August 16, 2019
Ear Canal Infections (Acute Otitis Externa)
Benign Positional Paroxysmal Vertigo (BPPV)
This is a very common cause of dizziness. It is caused by dislodged crystals in your inner ear.
These crystals are usually firmly attached to a part of your inner ear which detects gravity, so that you know what is up or down.
Sometimes these crystals can become dislodged and end up in a part of the inner ear which has “spin” sensors used to detect head turns.
These crystals can then hit the spin sensors in this part of the ear and patients experience a sudden sensation of spinning. It only lasts a few seconds to a minute, but it is quite disturbing. This is the “canalolithiasis” variant of BPPV.
It is provoked by lying down, sitting up in bed, rolling over in bed onto the affected ear, bending over to tie shoe laces and extending the head backwards when reaching up to a shelf above eye level. It is often called “morning vertigo” and is worse just after waking up.
Occasionally these floating crystals can stick to the spin sensors and the patient experiences persistent imbalance rather than short-lived spinning sensations. This is the “cupulolithiasis” variant of BPPV.
Other than dizziness there is no change in hearing or any buzzing in the ears. The dizziness is not usually associated with nausea.
It is often more common in the elderly, people who have had long bed rests, Méniere’s disease, migraine, Head injury, vestibular neuritis and yoga exercises.
Spontaneous resolution usually occurs but in 1/3rd of cases it can take many months.
This reveals a characteristic rapid eye movement when the head is put into specific positions by the doctor.
The characteristic rapid eye movements of the posterior canal BPPV is provoked by the Dix-Hallpike manoeuvre. The characteristic rapid eye movements of the horizontal canal BPPV is provoked by the supine roll manoeuvre. This then determines which therapeutic manoeuvers are used to cure the condition.
Of importance the examination will reveal no abnormality of brain function.
Therapeutic manoeuvers that are used to cure the condition are very effective with up to a 90% success rate. However, 50% of patients will get another attack in the next 10 years.
The specific manoeuvers are as follows:-
Posterior canal canalolithiasis is treated with either Epley’s, Semont’s or Semont’s Plus manoeuvers.
Horizontal canal canalolithiasis is treated with the Gufoni manoeuvre.
Patients with the rare more difficult to treat cupulolithiasis variant are treated with Brandt-Daroff exercises to convert them to the much more treatable condition of canalolithiasis.