Unusual vertigo can be triggered by coughing or loud noises

DEAR DR. ROACH: After many years of various treatments, including allergy shots, food studies and an ear tube, I was recently diagnosed with “semicircular canal dehiscence.” Can you explain what this is and the treatment (besides surgery) to relieve the symptoms of inner ear pressure, dizziness and pressure and pulsation in the head? Are there any medications? — J.D.W.

ANSWER: Semicircular canal dehiscence syndrome is an unusual cause of vertigo. Vertigo is sometimes referred to as dizziness, but “dizziness” may refer to both unsteadiness (a feeling that you are going to pass out, which medically is referred to as “presyncope”) or true vertigo (a sensation of movement when the person is actually still). The vertigo in semicircular canal dehiscence syndrome is different from most other causes of vertigo because it can be provoked by loud noises, coughing or sneezing. It is caused by abnormally thin bone in the semicircular canals, part of the organ of balance in the inner ear. The diagnosis is confirmed by a CT scan of the temporal bone.

The only treatment I have read that consistently is effective is surgery. An ear tube is sometimes tried in people who have symptoms with pressure changes. Medications used in some cases of vertigo, such as meclizine (Antivert), usually will make SCDS symptoms worse in the long term. Antinausea medications like ondansetron (Zofran) may help if nausea is severe, but have their own side effects. Vestibular rehabilitation by a specially trained physical or occupational therapist may have some benefit if surgery isn’t contemplated.

DEAR DR. ROACH: I have a relative with cancer who is about to begin multiple therapeutic interventions. My friends tell me that all cancer treatments are toxic and kill people instead of curing them, and that I should tell my relative to look into other forms of treatment. What do you suggest I do? — K.C.

ANSWER: There are hundreds of different types of cancer, and they vary widely in their capacity to grow and damage the individual, and in their response to treatment. For decades, this has meant mostly surgery, chemotherapy and radiation, but now includes newer treatments, including immune therapy. While not all cancers are curable in everybody, every year brings sometimes incremental, sometimes dramatic improvements in life expectancy for individual cancers.

Some cancers that were rapidly fatal even a few years ago are now curable in most cases. Getting the right diagnosis quickly and getting to an expert in treating that cancer are critical to having the best chance of a good outcome.

Treating some cancers remains difficult, and in many cases the treatments have significant side effects. Surgery scars may impair function, and chemotherapy can cause severe symptoms and may permanently affect body systems, as can radiation. It can be very hard on a family member observing these treatments, and if his or her loved one nevertheless succumbs eventually to the cancer, it is understandable to think the suffering the person went through was in vain.

So, while I understand where your friends may be coming from, their well-meaning advice, based on bad experiences possibly a long time ago, might cause your relative with cancer to delay the potentially lifesaving treatments that are available now. A study published in July 2018 showed that people who use alternative medical treatments for cancer are less likely to be cured and have a shorter life expectancy.

My advice is that you encourage your relative to find the most expert cancer treatment available. It’s up to your relative to accept the recommendations of the expert, but delaying the best available treatment in order to consider unproven therapies is likely to result in harm.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803. (c) 2018 North America Syndicate Inc. All Rights Reserved