Department of Otolaryngology, Peking Union Medical College Hospital
Motion Sickness (MS), also known asmotion sickness, carsickness, seasicknessAirsicknessCosmic motion sickness is a series of physiological reactions caused by various factors that lead to the human body's wrong perception of motion state.
The causes of motion sickness are complex, mainly due tovestibule. It is caused by the conflict between the information of vision and its own perception system, which is common when taking a ship, car, aircraft or other means of transportation.Among them, there are sensory conflict theory, nerve mismatch theory, vestibular organ hypersensitivity theory, hemodynamic change theory, neurotransmitter hypothesis, otolith weightlessness hypothesis.Pregnant women, children, migraine patients, environmental stimuli, diseases that change vestibular or visual sensory information, and other factors can also induce motion sickness.Motion sickness patients are mainly characterized by dizziness, headache, nausea, vomiting, epigastric discomfort, pale face, cold sweat, etc. The symptoms usually ease or disappear after stopping taking transportation, which does not constitute a life threat.The symptoms of motion sickness patients can be divided into mild, moderate and severe. In severe cases, severe dizziness, vomiting, nausea, panic, chest tightness, cold limbs, dehydrationdyspnea、Unresponsive、Near death feeling, coma, etc.
The treatment of motion sickness is mainly to get rid of the pathogenic movement environment and drug treatment.If the symptoms are not relieved after general treatment, drug treatment can be considered, including the use ofAntihistamine、Anticholinergic drug、Calcium channel blockerDopamine receptor antagonists.In addition, there are surgical treatment, traditional Chinese medicine treatment and other treatment methods to reduce the impact of diseases on patients' daily life and work.The ways to prevent motion sickness include avoiding pathogenic sports environment, carrying out adaptive training and balance function training.
The latest research progress mainly includes pathogenesis, prevention and treatment methods, and individual differences.With the further study of motion sickness, people can better understand the disease and develop more effective means of prevention and treatment.
Motion sickness is common in people between 3 and 20 years old, and rarely occurs in infants under 2 years old.
pathogeny
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The human brain mainly relies on vestibule, vision and its own sensory system to feel and control balance. When these information conflicts, motion sickness will occur.
Pathogenesis
The human brain mainly relies on vestibule, vision and its own sensory system to feel and control balance.
There are vestibular tip receptors in the inner ear of the human body, which are mainly composed of three semicircular canals, sacs, and ellipses. The sacs and ellipses are collectively called otoliths, and are mainly used to sense various positions and speeds of the human body.When the movement command of the human brain is inconsistent with the sensory feedback, there will be conflicts and motion sickness will occur.
For example, when a person is on a ship and his eyes see that the cabin is relatively still, his visual system will transmit static information to the brain, but his vestibular system will feel that the ship is shaking, so it will transmit movement information to the brain, so the brain will receive a burst signal, which will cause dizziness, nausea and other symptoms of motion sickness.
At present, experts mainly have the following theories on the pathogenesis of motion sickness:
Sensory conflict theory
Three dimensional spatial orientation is based on four sensory inputs:
Sense the otolith information of gravity and linear acceleration;
Semicircular canal information of sensory angular acceleration;
Visual information;
Ontological perception information.
When some specific movement conditions, such as traveling by car or boat, the information of these receptors conflicts, leading to motion sickness.
Neural mismatch theory
The information of the human body's motion balance system does not match the experience information stored in the brain.For example, when an astronaut first enters the universe, he often has motion sickness, because the balance information he feels in the universe is not consistent with the previous information in his brain due to the environment in the universe. Similarly, when he flies back to the earth, he is also prone to suffer from motion sickness.
Theory of hypersensitivity of vestibular organs
When the patient is on a boat, plane, car or other means of transportation, due to strong stimulation such as too fast acceleration and sudden deceleration, the vestibular end receptor changes, resulting in motion sickness symptoms.
Theory of hemodynamic changes
When the vestibular organs of the human body are stimulated, the nerve center will be disordered, which will lead to changes in blood and oxygen supply in the brain and the occurrence of motion sickness.
Neurotransmitter hypothesis
Some experts believe that the disease is a stress reaction of the central nervous system, mainly due to the imbalance of some neurotransmitters, such as norepinephrine, 5-hydroxytryptamine, acetylcholine, etc.
Otolith weightlessness hypothesis
Some people have different sensory abilities due to the different thickness and weight of the bilateral otolith membrane. When the spacecraft takes off, the bilateral otolith receptors cause motion sickness due to the asymmetric information transmitted to the brain.
Predisposing factors
Women, especially pregnant women, are prone to this disease, which may be related to pregnancy hormones.
Research shows that children around 12 years old have a higher incidence.
In patients with migraine, studies have shown that it may be related to the trigeminal nervous system.
Some directions of motion, such as a study of passengers traveling by plane, show that the amplitude of low-frequency horizontal and vertical motion is related to motion sickness.
Environmental stimulation, high temperature, high humidity and narrow space are easy to induce motion sickness.
Diseases that change vestibular or visual sensory information (such as labyrinthitis), and diseases that increase brain sensitivity to sensory stimuli (such as migraine) are related to the onset of motion sickness.
Psychosocial factors – expectations and other psychological factors may affect the risk of motion sickness.
symptom
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The main manifestations of patients aredizzy、headache、nausea、vomit、PaleEtc.When the symptoms are serious, symptoms such as vomiting, panic and cold limbs may occur.
When the patient takes a boat, plane, car and other means of transportation, the main symptoms are dizziness, headache, nausea, vomiting, pale face, etc. The symptoms are often relieved or even disappeared within ten minutes or several hours after stopping exercise.
The symptoms of motion sickness patients can be divided into mild, moderate and severe according to the severity of their symptoms.
Mild: mild dizziness, headache, slight nausea, pale complexion, increased drooling, lethargy, etc.
Moderate: dizziness, headache, nausea, vomiting, pale face, cold sweat, etc.
Severe: severe dizziness, nausea, panic, chest tightness, cold sweat, severe vomiting, cold limbs, dehydration, dyspnea, slow reaction, near death, coma, etc.
Medical treatment
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When the patient has severe dizziness, vomiting, dehydration, coma, continuous drop in blood pressure and other symptoms after taking a vehicle, he should seek medical advice in time.
Diagnostic criteria for motion sickness: the patient may be diagnosed with dizziness, headache, nausea, vomiting, pale face, cold sweat and other symptoms when taking a ship, plane, car and other means of transportation, including astronauts taking a spacecraft.If the patient has a history of motion sickness, it is more helpful for diagnosis.
Visiting department
Otolaryngology
Relevant inspection
The doctor may ask the following questions during the visit:
What are the symptoms?Under what circumstances?
Under what circumstances will the discomfort be relieved or improved?
Have you had similar symptoms before?
Motion sickness itself is an acute course, and its symptoms will be alleviated or disappeared after stopping taking transportation.The doctor makes a comprehensive diagnosis based on the patient's symptoms, past medical history and other relevant examination results.
Physician physical examination
The doctor will conduct a comprehensive physical examination, especially in the ear, nasal cavity and other parts, to rule out whether there is local infection.
laboratory examination
There is no special laboratory examination to assist in the diagnosis of this disease, but if it needs to be differentiated from other diseases that cause nausea and vomiting, relevant laboratory examinations need to be carried out.
Imaging examination
The doctor will perform CT, magnetic resonance imaging (MRI), electrocardiogram, etc. according to the patient's condition to differentiate and diagnose motion sickness and other diseases that cause dizziness, vomiting and other symptoms.
Special inspection
Vestibular function examination: including upright toppling test, standing step test, neck twisting test, cold and hot test, positional nystagmus test, electronystagmography, balance posturography, etc.
It is used to further understand the vestibular function of patients, which is beneficial for doctors to master the severity of patients' diseases and guide treatment.
differential diagnosis
This disease must be differentiated from other diseases that cause dizziness, nausea and other similar motion sickness symptoms. The doctor will make a detailed examination from many aspects to judge.It is often differentiated from the following diseases.
Meniere disease
Meniere's disease, also known as Meniere's disease, is an idiopathic disease of the inner ear, which is characterized by recurrent vertigo, hearing loss, tinnitus and a sense of stuffiness and distension of the ear.This disease is mostly seen in young and middle-aged people aged 30 to 50 years, and rarely seen in children. CT examination of temporal bone can show vestibular aqueduct stenosis.
Benign paroxysmal positional vertigo
The most common clinical peripheral vestibular vertigo is mainly related to the position change of the head. After rotating the head position, special positional vertigo and nystagmus are induced. Usually, it is relieved after a rest with eyes closed and aggravated after rotating the head, with the characteristics of self limitation and recurrent attacks
Vestibular neuritis
A sudden vertigo disease caused by vestibular neuron damage. Generally, patients have a history of upper respiratory tract virus infection about two weeks before the onset.
The main symptoms are dizziness and spontaneous nystagmus. In severe cases, nausea and vomiting are accompanied, but there is no tinnitus or deafness. The symptoms of the patient are usually gradually relieved within a few days, and generally can be completely recovered within two weeks.
treatment
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At present, motion sickness treatment is mainly based on the movement environment and drug treatment.
Drug therapy mainly includes antihistamines, anticholinergics, calcium channel blockers, dopamine receptor antagonists, etc.
Acute treatment
In case of severe dizziness, nausea, vomiting, cold sweat, etc., the patient should get out of the sports environment that causes the disease in time. If getting off the bus, find a well ventilated place to lie down and rest. If the symptoms continue to be unrelieved, seek medical advice in time.
General treatment
When the patient has motion sickness symptoms, some things can be done to alleviate the symptoms, such as:
Stop reading books, mobile phones and other behaviors, and focus on looking at the horizon or distant static objects.
Try to lean on the seat back and keep your head still. It is best to lie flat and close your eyes if conditions permit.
Maintain air circulation.
Adjust position: ask whether it is allowed to change position.For example, in front of or in the middle of the ship near the water level;In an airplane, on the leading edge of the wing;Take the train and sit forward near the window at the front;Take a car, drive or sit in the front passenger's seat.
If the symptoms remain unrelieved, consider medication.
medication
Due to large individual differences, there is no absolute best, fastest, and most effective drug use. In addition to commonly used over-the-counter drugs, the most appropriate drugs should be selected under the guidance of doctors and fully combined with personal conditions.
The following treatment plans and drugs are recommended to be used under the guidance of doctors after comprehensive evaluation by doctors.
Commonly used drugs include: theophylline tablets, diphenhydramine, promethazine, chlorphenamine, etc.
Diphenhydramine has a strong anti halo and anti emetic effect. It is generally taken 1~2 hours before travel to prevent motion sickness.The duration is short, about 4-6 hours, and it is not suitable for long-distance travel.
Tephenhydramine is a compound of diphenhydramine and aminophylline, which is the most commonly used anti halo drug at present, and can last for 8 hours.
Promethazine acts for about 6~12 hours. Within 1~2 days after taking the medicine, the patients who take the medicine appear obvious drowsiness, fatigue and inattention.
Common adverse reactions include drowsiness, blurred vision, dry mouth, and the elderly may have vague consciousness and urinary retention.
It is a relatively safe anti dizziness drug with less central adverse reactions, such as somnolence.
Cinnarizine can enhance cerebral blood supply and improve the tolerance to vestibular stimulation.
Dopamine receptor antagonists
Common drugs are domperidone.
It can promote gastrointestinal emptying, reduce neural activity of vomiting center, and inhibit nausea and vomiting.
This drug is not easy to cause nerve and mental adverse reactions such as extrapyramidal system, and common adverse reactions such as diarrhea and rash.
surgical treatment
Some patients' conditions seriously affect daily life workers, and doctors may choose vestibular neurotomy and other surgical treatments according to the situation.
TCM treatment
In traditional Chinese medicine, motion sickness is often classified as "vertigo", which refers to the upwardness of stomach qi and is closely related to the liver, spleen and kidney.
Traditional Chinese medicine treatment
At present, Xiaobanxia Decoction and Huoxiang Zhengqi Liquid are commonly used to treat motion sickness.Research shows that ginger is one of the "most ideal" natural drugs to alleviate motion sickness, which can alleviate the dizziness, nausea and vomiting symptoms of most patients, lasting for 4 hours, and has excellent effect on preventing seasickness without adverse reactions.
Acupuncture and moxibustion treatment
Frequently takenBaihui、Sishencong、Neiguan、Zusanli、HeguTo invigorate the spleen and refresh the brain.At present, some experts and scholars have studied and confirmed that massaging Banmen acupoints before or while taking a vehicle can prevent carsickness.
Other treatments
Some studies believe that the occurrence of dizziness and other symptoms can be prevented by smearing essential balm on the temples or Fengchi points when taking a vehicle.
prognosis
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Usually, patients can effectively relieve or disappear symptoms by getting rid of the pathogenic sports environment, that is, by stopping taking transportation.
daily
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The daily life management of motion sickness focuses on avoiding stimulation induced vertigo by reducing the number of vehicles. The disease can be prevented by drugs or training.
Daily life management
Try to reduce the number of vehicles that can induce disease attacks and avoid stimulationvertigo；
When traveling, avoid sitting in the back seat of the vehicle or the seat facing back.When taking a boat, hang it in front of or in the middle near the water level;When flying, try to sit on the leading edge of the wing;Take the train and sit forward near the window at the front;Take a car, drive or sit in the front passenger's seat.
Try to avoid reading books, playing with mobile phones and other behaviors in the process of taking transportation.
Do not smoke or sit near smokers.
Avoid strong smell, spicy and greasy food and alcohol.
Under the guidance of doctors, take medicine at least 30 to 60 minutes before travel to prevent motion sickness.
prevention
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Generally speaking, the best way to prevent motion sickness is to get rid of the pathogenic sports environment, that is, stop taking the natural therapy of transportation.
In real life, people can't do without taking various means of transportation, so they need to take medicine to prevent motion sickness.In addition, motion sickness can be prevented through adaptive training, balance training and other methods.
Adaptive training
By allowing the motion sickness patient to ride the vehicle that causes the disease repeatedly, the body of the patient will gradually adapt to this movement environment, so as to prevent or reduce the symptoms of the disease.
Balance function training
At present, this method is mainly used to train military personnel and astronauts abroad.
Research progress
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In 2020, Hu Zhen, Wang Jianhong, Long Ying, etc《Otolaryngology Head and Neck Surgery in China》Published research, analyzed the vestibular function test results of motion sickness patients, and evaluated the characteristics of peripheral vestibular function of patients.There was no statistical difference in the proportion of abnormal vestibular function between motion sickness patients and normal people, but the average slow phase angular velocity of cold and hot tests in motion sickness patients was higher than that in normal people. Considering that the vestibular sensitivity of patients might be higher than that in normal people.
In 2020, Wei Xiangbo《China's urban and rural enterprise health》A study was published, in which 40 patients were selected, and the total effective rate of the treatment group was significantly higher than that of the control group without treatment by continuously pressing bilateral Neiguan points for 2 minutes.The TCM treatment effect of pressing Neiguan point on motion sickness is obvious, which can alleviate the trouble of motion sickness patients to a certain extent.
In 2024, a study will《Progress in laser and optoelectronics》Published that, for the first time, systematic experimental methods were used to analyze physiological data and experimental questionnaire data such as balance and blinking from the perspective of combining subjective and objective, to compare the impact of different levels of spatial distortion on visual induced motion sickness, so as to verify the conclusion that virtual space distortion caused by mismatch between acquisition parameters and perception parameters enhances visual induced motion sickness.
