Remember how we learned about the mechanoreceptors in the cochlea that pick up waves in the inner ear and transmit that movement to the brain as sound? Well, the other half of the inner ear has a portion called the utricle and saccule, which also have mechanoreceptors. These receptors are connected to tiny calcium particles called otoliths, which move and float in the fluid filling the inner ear, giving the mechanoreceptors information about which way down is and which direction we are accelerating in.
How can this go wrong? Sometimes, the otoliths detach from the otolithic membrane that they normally sit on and float off to different corners of the inner ear. This triggers a local mechanoreceptor and starts telling the brain that the body is moving even when it's not. The resulting clash between visual input and inner ear input causes intense disorientation and sometimes vomiting.
So how do you fix it? Enter the Epley Maneuver, a shockingly simple technique that helps to dislodge the stuck otoconia and return them to their correct location. A 1999 study in which the maneuver was tested on 107 patients with BPPV showed a 93.4% success rate as long as the patient wore a soft collar for the week following to prevent further disruption of the otoliths.
How do you do it? Look no farther than this helpful youtube video (treatment begins at 02:00).
The rule of thumb for most things that if a treatment sounds too good to be true, it usually is, but it's always nice to find an exception.
Enjoyed the video, what an awesome simple treatment!
ReplyDeleteI was thinking, this is such an easy treatment patients could this at home! Then I thought, what if I designed a device that could help patients do the treatment at home, and market that device to the otorhinolaryngology community to become the capitalistic emperor of vertigo. Unfortunately, looks like someone beat me to that throne. Enter the DizzyFIX hat: https://youtu.be/tphLdaNgfTo
It's a ball cap with a plastic fluid filled tube that contains a small ball. $201.00 (and sold out, mind you) on armydeals.com. This inventor must be making a killing! I'm no monster, I would have sold it far cheaper! Anyway, you wear the cap and lean back and tilt your head to guide the ball through the tube which simulates the correct movements of the Epley Maneuver at the correct times. Pretty neat, only thing is I suppose the patients might not know that if it doesn't work on one side they need to try the other according to the doctors in your video. I hope that comes with the instructions of the DizzyFIX. (Mine would've).
I was also curious about the Nystagmus the doctors in your video mentioned, and found out its a way to diagnosis what the patient is experiencing is in fact BPPV. The semilunar canals firing action potentials tells the eye muscles (CN III) to adjust to accelerated movement (Saladin, Kenneth, 2012). Thus, with the presence of nystagmus when the patient is not accelerating, we have BPPV.
Citations:
1. Saladin, Kenneth (2012). Anatomy and Physiology: The Unity of Form and Function. New York: McGraw-Hill. pp. 597–609. ISBN 978-0-07-337825-1.
This past summer, I was able to shadow several Internal Medicine doctors at the East Denver Kaiser Permanente offices. I remember one week in particular when the doctor I was shadowing saw several patients who were experiencing dizziness and vertigo. And the doctor (who is awesome, by the way) definitely used this Epley Maneuver to help his patients with their symptoms. I also remember watching the patients’ eyes for nystagmus. Nystagmus is the jerky and involuntary movements of the eyes that occurs when a patient has BPPV. It was pretty cool for me to see (not so cool for the patient who has vertigo, of course).
ReplyDeleteAfter reading this blog post and researching what might cause vertigo, I came across an article called “An Approach to Vertigo in General Practice.” The article outlines what vertigo is, what physical examinations can be performed to identify vertigo, what can cause vertigo, and how vertigo can be treated. The most common causes of vertigo, according to the article, are BPPV, VN (Vestibular Neuronitis), acute labyrinthitis, and Meniere’s disease. BPPV is most common and is caused by an accumulation of calcium crystals in the posterior semicircular canal of the ear that affect the movement of endolymph (the fluid in the ear) in the canal. Acute labyrinthitis is the inflammation of the membranous labyrinth in the inner ear, which can cause vertigo and hearing loss. VN is caused by the inflammation of the vestibular nerve, which can cause acute onset vertigo. Meniere’s disease, while fairly uncommon compared to the others listed, can be caused by an increase in endolymph fluid in the cochlea, which can affect the semicircular canals and cause vertigo.
The article is short and sweet, and has a diagram/flow chart that outlines an approach to assessing vertigo and its probable causes. I would encourage you all to take a look – it is easy to read and fun! Here is a link to the article: https://www.racgp.org.au/download/Documents/AFP/2016/April/AFP-Clinical-Dommaraju.pdf
References:
Dommaraju, S., Perera, E. (2016). An Approach to Vertigo in General Practice. American Family Physician, 45(4), pp. 190-194.