A to Z of Medical Conditions

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Labyrinthitis – so what is Labyrinthitis?

Labyrinthitis

Labyrinthitis

Labyrinthitis is an inner ear infection.

It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, which affects your hearing and balance.

 

Symptoms of labyrinthitis

The most common symptoms of labyrinthitis are:

feeling that you or your surroundings are moving or spinning (vertigo)

feeling or being sick

some hearing loss

These symptoms can vary in severity, with some people feeling that they can’t stand upright.

Other symptoms of labyrinthitis may include:

mild headaches

ringing or humming in your ear(s) (tinnitus)

fluid or pus leaking out of your ear(s)

ear pain

changes in vision, such as blurred vision or double vision

The symptoms of labyrinthitis can be quite severe during the first week, but usually get better after a few weeks.

In some cases the symptoms can last longer and have a significant impact on your quality of life and ability to carry out everyday tasks.

When to get medical help

If you have dizziness, vertigo, some hearing loss or any of the above symptoms and they don’t get better after a few days, or your symptoms are getting worse, see your GP or call NHS 111.

Symptoms of vertigo, nausea and sickness often improve gradually over a few days, although they can sometimes last for several weeks.

You may feel unsteady for a number of weeks or months. This usually improves over time and with treatment. Your hearing should return, although this may depend on the type of infection that caused the problem.

See your GP or call NHS 111 immediately if you have sudden hearing loss in one ear, with or without vertigo. It’s important the cause is investigated.

Diagnosing labyrinthitis

Labyrinthitis is diagnosed based on your symptoms, medical history and a physical examination.

Your GP may ask you to move your head or body, and your ears will be checked for signs of inflammation and infection.

You may also have some hearing tests, as labyrinthitis is more likely if you have hearing loss.

Your GP will also check your eyes. If they’re flickering uncontrollably, it’s usually a sign that your vestibular system, the body’s balancing system, isn’t working properly.

Treating labyrinthitis

The symptoms of labyrinthitis usually pass within a few weeks.

Treatment involves drinking plenty of fluid to avoid becoming dehydrated, bed rest, and medication to help you cope better with the symptoms.

Most cases of labyrinthitis are caused by a viral infection, in which case antibiotics won’t help. But you’ll be offered antibiotics if your doctor thinks your infection is bacterial.

Contact your GP if your symptoms don’t improve after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

A small number of people have symptoms that persist for several months or, in some cases, years. This requires a more intensive type of treatment called vestibular rehabilitation therapy (VRT). VRT is a specialised form of physiotherapy.

Read more about treating labyrinthitis.

What causes labyrinthitis?

Labyrinthitis is caused by an infection in the labyrinth. The labyrinth is the innermost part of the ear.

It contains the:

cochlea – a small spiral-shaped cavity that relays sounds to the brain and is responsible for hearing

vestibular system – a set of fluid-filled channels that contributes to your sense of balance

Labyrinthitis usually follows a viral infection, such as a cold or the flu. The infection can spread from the chest, nose, mouth and airways to the inner ear.

Infections that affect the rest of the body, such as measles, mumps or glandular fever, are a less common cause of viral labyrinthitis.

In rare cases, labyrinthitis can be caused by a bacterial infection. Bacterial labyrinthitis is more likely to affect young children and can be serious.

Bacteria can enter the labyrinth if the thin membranes separating your middle ear from your inner ear are broken. This can happen if you have a middle ear infection or an infection of the brain lining (meningitis).

Labyrinthitis can also develop in people who have an underlying autoimmune condition, where the immune system mistakenly attacks healthy tissue rather than fighting off infections.

Complications of labyrinthitis

Bacterial labyrinthitis carries a higher risk of causing permanent hearing loss, particularly in children who’ve developed it as a complication of meningitis.

As a result of this increased risk, a hearing test is recommended after having bacterial labyrinthitis.

Severe hearing loss after bacterial labyrinthitis can sometimes be treated with a cochlear implant. This is a small hearing device fitted under the skin behind your ear during surgery.

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Lambert-Eaton myasthenic syndrome (LEMS) – What are the signs and why you need to know?

Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is a very rare condition that affects the signals sent from the nerves to the muscles.

It means the muscles are unable to tighten (contract) properly, resulting in muscle weakness and a range of other symptoms.

About half of LEMS cases occur in middle-aged or older people with lung cancer. The remaining cases aren’t associated with cancer and can start at any age.

LEMS is also known as myasthenic syndrome or Eaton-Lambert syndrome.

 

Symptoms of LEMS

The symptoms of LEMS develop gradually over weeks or months.

The main symptoms are weakness in the legs, arms, neck and face, as well as problems with automatic body functions, such as controlling blood pressure.

Common symptoms include:

aching muscles

difficulty walking and climbing stairs

difficulty lifting objects or raising the arms

drooping eyelids, dry eyes and blurred vision

swallowing problems

dizziness upon standing

a dry mouth

constipation

erectile dysfunction in men

strength that temporarily improves when exercising, only to reduce as exercise continues

See your GP if you have a combination of these symptoms.

Causes of LEMS

LEMS is caused by the body’s natural defences (the immune system) mistakenly attacking and damaging the nerves.

Normally, nerve signals travel down the nerves and stimulate the nerve endings to release a chemical called acetylcholine. This chemical then helps activate the muscles.

If the nerve endings are damaged, the amount of acetylcholine they produce decreases, which means nerve signals don’t reach the muscles properly.

It’s not known what triggers the immune system to attack the nerves. It’s often associated with lung cancer, but can occur in people without cancer.

LEMS is not inherited.

Tests for LEMS

Your GP will first check your medical history, ask about your symptoms, carry out a physical examination, and test your reflexes.

If they think you have a problem with your nerves, they may refer you to a specialist called a neurologist for further tests to determine the cause.

Tests you may have include:

blood tests – a blood test can detect substances in the blood (antibodies) resulting from the immune system attacking the nerves

nerve studies – a needle may be inserted into your skin to check how well signals are reaching the muscles from the nerves

scans – you may have a computerised tomography (CT) scan or positron emission tomography (PET) scan to check for lung cancer

If initial scans don’t find cancer, you may be advised to have regular scans every few months for a few years to check that it doesn’t develop later on.

Treatments for LEMS

There’s currently no cure for LEMS, but a number of treatments can help reduce the symptoms.

These include:

treatment for lung cancer – if you have lung cancer, treating it can significantly improve the symptoms of LEMS

medication to help nerve signals reach the muscles – commonly used medicines include 3,4-diaminopyridine and pyridostigmine

to reduce the activity of the immune system (immunosuppressants) – commonly used medicines include steroid tablets (prednisolone), azathioprine and methotrexate

immunoglobulin therapy – injections of antibodies from donated blood that temporarily stop your immune system attacking your nerves

plasmapheresis – a procedure to redirect your blood through a machine that filters out the antibodies attacking your nerves

Medication is the main treatment, although immunoglobulin therapy and plasmapheresis may be recommended in the short term, or if muscle weakness is severe and other treatments haven’t helped.

Outlook for LEMS

Some people respond well to treatment and are eventually able to stop taking medication, although this may not be for several years.

Others respond less well and find the condition affects their everyday activities and quality of life.

LEMS doesn’t affect life expectancy if it’s not associated with cancer. But people with lung cancer and LEMS tend to have a shorter life expectancy because it’s often not diagnosed until the cancer has spread, and by this point it’s very difficult to treat.

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Dysarthria – what is dysarthria? Some tips for dealing with speech difficulties

Dysarthria

Dysarthria

Dysarthria is difficulty speaking caused by brain damage or brain changes later in life.

 

Symptoms of dysarthria

A child or adult with dysarthria may have:

slurred, nasal-sounding or breathy speech

a strained and hoarse voice

excessively loud or quiet speech

problems speaking in a regular rhythm, with frequent hesitations

“gurgly”-sounding or monotone speech

difficulty with tongue and lip movements

difficulty swallowing (dysphagia), which may lead to constant drooling

As a result of these problems, a person with dysarthria may be difficult to understand. In some cases, they may only be able to produce short phrases, single words, or no intelligible speech at all.

Dysarthria doesn’t affect intelligence or understanding, but a person with the condition may also have problems in these areas. Speech problems can also affect social interaction, employment and education.

If you or your child has dysarthria, you may find it helpful to see a speech and language therapist (SLT). Ask your GP about your nearest speech and language therapy clinic.

What causes dysarthria?

The muscles used for speech are controlled by the brain and nervous system. Dysarthria can develop if either of these is damaged in some way.

Dysarthria can either be:

developmental – when it occurs as a result of brain damage before or during birth, such as in cerebral palsy

acquired – when it occurs as the result of brain changes later in life, such as damage caused by a stroke, head injury or brain tumour, or a progressive condition such as Parkinson’s disease or motor neurone disease

Dysarthria in children is usually developmental, while dysarthria in adults is often acquired, although both types can affect people of any age.

Whether dysarthria will improve with speech and language therapy depends on the cause and the extent of the brain damage or dysfunction. Some causes remain stable, while others may worsen over time.

Diagnosing dysarthria

Speech and language therapists can carry out an assessment to determine the extent of the speech problem. They may ask you or your child to:

make different sounds

talk about a familiar topic

count numbers or recite days of the week

read a passage aloud

The therapist may also want to examine the movement of the muscles in the mouth and voice box (larynx), and may wish to make a recording.

Treating dysarthria

A speech and language therapist will work as part of a team of healthcare professionals that includes people from the health, social and voluntary sector.

The therapist will try to improve and maximise your or your child’s ability to talk. They’ll help you find different ways of communicating, and will assist you and your family in adapting to your new situation.

They may recommend:

strategies to improve speech, such as slowing speech down

exercises to improve the volume or clarity of speech

assistive devices, such as a simple alphabet board, an amplifier, or a computerised voice output system

Some speech and language therapists may be able to carry out or refer you for a specialist assessment of communication aids, including computerised voice output systems. For some people, these devices can be used alongside or instead of speech to help them communicate.

See your local speech and language therapist if you’re interested in having an assessment. They’ll be able to provide further information and advice about arranging an assessment and trial of a communication aid.

There’s no guarantee that speech and language therapy can improve the speech of everyone with dysarthria. Whether treatment is successful will depend on the extent and location of the brain damage or dysfunction, the underlying condition causing it, and the individual’s personal circumstances.

Communication tips

The following advice may help you communicate more effectively if you’ve got dysarthria or if you’re communicating with someone with the condition.

Tips for people with dysarthria

If you have dysarthria, you may find it helpful to:

take a good breath before you start speaking

put extra effort into stressing key words

speak slowly, saying one word at a time if necessary

leave a clear space between each word

make sure you’re in the same room as the person you’re talking to and face them

attract the listener’s attention – for example, by touch or calling their name before you begin talking to them

keep sentences short and avoid long conversations if you’re feeling tired

reduce background noise – for example, switch off the TV or radio

repeat yourself if needed

Tips for family, friends and carers

If you’re speaking to a person with dysarthria, you may find the following advice helpful:

reduce distractions and background noise when you’re having a conversation

look at the person as they talk

after speaking, allow them plenty of time to respond – if they feel rushed or pressured to speak, they may become anxious, which can affect their ability to communicate

be careful about finishing their sentences or correcting any errors in their language as this may cause resentment and frustration

if you don’t understand what they’re trying to communicate, don’t pretend you understand as they may find this patronising and upsetting – it’s always best to be honest about your lack of understanding

if necessary, seek clarification by asking yes/no questions or paraphrasing – for example, say: “Did you ask me if I’d done the shopping?”

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Thalassaemia – get informed here

Thalassaemia

Thalassaemia

Thalassaemia is the name for a group of inherited conditions that affect a substance in the blood called haemoglobin.

People with the condition produce either no or too little haemoglobin, which is used by red blood cells to carry oxygen around the body. This can make them very anaemic (tired, short of breath and pale).

It mainly affects people of Mediterranean, South Asian, Southeast Asian and Middle Eastern origin.

There are a number of types of thalassaemia, which can be divided into alpha and beta thalassaemias. Beta thalassaemia major is the most severe type. Other types include beta thalassaemia intermedia, alpha thalassaemia major and haemoglobin H disease.

It’s also possible to be a “carrier” of thalassaemia, also known as having the thalassaemia trait. Thalassaemia carriers don’t have any serious health problems themselves, but are at risk of having children with the condition.

 

Symptoms of thalassaemia

Most people born with thalassaemia experience problems from a few months after birth. Less severe cases may not be noticeable until later in childhood or even until adulthood.

The main problems associated with thalassaemia are:

  • anaemia – severe tiredness (fatigue), weakness, shortness of breath, noticeably pounding, fluttering or irregular heartbeats (palpitations), and pale skin caused by the lack of haemoglobin
  • excess iron in the body – this is caused by the regular blood transfusions used to treat anaemia and it can cause problems with the heart, liver and hormone levels if untreated

Some people experience other problems such as delayed growth, weak and fragile bones (osteoporosis), and reduced fertility.

Read more about the symptoms of thalassaemia.

Causes of thalassaemia

Thalassaemia is caused by faulty genes that affect the production of haemoglobin.

A child can only be born with the condition if they inherit these faulty genes from both parents.

For example, if both parents have the faulty gene that causes beta thalassaemia major, there’s a 25% chance of each child they have being born with the condition.

The parents of a child with the condition are usually carriers of thalassaemia (see below). This means they only have one of the faulty genes that causes the condition.

Read more about the causes of thalassaemia.

Screening and testing for thalassaemia

Thalassaemia is often detected during pregnancy or soon after birth.

Screening for thalassaemia in pregnancy is offered to all pregnant women in England to check if there’s a risk of a child being born with the condition, and some types may be picked up during the newborn blood spot test (heel prick test).

Blood tests can also be carried out at any age to check for the condition or to see if you’re a carrier of a faulty gene that causes it.

Read more about screening and testing for thalassaemia.

Treatments for thalassaemia

People with thalassaemia major or other serious types will need specialist care throughout their lives.

The main treatments are:

  • Blood transfusions – regular blood transfusions are given to treat and prevent anaemia; in severe cases these are needed around once a month.
  • Chelation therapy – treatment with medications to remove the excess iron from the body that builds up as a result of having regular blood transfusions. Some people experience a build-up of iron even without transfusions and need treatment for this.

Eating a healthy diet, doing regular exercise and not smoking or drinking excessive amounts of alcohol can also help to ensure you stay as healthy as possible.

The only possible cure for thalassaemia is a stem cell or bone marrow transplant, but this isn’t done very often because of the significant risks involved.

Read more about how thalassaemia is treated and living with thalassaemia.

Outlook for thalassaemia

Although the main problems associated with thalassaemia can often be managed with treatment, it’s still a serious condition that can have a significant impact on a person’s life.

Even in mild cases with few symptoms, there’s still a risk you could pass on a more serious form of the condition to your children.

Without close monitoring and regular treatment, the most severe types can cause serious organ damage and can be life-threatening.

In the past, severe thalassaemia was often fatal by early adulthood. But with current treatments, average life expectancy is expected to increase significantly, with people likely to live into their 50s, 60s and beyond.

Carriers of thalassaemia (thalassaemia trait)

A carrier of thalassemia is someone who carries at least one of the faulty genes that causes thalassaemia, but doesn’t have the condition themselves. It’s also known as having the thalassaemia trait.

People with this trait won’t develop severe thalassaemia, but are at risk of having a child with the condition if their partner is also a carrier.

You can request a blood test to check if you’re a carrier of thalassaemia from your GP surgery or nearest sickle cell and thalassaemia centre.

Read more about being a thalassaemia carrier.

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Tuberous sclerosis – what are the features of Tuberous sclerosis?

Tuberous sclerosis

Tuberous sclerosis

Tuberous sclerosis causes non-cancerous (benign) tumours to develop in many areas of the body. The condition can lead to a range of different problems, depending on where the tumours grow.

The areas most commonly affected are the:

  • brain
  • skin
  • kidneys
  • heart
  • eyes
  • lungs

Problems caused by these tumours can develop at any age, but most often start early in childhood. The severity of these problems can vary significantly and some tumours cause no noticeable problems.

The main problems these tumours can cause are described below.

Problems affecting the brain

Tumours that develop in the brain can potentially cause a range of problems.

Epilepsy and spasms

Most people with tuberous sclerosis will have epilepsy and experience repeated seizures (fits).

Some young children experience a more serious condition, known as infantile spasms, where they have lots of seizures over a short space of time, and brain activity is abnormal all the time. These usually develop during the first year of life.

Infantile spasms tend to disappear as a child gets older, but by then they may have led to some degree of permanent brain damage, which can cause problems such as moderate to severe intellectual disability, epilepsy that doesn’t respond to medication, and autism.

It’s important for infantile spasms to be identified as early as possible, as early treatment markedly reduces the risk of brain damage.

Learning disabilities

Nearly half of all children with tuberous sclerosis will have a learning disability, which can range from mild to severe.

Possible problems include:

  • poor memory
  • poor attention span
  • difficulty making plans or organising activities
  • learning much more slowly than other people
  • in severe cases, being unable to communicate or look after themselves

Read more about learning disabilities.

Behavioural and developmental disorders

Behavioural and developmental disorders are more common in children with tuberous sclerosis, particularly those with learning disabilities.

These problems can include:

  • autism spectrum disorder – a condition that affects social interaction, communication, interests and behaviour
  • hyperactivity and impulsive behaviour
  • aggression and self-harm
  • anxiety
  • extreme shyness
  • depression
  • sleep disorders – such as finding it difficult to get to sleep or frequently waking up during the night

Hydrocephalus

A small number of people with tuberous sclerosis develop large brain tumours that grow big enough to obstruct the flow of cerebrospinal fluid through the brain.

If the flow of cerebrospinal fluid is blocked, it can cause pressure to build in the brain. This is known as hydrocephalus. Symptoms can include:

  • headaches
  • neck pain
  • feeling and being sick
  • increasing drowsiness
  • changes in your mental state, such as confusion
  • blurred vision, double vision or loss of vision
  • difficulty walking
  • a sudden change in bladder or bowel control, such as urinary incontinence
  • worsening epilepsy or challenging behaviour

Brain tumours can be detected through regular brain scans and treated before they go on to cause hydrocephalus.

If hydrocephalus does develop, emergency surgery is required to drain away excess fluid from the brain. If left untreated, it can cause brain damage or, in the most serious cases, death.

Skin problems

Most people with tuberous sclerosis will have abnormal growths or patches on their skin. They usually first develop during early childhood and can include:

  • patches of light-coloured skin
  • red acne-like spots and blemishes on the face
  • areas of thickened skin
  • growths of skin under or around the nails

Kidney problems

Most people with tuberous sclerosis will have multiple growths in their kidneys, including tumours and cysts (small fluid-filled sacs).

These don’t always cause problems, but can lead to:

About 4 in every 100 people with kidney growths caused by tuberous sclerosis go on to develop kidney cancer.

Heart tumours

Many children born with tuberous sclerosis will develop one or more tumours inside their heart.

These tumours are usually very small and don’t cause any symptoms. Most heart tumours will shrink as a child gets older.

However, in a small number of cases, the tumours can cause problems such as an irregular heart beat (arrhythmia) or heart failure.

Eye tumours

Most people with tuberous sclerosis will develop one or more tumours inside their eyes. These tumours grow on the surface of the retina, which is the thin layer of nerve cells that line the inside of the back of the eye.

However, these tumours rarely grow large enough to affect a person’s vision.

Lung tumours

At least one in every three women with tuberous sclerosis will develop tumours and cysts inside their lungs, usually between the ages of 20 and 40. It’s unclear why women are commonly affected and men rarely are.

In many cases, these cysts and tumours do not cause a problem.

However, some women experience breathing difficulties similar to chronic obstructive pulmonary disease (COPD) and occasionally the tumours can rupture, causing a serious problem where air leaks out of the lungs and into the surrounding area.