Hearing loss and dizziness of nervous origin
Radicular cochleovestibular syndrome
The most common cause is acoustic neurinoma and, amongst others, vascular, viral disorders, sequels of meningitis, cholesteatoma and other tumors.
Vestibular signs occur, with dizziness of labyrinth type and nystagmus of horizontal-rotary type, progressive hypoacusis of unilateral perception and few signs of injury of the facial nerve.
Central vestibular syndrome
It is caused by tumor compressions or abscesses, vascular disorders such as vertebrobasilar insufficiency syndrome or diffuse atherosclerosis of the posterior fossa, degenerative or inflammatory syndromes such as sclerosis in plaques, syringobulbia and others.
In the hypoexcitability syndrome, dizziness is less marked than in the peripheral syndrome, on the other hand the imbalance it is striking. Spontaneous nystagmus is constant and extremely severe.
In the hyperexcitability syndrome, dizziness is also minor and the imbalance very significant. There is generally no spontaneous nystagmus.
It is a benign disease characterized by the sudden establishment of severe dizziness persistent at the start and then becoming paroxysmal. It seems to affect the vestibular branch of the VIII cranial pair.
The first episode of dizziness is severe, it is associated with nausea, vomiting, persistent nystagmus toward the affected side, and lasts 7-10 days. It can be a single episode or relapse in the next months.
Otic herpes zoster
It is characterized by the invasion of the node of the VIII cranial pair and of the geniculate node of the facial nerve by the herpes zoster virus, that causes severe earache, deafness, dizziness and facial nerve palsy.
Deafness can be permanent or recover partially or completely. Dizziness lasts from days to several weeks. Facial palsy can be transient or permanent.
The treatment is varied and based on corticoids, aciclovir, analgesics, codeine, anxiolytics, etc.
Tumor derived from Schwann cells, affecting more frequently the vestibular than the cochlear branch of the VIII cranial pair.
Deafness and tinnitus are initial symptoms, associated with instability and lightheadedness
As the tumor increases in size, it starts to compress the cerebellum and the cerebral trunk, implicating the V and subsequently the VII cranial pair.
Early neurosurgical approach is the best therapeutic indication.
Spinal nerve or XI cranial pair disorder
Its damage causes weakness of head rotation to the healthy side for sternocleidomastoid palsy, shoulder lowering, oscillation of the shoulder blade outwards, and weakness of shoulder rising for palsy of the upper part of the trapezium.
Advice on radicular cochleovestibular syndrome
The patient with dizziness and nystagmus must not drive.
Hypoacusis not reaching the authorized hearing ranges set out by the law is disabling for driving.
Once the causal treatment is completed, the patient will be evaluated for possible sequels and informed of the influence of these in driving.
The evolution of the disease will be specified in the medical report provided to the patient to assess his ability to drive.
Advice on central vestibular syndrome
The patient must not drive.
If the causal disease is controlled, the possibility for obtaining the driving license or extension will be evaluated, but individualizing each case with periodic reports from the specialist.
Advice on vestibular neuronitis
This clinical condition is completely disabling for the patient to drive.
The complete resolution of the symptoms will allow for driving.
If the asymptomatic driver notices the onset of a new crisis, he should stop the car and ask for assistance. He should never try to drive to the hospital.
Our patient should be warned of this possibility after a first episode of vestibular neuronitis.
Advice on otic herpes zoster
The patient with symptoms must not drive.
The outcome of each case ranges from complete resolution of the clinical condition and driving without restrictions to permanent hypoacusis or facial paralysis and long-term dizziness.
In the cases of persistent symptoms, continued, repeated assessment of the patient will allow the physician for informing in writing of the sequels and evolution of the disease, in order to assess the possibility of recovering the driving license.
Advice on acoustic neurinoma
The patient with instability and dizziness must not drive.
The good outcome without sequels after neurosurgical treatment of acoustic neurinoma will allow for driving without restrictions if the physician reports favorably about it.
The definitive or evolutive injuries require a medical report in order to assess their influence on the ability to drive, and act accordingly with the driving license of the patient.
Advice on spinal nerve or XI cranial pair disorders
The driver with transient spinal nerve palsy cannot drive until complete recovery from his clinical condition.
Permanent paralysis of the spinal nerve prevents from performing some necessary maneuvers in the control of the car and environment, when driving.
A detailed medical report is required trying to adapt the car to the driver and obtain the necessary ability when driving to obtain the driving license.