevent muscle atrophy. However, the latest thinking is that forced movement can encourage synkinesis and that the risks outweigh the possible benefits. Many patients experience a full recovery without ever performing facial exercises.
Nerve Decompression Surgery
Nerve decompression surgery has for a long time been used to treat nerve compression in conditions like Carpal Tunnel Syndrome. However the surgery is not recommended for RHS.
Speech Therapy
Facial paralysis resulting from RHS frequently affects clarity of the patient’s speech, particularly sounds which require firmness of the lips to execute, for example, the sounds “B,” “P,” and “F.” Speech therapy by a trained therapist may be recommended to optimise speech clarity, particularly if the paralysis lasts more than a few weeks.
Surgical Nerve Grafting
About 90% of idiopathic facial paralysis cases recover without the need for further treatment or therapy. However, long term cases may consider surgery to repair or replace the damaged nerve.
Treatment for Hyperacusis
No medically accepted corrective surgical or medical treatments exist for hyperacusis.
However, retraining of the section of the brain which processes auditory information may be attempted. In this sort of sound therapy, a noise-generating device is worn on the affected ear or ears. The noise produced by the device is a gentle static-like sound (white noise) that is barely audible, and is acceptable to most of those with hyperacusis. The therapy may take up to twelve months to improve tolerance of everyday sounds.
Counseling may be indicated in some cases to treat the depression and isolation that often result from the painful loudness of normal social and business situations.
Treatment for Nausea & Vomiting
Anti-emetics
Anti-emetic (anti sickness) drugs can be prescribed to control the nausea and vomiting brought on by vertigo in Ramsay Hunt cases. Oral treatments like Domperidone and Cyclizine or intra-muscular injections of Prochlorperazine help counter the chronic effects of loss of balance but symptoms may be amplified in some cases when the drugs wear off. Associated side effects can be constipation, headaches, flushing, fatigue, indigestion, insomnia and twitching.
Treatment for Pain
Most patients find that gentle moist heat and over-the-counter pain medications are sufficient to ease the pain of Ramsay Hunt Syndrome. However, sometimes strong prescription painkillers are needed if the pain is severe or if it persists as postherpetic neuralgia. Several different classes of medications have been used with success for RHS pain, including:
Topical lidocaine patch
This is the only drug approved by the Food and Drug Administration for PHN pain. The patch, which contains a 5% solution of lidocaine, is applied directly on the site of the pain. In addition to the analgesic effect of the Lidocaine, the patch itself acts as a barrier against pain triggers such as clothing rubbing against the painful area. Lidocaine does not cause any serious side effects. Lidocaine is also available in cream, gel, or spray form.
Antidepressants
The tricyclic antidepressants have been shown to help some patients with PHN pain. These include amitriptyline, nortriptyline, and doxepin, as well as a few others. These antidepressants most likely work by affecting certain neurotransmitters that carry signals between nerve cells and other cells. Tricyclic antidepressants are prescribed in smaller doses for easing the pain of PHN than are needed to ease depression. Other types of antidepressants are not usually used to treat PHN.
Anticonvulsants
These drugs were originally developed to prevent seizures in patients with epilepsy. However, they can be quite effective in relieving neuralgic conditions such as PHN. The anticonvulsant gabapentin (e.g., Neurontin), is frequently used for PHN. A newer anticonvulsant found effective for some patients with PHN is pregabalin (Lyrica). The only problems with gabapentin and pregabalin are that it can take as much as fourteen days for the medication to build up sufficiently in your body to begin to relieve the pain, and that fairly large doses are sometimes needed before pain relief is experienced.
Opioids
Recent studies show that pain drugs such as morphine, methadone, and oxycodone can relieve PHN pain with little risk of serious side effects or addiction. It is wise, however to use these drugs only after trying other drugs or as a backup to other drugs.
Treatment for Post-Viral Fatigue
There is as yet no cure for Post-Viral Fatigue (PVF), and no PVF-specific prescription drugs have been developed. Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen may help control any aches or pain associated with PVF.
Certain dietary supplements and herbal remedies have been claimed to treat or even cure PVF, but their effectiveness hasn’t been proven in controlled studies. And, it is important to remember, although a product may be labelled “natural,” that doesn’t guarantee it is safe. Supplements and herbal remedies can have harmful side effects and may interfere or interact with prescription medications.
Treatment of PVF is based on managing the patient’s symptoms, and it is critical not to delay such symptom management. For example, untreated sleep problems often make symptoms such as pain and memory problems worse, muscle and joint pain can affect the patient’s fitness, etc.
Learning how to manage the fatigue will help restore normal functioning and improve quality of life, even while the symptoms persist. The patient must work with the health care team to develop an individualised treatment plan combining coping techniques and symptom and activity management. A rehabilitation specialist can teach the patient how to plan activities to make use of his/her better days.
Maintaining good general health is a critical factor in symptom management. This may require many changes in the patient’s lifestyle.
Some alternative therapies can benefit PVF patients by relaxing tense muscles, reducing anxiety, and improving morale. These include deep-breathing and muscle-relaxation exercises, massage and healing touch, and movement therapies such as yoga, stretching, and tai chi.
The patient should never use any alternative medicine or therapy without discussing it with his/her doctor.
Sleep
Enough time must be allowed for sleep each night. Additionally, good sleep habits, for example, getting up at the same time each day, limiting naps, and maintaining a regular bedtime can help improve the restorative qualities of sleep. Limiting caffeine and alcohol intake is also important to improving the quality of sleep.
Stress Control
As much as possible, emotional and physical stress must be avoided. Each day, time should be scheduled to relax. That may mean learning how to say no without guilt. If possible, the patient’s routine should not be totally changed. People who remain active tend to do better over time than those who avoid all activity. Stress management techniques such as massage and meditation may prove beneficial for some patients.
Pacing activity
Learning to manage activity levels is critically important to managing PVF. Normal activity should be scheduled regularly, and kept on as even a level as possible. If a patient does too much on a good day, it may result in several days of increased fatigue. The goal should be to balance activity and rest to avoid both deconditioning and overexertion-induced flare-ups. Pacing activity can improve mood and sleep, as well as decrease pain and other symptoms, leading to better functioning. The most seriously ill patients may need to concentrate at first on achieving simple self-care activities such as getting out of bed, getting dressed, etc. before proceeding to more structured exercise routines.
Exercise
It is important not to avoid exercise altogether, since this results in deconditioning which can make symptoms worse. Regular, gentle exercise often improves symptoms and can also improve mobility and morale. It is usually best to start slowly and build up fitness gradually. A physical therapist is often of great value in developing an exercise program. Many patients find gentle exercise, for example, stretching and relaxation exercises, a good place to start. As fitness improves, gentle strengthening and conditioning exercises may be added. Eventually, walking, biking, swimming, or water aerobics, may be helpful. Strenuous exercise programs to optimise aerobic capacity are not recommended.
Lifestyle management
Eating a balanced diet, drinking sufficient fluids, limiting caffeine and alcohol intake, smoking cessation, adequate rest, and regular exercise will maximise a patient’s quality of life. A career or hobby that’s enjoyable and fulfilling will reduce stress and promote a sense of well-being.
Treatment for PostHerpetic Itch
Postherpetic itch can be quite severe and painful, and harder to treat than postherpetic neuralgia. Topical local anesthetics (which numb the skin) provide substantial relief to some patients. It is important to avoid scratching, since the itch typically develops in an area left with sensory loss, and scratching can cause injury.
Treatment for PostHerpetic Neuralgia
Treatment for PostHerpetic Neuralgia (PHN) Treatment for PHN begins with administration of antivirals during the acute phase of the herpes zoster outbreak. The antivirals acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) have been shown to reduce the duration of the zoster-associated pain, which researchers have come to believe lessens the likelihood of developing PHN. These antivirals are most effective when used within the first 72 hours of the onset of the rash.
If PHN does develop, treatment focuses on relieving pain, since no cure has been found. Because of the complexity of PHN, most patients require a combination of medications for adequate pain relief. Almost every patient eventually finds relief, but the trial and error process of finding an effective medication or combination can be frustrating and time consuming. The following are the most commonly prescribed medications for pain relief:
Anticonvulsants
These drugs were originally developed to prevent seizures in patients with epilepsy. However, they can be quite effective in relieving neuralgic conditions such as PHN. The anticonvulsant gabapentin (e.g., Neurontin), frequently used for PHN, has minimal side effects and no interactions with other drugs. A newer anticonvulsant found effective for some patients with PHN is pregabalin (Lyrica). The only problem with gabapentin and pregabalin is that fairly large doses are sometimes needed before pain relief is experienced.
Capsaicin Cream
Capsaicin cream, made from the seeds of hot peppers, is not recommended for PHN. The cream is rubbed into the painful area 3 to 6 times a day. Many patients find that the cream causes skin irritation, worsening PHN.
Opioids
Recent studies show that pain drugs such as morphine, methadone, and oxycodone can relieve PHN pain with little risk of serious side effects or addiction. It is wise, however to use these drugs only after trying other drugs or as a backup to other drugs.
TENS
Although transcutaneous electrical nerve stimulation (TENS) is not a medication, we include it here because some patients have tried it with some success. The TENS unit is a small machine that can be worn on the body. The TENS electrodes are attached to the painful area, to send small electrical impulses to nerves in the skin. The patient assesses the level of pain and decides when the unit should be turned on.
Topical Lidocaine Patch
The patch, which contains a 5% solution of lidocaine, is applied directly on the site of the pain. In addition to the analgesic effect of the Lidocaine, the patch itself acts as a barrier against pain triggers such as clothing rubbing against the painful area. Lidocaine does not cause any serious side effects. Lidocaine is also available in cream, gel, or spray form.
Tricyclic Antidepressants
The tricyclic antidepressants have been shown to help some patients with PHN pain. These include amitryptiline, nortriptyline, and doxepin, as well as a few others. These antidepressants most likely work by affecting certain neurotransmitters that carry signals between nerve cells and other cells. Tricyclic antidepressants are prescribed in smaller doses for easing the pain of PHN than are needed to ease depression. Other types of antidepressants are not usually used to treat PHN.
Treatment for Shingles
Antivirals
In RHS shingles, the antiviral medication inhibits the replication of viral DNA needed to reproduce itself. Virally infected cells absorb more of the antiviral medication than do normal cells, and convert more of it to an active form which prolongs its antiviral activity where it is most needed. Appropriate antiviral medication may reduce the severity and duration of RHS if given soon after the onset of symptoms. Examples of antivirals commonly used in the treatment of RHS shingles include
- Acyclovir (Zovirax), a synthetic nucleoside analogue.
- Famciclovir (Famvir), a prodrug of the antiviral agent penciclovir and a synthetic acyclic guanine derivative.
- Valacyclovir (Valtrex), the hydrochloride salt of the L-valyl ester of the antiviral drug acyclovir.
Topical Antiviral Cream
Some doctors recommend applying a topical antiviral cream to the shingles lesions of RHS in addition to using oral antiviral medication. Various creams are available by prescription or over the counter at pharmacies, and are usually labeled for treatment of cold sores. Most of these creams contain either Acyclovir or Penciclovir, the most common brand names being Zovirax and Vectavir.
Treatment for Tinnitus
Most cases of mild tinnitus do not require treatment, and most cases of tinnitus caused by RHS eventually resolve without treatment. For severe, long-lasting cases, however, there are several treatment options which have been tried. Be sure to check with your doctor before trying any of the treatments listed below.
Dietary Supplements and Other Alternative Treatments
Some people have tried treating their tinnitus with magnesium, zinc, or other minerals; herbal supplements such as Ginkgo biloba; B complex vitamins; or homeopathic remedies, and have reported some improvement. Others have reported relief with acupuncture, magnets, craniosacral therapy, hyperbaric oxygen, or hypnosis. A few of these therapies have been researched in an attempt to verify the anecdotal claims, but the test results have not conclusively confirmed the helpfulness of these treatments for tinnitus. Given that these treatments generally carry little risk to health and some people find them helpful, your doctor might not mind if you try them.
Sound Therapy
Some treatment plans use sound to decrease the loudness or prominence of tinnitus. Often, a masking noise is used to completely or partially cover the tinnitus. Typical sound-making devices include both wearable devices, similar to a hearing aid, and non-wearable devices (such as table-top sound machines or a whirring fan). Sound therapies should always be combined with counseling.
Amplification (Hearing Aids)
Some patients with hearing loss in a frequency range of their tinnitus experience total or partial tinnitus relief while wearing hearing aids. In such cases, hearing aids may recover the ambient sounds that cover the tinnitus.
Biofeedback
Many people have noticed a reduction in their tinnitus when they are able to modify their reaction to the stress in their lives through biofeedback. Biofeedback teaches people to control certain autonomic body functions, such as pulse, muscle tension, and skin temperature. The goal of biofeedback is to help people manage stress in their lives not by reducing the stress but by changing the body’s reaction to it.
Cochlear Implants/Electrical Stimulation
Half of the patients, in one study, who had tinnitus before their cochlear implants experienced tinnitus relief after their cochlear implants. Because electrode implantation destroys whatever healthy hair cells are left inside the cochlea, these implants are prescribed only to profoundly deaf patients. A cochlear implant has two components: an electrode array that is threaded into the cochlea and a receiver that is implanted behind the ear, just under the skin. The electrode array sends electrical sound signals received by the ear, via the receiver, to the brain. There are two possible reasons cochlear implants may help relieve tinnitus: 1.) As with a hearing aid, the ambient sounds that these devices bring back in may mask the tinnitus. 2) The electrical stimulation sent through the auditory nerve by the implant might suppress the tinnitus. Similarly, some forms of electrical stimulation to the ear can stop tinnitus briefly.
Cognitive Therapy
Cognitive therapy counseling that treats a patient’s emotional reaction to tinnitus rather than the tinnitus itself. To accomplish this change in perception, a counselor will help the patient identify negative behaviors and thought patterns, then alter them. Counseling programs are individually designed for patients and are most effective when coupled with other tinnitus treatments, such as masking or medication.
Drug Therapy
Many drugs have been researched and used to relieve tinnitus, but there is not a drug that has been designed specifically to treat tinnitus. Some drugs that have been studied include anti-anxiety drugs, antidepressants, antihistamines, anticonvulsants, and even anesthetics. All successfully quieted tinnitus for some people.
This website cannot recommend which treatment, drug or otherwise, is right for you; this must be determined by you and your doctor. Remember to report to your doctor any side effects and as well as medications you currently are taking. Because side effects can happen with any drug or drug combination, patients have to decide for themselves if tinnitus relief is worth any undesirable side effects experienced.
Treatment for Vertigo
Epley Manoeuvre and Semont Manoeuvre
These are two treatments for Benign Paroxysmal Positional Vertigo (BPPV) that are usually performed in the office of an ENT. Both treatments have approximately an 80% cure rate. The manoeuvres are both designed to move debris out of the posterior canal of the ear to a less sensitive location. Each manoeuvre is completed in about 15 minutes.
The Epley manoeuvre involves a series of movements of the head into four positions, remaining in each position for approximately 30 seconds. In some cases a second treatment may be necessary.
The Semont manoeuvre is similar to the Epley manoeuvre.
It is advisable to perform these manoeuvres under medical supervision to avoid serious side effects. After either of these manoeuvres, you should follow the instructions of your doctor, which are intended to reduce the chance that debris might return to the sensitive canals of the ear.
Medications
Several medications, for example, Valium, meclizine and dramamine, are available to help control vertigo. Most doctors do not advise taking these medications for more than a few months, since they may hinder the ability of the brain to compensate for (adjust to) the loss of vestibular function.
Vestibular Therapy
Vestibular therapy can be quite effective in treating loss of vestibular function by accelerating the body’s adaptation to such loss. The basic premise of vestibular therapy is to have the patient perform motions that induce dizziness while at the same time making him/her focus on body position and coordination. This helps the brain learn to compensate for lost vestibular function. The therapy, in the form of exercises, can be performed at a vestibular therapy center or at home. It is important to keep safety of the patient in mind. For this reason, any of the exercises which could lead to falls should not be performed while alone.
Treatment for the Eye
During the period of facial weakness great care must be taken to avoid damage to the eye. Dryness may promote abrasions and ulceration which may lead to other more serious complications, and lack of protection by the eyelid can lead to risk of abrasion of the cornea. The use of eyepatches has been recommended in the past but in reality these can cause the patch to brush against the surface of the eye and cause further damage. Regular use of eyedrops, eye moisturizing ointment, and/or a moisture chamber, and taping the eye shut at night helps protect the eye.
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