“If the dizziness cannot be relieved with the conservative medical approach, surgery may be recommended to help alleviate the symptoms. There are 3 commonly accepted procedures to accomplish this:

1. Posterior semicircular canal plugging procedure
2. Singular nerve removal
3. Vestibular nerve clipping

Posterior semicircular occlusion has been adapted and utilized at the Michigan Ear Institute with great success. Only a small portion of the people with BPPV are even considered for this surgery, but because the success of this procedure at the Michigan Ear Institute has been excellent, it is an appropriate possibility for those who may require it.”

Michigan Ear Institute (https://michiganear.com/posts/bppv-fact-sheet/)

“BPPV with the most common variant (crystals in the posterior SCC) can be treated successfully — with no tests, pills, surgery or special equipment — by using the Epley maneuver.  If some situations pills may be ordered (Ex. antivert)”

John Hopkins Medicine

(https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv)

Reassurance and avoidance of the provocating position. Antivertigo drugs: prochlorperazine (stemetil), Cinnarzine (stugeron) and Betahistine (Serc). Surgical: Posterior semicircular canal denervation.

TREATMENT

In all cases the doctor first has the patient (pt.) in their office and either through them or through physical therapy ordered by the M.D. after evaluating the pt with diagnosing the pt. with BPPV in treating the pt. using exercises which help in high percentages resolving the vertigo but continuing them when the vertigo is gone will do very little help unfortunately including it commonly comes back several weeks to months later and the exercises help more than. These exercises used are:

OFFICE TREATMENT OF BPPV: The Epley and Semont Maneuvers

There are two treatments of BPPV that are usually performed in the doctor’s office. Both treatments are very effective, with roughly an 80% cure rate, ( Herdman et al, 1993; Helminski et al, 2010). If your doctor is unfamiliar with these treatments, you can find a list of clinicians who have indicated that they are familiar with the maneuver from the Vestibular Disorders Association (VEDA) .

The maneuvers, named after their inventors, are both intended to move debris or “ear rocks” out of the sensitive part of the ear (posterior canal) to a less sensitive location. Each maneuver takes about 15 minutes to complete. The Semont maneuver (also called the “liberatory” maneuver) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other (Levrat et al, 2003). It is a brisk maneuver that is not currently favored in the United States, but it is 90% effective after 4 treatment sessions. In our opinion, it is equivalent to the Epley maneuver as the head orientation with respect to gravity is very similar, omitting only ‘C’ from the figure to the right.

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure. It was invented by Dr. John Epley.  It involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds. The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary.

When performing the Epley maneuver, caution is advised should neurological symptoms (for example, weakness, numbness, visual changes other than vertigo) occur. Occasionally such symptoms are caused by compression of the vertebral arteries (Sakaguchi et al, 2003), and if one persists for a long time, a stroke could occur. If the exercises are being performed without medical supervision, we advise stopping the exercises and consulting a physician. If the exercises are being supervised, given that the diagnosis of BPPV is well established, in most cases we modify the maneuver so that the positions are attained with body movements rather than head movements.

After either of these maneuvers, you should be prepared to follow the instructions of your doctor or physical therapist who should give you written instructions on them to take home with you, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear. Not always the case.

       What to expect from your doctor on your visit with vertigo

A doctor who sees you for symptoms common to BPPV may ask a number of questions, such as:

• What are your symptoms, and when did you first notice them?
• Do your symptoms come and go? How often?
• How long do your symptoms last?
• Is one or both of your ears affected?
• Does anything in particular seem to trigger your symptoms, such as certain types of movement or activity?
• Do your symptoms include vision problems?
• Do your symptoms include nausea or vomiting?
• Do your symptoms include headache?
• Have you lost any hearing?
• Have you had any weakness, numbness or tingling in your arms or your legs?
• Have you had any difficulty talking or walking?
• Have you had chest pain?
• Are you being treated for any other medical conditions?
• What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?

Need assistance in where to go for help treatment on surgery in the hospitat for benign posterior paroxysmal vertigo?  Than tune in tomorrow to Part IV.

“The signs and symptoms of BPPV can come and go and commonly last less than one minute. Episodes of BPPV can disappear for some time and then recur. Symptoms varying from dizziness, unsteadiness, nausea, vomiting, and a sense of feeling everything around you is spinning. Often, there’s no known cause for BPPV. This is called idiopathic BPPV. Although BPPV is uncomfortable, it rarely causes complications. The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055)

Causes of BPPV:

Timothy C. Hain MD of dizziness and balance.com states The most common cause of BPPV in people under age 50 is head injury . The head injury need not be that direct – -even whiplash injuries have a substantial incidence of BPPV (Dispenza et al, 2011). There is also a strong association with migraine (Ishiyama et al, 2000). BPPV becomes much more common with advancing age (Froeling et al, 1991) and in older people, the most common cause is degeneration of the vestibular system of the inner ear. Viruses affecting the ear such as those causing vestibular neuritis and Meniere’s disease are significant causes(Batatsouras et al, 2012).

Occasionally BPPV follows surgery, including dental work, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear (Atacan et al 2001). While gentamicin toxicity is rarely encountered, BPPV is common in persons who have been treated with ototoxic medications such as gentamicin (Black et al, 2004). In half of all cases, BPPV is called “idiopathic,” which means it occurs for no known reason. Other causes of positional symptoms are discussed here.

Web MD points out tiny calcium “stones” inside your inner ear canals help you keep your balance. Normally when you move a certain way, such as when you stand up or turn your head, these stones move around. But things like infection or inflammation can stop the stones from moving as they should. This unfortunately sends a false message to your brain and causes the vertigo. About half the time, doctors can’t find a specific cause for BPPV.

When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back. BPPV also has been associated with migraines. In many cases the doctors can’t figure out the cause.

Know The ear’s role

Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.

Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head’s position related to gravity. These otolith organs — the utricle and saccule — contain crystals that make you sensitive to gravity.

For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you’re lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy. Depending what section of the semicircular canal the problem is in will be a factor with the actual result on the crystals or rocks flowing freely or become stuck together causing a blockage in one of the canals. The other factor that determines this is the etiology for it occuring (ex. Dehydration or blow to the head).

Complications of BPPV:

Benign paroxysmal positional vertigo occurs most often in people age 60 and older, but can occur at any age. Aside from aging, there are no definite factors that may increase your risk of benign paroxysmal positional vertigo. However, a head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.

Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. In rare cases, if severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration. The dizziness of BPPV can put you at greater risk of falling. It is more of a headache in going through the time to resolve the vertigo possibly affecting people in doing their regular activities of living for a week to several weeks. For some it never comes back but for many it does after several months depending on what the cause is.

“In general; Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder. A person with BPPV experiences a sudden spinning sensation whenever they move their head. BPPV isn’t a sign of a serious problem. If it doesn’t disappear on its own within six weeks, a simple in-office procedure can help ease your symptoms.”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv)

“Mal de débarquement syndrome (MdDS) — which means, “sickness of disembarkation” — is a rare condition that makes you feel like you’re moving, even when you’re not. “Disembarkation” is a word to describe getting off of a boat or aircraft. This can cause a change in your stability or balance.

MdDS commonly occurs after boating or sea travel, though it can happen after air travel, extended land travel and even sleeping on water beds. In some cases, MdDS can occur after non-motion events (like surgery or childbirth), or for no known reason (spontaneous mal de débarquement syndrome).”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/24796-mal-de-debarquement-syndrome-mdds)

woman feeling rocking dizziness from mal de debarquement after cruise ship vacation

Mal de debarquement (MDD) is a rare and poorly understood disorder of the vestibular system that results in a phantom perception of self- motion typically described as rocking, bobbing or swaying. The symptoms tend to be exacerbated when a patient is not moving, for example, when sleeping or standing still.

When you head out to sea on a cruise ship, your brain and body have to get used to the constant motion. It’s called “getting your sea legs,” and it keeps you from crashing into a wall every time the ship bobs up or down.

When you get back on shore, you need time to get your land legs back. That usually happens within a few minutes or hours, but it can take up to 2 days. With mal de debarquement syndrome, though, you can’t shake the feeling that you’re still on the boat. That’s French for “sickness of disembarkment.” You feel like you’re rocking or swaying even though you’re not.

It can happen to anyone, but it’s much more common in women ages 30 to 60. It’s not clear if hormones play a role.

People who get migraines may be more likely to get it, too, but doctors aren’t sure how the two conditions are linked.

What Are the Symptoms?

Mainly, you feel like you’re rocking, swaying, or bobbing when there’s no reason for it. You might feel unsteady and even stagger a bit.

Other symptoms include:

• Anxiety
• Confusion
• Depression
• Feeling very tired
• Having a hard time focusing
• Nausea

Your symptoms may go away when you ride in a car or train, but they’ll come back when you stop moving. And they can get worse with:

• Being in a closed-in space
• Fast movement
• Flickering lights
• Stress
• Tiredness
• Trying to be still, like when you’re going to sleep
• Intense visual activity, like playing video games

What Causes It?

It happens most often after you’ve been out on the ocean, but riding in planes, trains, and cars can lead to it, too. It’s even been caused by water beds, elevators, walking on docks, and using virtual reality.

While almost any kind of motion can cause it, doctors don’t know what’s really behind it. In most cases, you get it after a longer trip. But there’s no tie between the length of your trip and how bad the symptoms are or how long they last.

In trying to diagnose this condition through ruling out other problems since no one test diagnoses this condition.  It’s a rare condition, so it may take a few visits to figure it out. Your doctor probably will want to rule out other causes for your symptoms with things like:

Some Facts on Blood:

“01 Up to 3 lives are saved by one pint of donated blood.
02. Between 8-12 pints of blood are in the body of an average adult.
03. One unit of blood is ~525 mL, which is roughly the equivalent of one pint.
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05. The average transfusion patient receives 3 units of red blood cells.
06. A, B, AB and O are the four main types of blood types. AB is the universal recipient, O negative is the universal donor.
07. Blood centers often run short of types O and B blood.“

70 Rock River Valley Blood Center (Saving lives 70 years.) – (https://www.rrvbc.org/)

“Everyone deserves the opportunity to lead a full and healthy life. Sadly, systemic issues contribute to health disparities, including for those facing lung cancer. Individuals of color who are diagnosed with lung cancer face worse outcomes compared to white individuals living in America because they are less likely to be diagnosed early, less likely to receive surgical treatment, and more likely to not receive any treatment. Close to two-thirds of the 28 million uninsured people living in America are people of color, and research is clear that having health coverage impacts people’s medical care and ultimately their health outcomes. Addressing racial disparities in healthcare coverage is critical to addressing racial disparities in lung cancer care. Black individuals with lung cancer were 15% less likely to be diagnosed early, 19% less likely to receive surgical treatment, 11% more likely to not receive any treatment, and 16% less likely to survive five years compared to white individuals.”                                                                                        American Lung Association (https://www.lung.org/research/state-of-lung-cancer/racial-and-ethnic-disparities)