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. Anti-nausea 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: My father is 72 years old. This year he was diagnosed with an enlarged prostate. For now, the doctor has inserted a catheter. My question is: What process or what treatment is best at his age? We are in the Philippines. — M.M.C.
ANSWER: Enlargement of the prostate gland is a common problem for men in their 70s and older. Sometimes it gets so bad that a man cannot urinate at all or the pressure in the bladder is at risk of damaging the kidney. In those cases, a catheter often is used as a temporizing measure. Unfortunately, a catheter causes inflammation, so it may actually worsen the prostate problem temporarily while still protecting the kidneys. Because of this, the catheter usually needs to be kept in only for about one to two weeks.
During this time, medication usually is started to try to reduce prostate size. For most men, a benign (not cancerous) enlarged prostate can be treated with medication — an alpha blocker, like tamsulosin, sometimes with a second medicine, like finasteride. If that doesn’t work, there are several surgical options.
His doctor needs to be sure that the enlarged prostate isn’t cancer. A physical exam and blood tests may answer that question; other times, a biopsy is needed.
There is no best treatment for everyone. It depends on how large his prostate is, any other medical problems he may have and the expertise of the doctor treating him.
In the United States, the options include a traditional surgery, called a transurethral resection of the prostate (TURP); laser-based treatments; other heat-based treatments (microwave, water vapor ablation and radiowave); and even more newer treatments that are less well-studied. In general, medical therapy is worth a try for most men before considering surgery.