이석증

오늘은 이석증의 병명과 생기는 이유 발생하는 원인과 치료 방법에 대해 알아보자. 
수년전 블루투스 이어폰을 왼쪽에 착용한체 누어 자다 일어났는데 어지러움증을 동반한 매스꺼움 왼쪽 귀의 고통을 참으며 아무 생각없이 일어나려다 주져 앉는일이 발생하였다. 가위에 눌린듯 몸을 추스리지도 못한체 잠시 생각에 잠겼다. 시간이 얼마나 흘렀을까? 한 시간이 흘렀나? 아니면 오분같은 한 시간이였을까? 일어설수 없다는 생각에 나는 혹시나 하는 마음으로 불현듯 모든 것은 발렌스가 맞아야 한다는 생각으로 천천히 오른쪽으로 돌려누웠다. 얼마의 시간이 흘렀나? 달팽이 관밑으로 무엇인가 빨려들어가듯 어느 한순간에 아~ 인제 괜찮아 진거 같은데? 라는 생각과 함께 어지러움증은 온대간데 없어지고 맑은 정신으로 돌아오는 느낌을 받았다. 잠시 한순간이 였지만 이래서 앉은 뱅이로 삶을 연맹할수도 있겠다는 생각이 불현듯 떠올랐다. 
나는 무슨 불치병이라도 걸린듯 원인을 찾아 인터넷을 뒤지기 시작하였고 결론적으로 가장 정확하게 설명해주는 몇 싸이트를 찾아 영상으로 만들어 봤다. 이석증은 불치병도 아니려니와 간단히 설명하자면 귀속의 작은 돌덩어리가 무슨 이유에서건 제 자리에서 벗어나면 생기는 어지러움증이다. 그 기관은 반고리관에 들어간 이석은 움직이지 않고, 가만히 있을 때는 어지럼증을 일으키지는 않지만. 눕거나 일어날 때, 혹은 누워서 고개를 돌리면 반고리관에 들어 있는 이석이 움직이면서 반고리관의 기능에 자극을 주게 된다. 
예를 들어 관에 물이 들어있는 상태에서 조그마한 돌이 들어있다고 생각해보자. 가만히 있을 때는 돌이 움직이지 않기 때문에 파동이 없이 고요하다. 하지만 이 관을 움직이면서 돌이 옆으로 굴러간다면, 고요하던 물에 파동이 발생하게 되고, 즉시 이렇게 반고리관에 들어있는 이석이 움직이면서 파동이 발생하게 된다. 이러한 파동이 반고리관의 끝에 위치한 어지럼증 관련 기관에 영향을 줘서 어지럼증이 생기게 되는 현상이다. 이러한 파동은 오랜 시간 지속되는 게 아니라 짧은 시간이 지나면 사라져서 이석증으로 발생한 어지럼증은 오래 지속되지는 않습니다.


Q. 이석증이 생기는 원인이 궁금하다. 
아직 이석증이 생기는 원인을 정확하게 다 알지는 못합니다. 알려진 이석증의 원인에는 머리의 외상, 장시간 누워있는 자세, 귀 안의 염증 등이 있습니다. 특히 머리에 외상이 있는 경우, 이석기관에서 이석이 떨어져서 반고리관에 들어가는 경우가 자주 있습니다. 또한, 병원에서 수술 등을 시행하고 장시간 누워있는 경우에 이석증이 잘 발생합니다. 

이외에도 고혈압, 당뇨, 고지질혈증, 갑상선 질환과도 이석증이 약간의 관계가 있다고 합니다. 하지만 대부분의 이석증은 원인을 모르는 원인불명의 경우가 가장 많습니다. 한편, 비타민 D 수치 저하와 관련이 있으며, 스트레스나 불안 상태에서도 이석증의 발생 빈도가 증가합니다.
Q. 이석증의 치료, 어렵지 않은가? 
이석증이라는 질병이 어떤 질병이라는 것을 안다면 치료는 간단합니다. 물리적으로 반고리관에 들어간 이석을 다시 원래의 자리인 이석기관으로 넣어주면 됩니다.

치료의 첫 단계는 이석이 어느 부분의 반고리관에 들어있는지를 확인하는 겁니다. 반고리관은 오른쪽과 왼쪽에 각각 존재하며, 3개의 전반고리관, 후반리관, 수평 반고리관이 있습니다. 조그만한 이석이 반고리관에서 떠다니는 경우도 있고, 좀 더 큰 이석이 반고리관의 중간이나 끝 부분에 붙어있는 경우도 있습니다. 이렇게 생각하면 경우의 수는 생각보다 많아지죠? 검사 등을 통해 어느 부분에 이석증이 생겨 있는 걸 확인하는 것이 치료의 첫걸음입니다.

이후 각각의 경우에 맞는 이석교정술을 시행합니다. 예를 들어 이석이 우측 후반고리관에 들어있다면, 침대에 앉은 상태에서 고개를 우측으로 돌려 눕고, 이후 고개의 방향을 좌측으로 돌려주는 ‘에플리 이석교정술’을 시행하게 됩니다. 쉽게 치료되는 이석증은 한번 치료법을 시행하고 나면 바로 호전이 되고, 치료에 걸리는 시간은 5분도 걸리지 않습니다. 

하지만 간혹 쉽게 치료가 잘 안 되는 이석도 있습니다. 특히 수평 반고리관에 붙어있는 이석증의 경우에는 시간이 오래 걸리고, 환자분이 집에서 이석 자가 재활운동을 해야 하는 경우도 있습니다. 이렇게 하면 치료가 되고, 이후 남아있는 조금의 어지럼증에 대해서는 약물치료를 같이 시행하면 대부분 완쾌가 됩니다.
Q. 이석증은 재발이 잦다고 알고있다. 
이석증은 생각보다 재발이 자주 발생하는 질병으로, 1년에 15%, 10년에 50% 정도에서 재발이 됩니다. 이런 재발은 처음 발생 이후 6개월 안에 가장 많이 생기고 실제 병원에서 진료할 때도 재발하는 환자분을 자주 만나게 됩니다. 이석증의 재발을 막기 위해서 약물 복용, 어지럼증에 대한 전정재활치료, 이석증 발생을 막기 위해 자세를 제한하는 방법은 효과가 없었습니다.

이석증의 재발을 줄이는 방법은 3가지가 있습니다. 첫 번째가 제일 중요한데, 바로 비타민 D의 보충입니다. 이석의 성분인 칼슘을 흡수하는데 비타민 D가 중요한 역할을 하기 때문입니다. 비타민 D가 부족한 경우 이석에서 칼슘 수치가 줄어들고, 이석 또한 불량하고 약해지게 됩니다. 결국, 이러한 이석이 떨어져서 이석증을 일으키게 됩니다. 그러니 재발을 방지하기 위해서는 비타민 D 영양제 복용을 먼저 권합니다.

두 번째 방법은 수면 자세입니다. 수면 시의 자세를 볼 때, 우측으로 자는 분은 우측에 이석증이 잘 생기고, 좌측으로 자는 분은 좌측에 잘 생깁니다. 그래서 이석증을 치료하고 난 뒤에는 이석증이 발생한 방향의 반대편으로 자는 것이 재발 방지에 도움이 됩니다.

세 번째 방법은 적절한 신체 활동과 운동을 하는 겁니다. 적절한 신체 활동을 하지 않는 경우 이석증의 발생 위험이 2.6배 정도 증가하므로, 증상이 발생하고 난 뒤에도 적절한 신체활동과 운동을 하는 것이 재발을 막는 데 도움이 됩니다. 이 3가지 방법이 이석증의 재발을 줄일 수 있는 방법입니다. 자주 이석증이 생기는 경우에는 꼭 시행하기를 추천합니다.
Today, we'll look at vertigo disease and why it occurs, the causes of it, and how to treat it. 

A few years ago, I slept and woke up with Bluetooth earphones attached on my left ear, but I endured nausea accompanied by dizziness and pain in my left ear. I tried to get up without thinking but couldn't. The great pain made me sit down. I felt momentarily unable to collect myself, as if tones of weight had pressed me down. How much time has passed? Has an hour passed? Or was it an hour, like five minutes? Thinking I couldn't stand up, I slowly turned to the right, considering everything had to be balanced, just in case. How much time has passed? Like something being sucked under the snail's tube at a particular moment, ah~ I think I'm okay, right? With that, I felt that the dizziness had disappeared, and I was returning to a clear mind. It took a moment, but it suddenly occurred to me that I could have made a life of a lame man. 

As if I had some terminal illness, I started searching the internet for the cause, and in the end, I found a few sites that explained it most accurately and made this video. Otolithiasis is not an incurable disease, but the simple explanation is that dizziness occurs when a small block of stone in the ear moves out of place for whatever reason. The organ does not move the otoliths that have entered the semicircular canal, although they do not cause dizziness when they are still. When you lie down, get up, or turn your head while lying down, the otoliths in the semicircular canal move and stimulate the function of the semicircular canal. 
For example,  a tube contains water, and a small stone is inside. It is silent without waves when it is still because the stone does not move. However, if the stone rolls sideways as the tube moves, it creates a ripple in the otherwise silent water. In other words, the otoliths contained in the semicircular canal move and waves are generated, and these waves affect the dizziness-related organs located at the end of the semicircular canal, causing dizziness. These waves do not last long but disappear after a short period, so the dizziness caused by urolithiasis does not last long.

Q. I'm curious about the cause of otolithiasis. 

We don't yet know precisely what causes otolithiasis. Known causes of otolithiasis include trauma to the head, prolonged lying position, and inflammation of the inside of the ear. Especially in cases of trauma to the head, otoliths often fall off the otolith organ and enter the semicircular canal. In addition, urolithiasis is more likely to occur when surgery is performed in a hospital and lying down for a long time. 

In addition, otolithiasis is said to be slightly related to high blood pressure, diabetes, hyperlipidemia, and thyroid disease. However, most otolithiasis cases are unexplained, and the cause is unknown. On the other hand, it is associated with low levels of vitamin D, and the incidence of urolithiasis also increases during times of stress or anxiety.

Q. Isn't it difficult to treat otolithiasis? 

The treatment is simple if you know what kind of disease otolithiasis is. The otolith, which has physically entered the semicircular canal, is inserted back into the otolith organ, which is its original place.

The first step in treatment is to determine which part of the otolith is in the semicircular canal. The semicircular canal is present on the right and left sides, respectively, and there are three anterior annular canals, posterior lig canals and horizontal semicircular canals. Smaller otoliths sometimes float in the semicircular canal, while larger otoliths are attached to the middle or end of the semicircular canal. If you think about it this way, the number of cases is higher than you think, right? Confirming that otolithiasis is present in a specific part of the treatment is the first step in treatment.

Afterwards, otolith correction surgery is performed according to each case. For example, if the otolith is in the right posterior ring canal, the patient will lie down with his head turned to the right while sitting on the bed, and then the head will be turned to the left. Otolithiasis, which is easily treated, improves immediately after treatment, and treatment takes less than 5 minutes. 

Sometimes, however, some otoliths are not easily treated. In particular, otolithiasis attached to the horizontal semicircular canal takes a long time, and the patient may need to perform otolith self-rehabilitation exercises at home. This will cure the disease, and if you take medication for any lingering dizziness, you will usually be cured.
Q. I know that otolithiasis often recurs. 

Otolithiasis is a disease that recurs more frequently than expected, with recurrence occurring in about 15% of cases in 1 year and 50% in 10 years. These recurrences arise most often within the first six months, and we usually see patients with relapses when we are actually in the hospital. Medications to prevent the recurrence of urolithiasis, vestibular rehabilitation for dizziness, and posture restriction to prevent urolithiasis were ineffective.

There are three ways to reduce the recurrence of urolithiasis. The first is the most important one: vitamin D supplementation. This is because vitamin D is vital in calcium absorption, a component of otoliths. If vitamin D is deficient, calcium levels in the otoliths will decrease, and the otoliths will also become poor and weak. Eventually, these otoliths will fall off and cause urolithiasis. Therefore, to prevent recurrence, it is recommended that you take vitamin D supplements first.

The second way is the sleeping position. When looking at the sleeping position, those who sleep on the right side are more likely to have urolithiasis on the right side, and those who sleep on the left side are more likely to have urolithiasis on the left side. Therefore, resting on the opposite side of the urolithiasis can help prevent a recurrence after treating urolithiasis.

The third method is to engage in adequate physical activity and exercise. Lack of sufficient physical activity increases the risk of urolithiasis by 2.6 times, so adequate physical activity and exercise after symptoms can help prevent a recurrence. These three methods can reduce the recurrence of urolithiasis. If urolithiasis occurs frequently, it is recommended that it be performed.