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10.01.2014
Benign positional vertigo (BPV) is a relatively common condition which is characterized by episodes of severe spinning (vertigo) associated with turning the head.
The treatment for this type of dizziness is a physical maneuver which can easily be done in the office. The balance system in the ear is called the vestibular system and it consists of the semicircular canals which have the nerve endings of the nerve of balance. Meniere's Disease (MD) is characterized by hearing loss, ringing in the ear, and episodes of severe dizziness often with nausea and vomiting. Treatment of MD is directed primarily at controlling the episodes of dizziness which can be debilitating.
Treatment includes antibiotics to treat the infection and in some cases allergy treatment to reduce Eustachian Tube swelling and help with drainage.
In some cases the bacteria can be eliminated but the fluid remains causing a persistent hearing loss.
In some situations the acute infection may resolve, but continue to recur despite medical therapy. In some cases these infections are recurrent or chronic and require other treatments and medications. The medical diagnosis of 'SUDDEN HEARING LOSS' is a hearing loss due to inflammation of the nerve of hearing (viral infection is the most accepted theory).
Calcium crystals floating in the inner ear fluid stimulate the nerve of balance and stimulate dizziness.


In some cases the pattern of symptoms suggests a specific cause and this provides a starting point for the evaluation.
MD is a chronic condition which is managed like other chronic conditions such as asthma or arthritis. People can have one episode every few years or frequent episodes several times a week or month. Bacterial or viral infection sometimes in association with allergy leads to an accumulation of fluid in the middle ear space behind the ear drum (see ear diagram). In these cases the fluid is drained by placing a ventilation tube (or pressure equalization tube, PE tube) through the ear drum with a brief surgical procedure. This is an emergency requiring immediate treatment in order to maximize the chance of regaining hearing.
The dizziness can be controlled with medications until the virus has passed through the system. This triggers both the nerve of hearing and the nerve of balance leading to the typical symptoms. There are medications or treatments taken on a regular maintenance basis and there are other medications or treatments for acute flare ups. Normally this fluid would drain through the Eustachian Tube into the nose but with an infection the drainage tube may be blocked. Placement of a ventilation tube creates an alternative pathway and helps control the infections.


If that hole is plugged by water or shifting wax, the patient experiences a 'sudden hearing loss'. The noises range from infrequent and inconsequential to continuous and disruptive during the day and night. The sense of balance is also affected by vision, special sensory nerves in the muscles and joints, blood pressure and circulation, and some hormones in the blood.
In some instances the heart, blood vessels, and brain may also need evaluation by the appropriate specialists. If pressure builds up in the middle ear because of Eustachian tube dysfunction or infected fluid that can also cause a 'sudden hearing loss'.
The vestibular system is based on symmetry; the input from each nerve of balance has to be coordinated with the other. When one nerve has a viral inflammation it begins to send signals to the brain out of sync with the other ear. These signals tell the brain you are moving when you are not actually moving, resulting in the sensation of spinning known as vertigo.



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