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Author: admin | 13.02.2015 | Category: Relieve Tinnitus

Benign Paroxysmal Positional Vertigo (BPPV) is an inner ear problem that results in short lasting, but severe, room-spinning vertigo. There is no new hearing loss or severe ringing associated with these attacks, which helps to distinguish BPPV from other inner ear conditions.
The external ear consists of the part of the ear you can see (the auricle) and the ear canal.
The inner ear also contains 3 semicircular canals which are responsible, in part, for sensing movement and maintaining balance. It has been discovered that the probable cause of BPPV is dislodgement of small calcium carbonate crystals that float through the inner ear fluid and strike against sensitive nerve endings (the cupula) within the balance apparatus at the end of each semicircular canal (the ampulla).
These crystals, known as otoconia, usually dissolve or fall back into the vestibule within several weeks, and no longer cause any symptoms. Interestingly, the loose otoconia tend to settle preferentially within the posterior semicircular canal. The most important means for diagnosing this condition is the physical examination and history of the patient. Once tests have confirmed the diagnosis of BPPV and the affected ear, patients are instructed to avoid lying down on the affected side.
Recently, researchers have found that a simple and well-tolerated physical therapy technique performed in the office can relieve the vertigo in a high percentage of patients. Watch the animation and notice that as the patient is moved into the various positions of the maneuver, the posterior semicircular canal is rotated in such a way as to deposit the displaced otoconia back into the vestibule where they can do no further harm. Rarely, when time and the otolith repositioning techniques have failed, severe cases may eventually require surgical intervention.
A tiny branch of the balance nerve travels through a bony canal before it reaches the nerve endings of the balance canal. This is a recently developed procedure that has nearly replaced the singular neurectomy due to its ease and effectiveness. Most patients will be somewhat dizzy the first night after this surgery, so a one-night hospital stay is advised. In some cases, when positional vertigo is quite severe and hearing is still normal, testing reveals that this is not due to crystalline debris floating in the canal, but due to a severely damaged balance nerve.
Information should be considered advisory in nature, and not intended to be a substitution for evaluation and treatment by a licensed medical physician. Just click the button below to get started, it takes less than 5 minutes to register and be online. We provide you with a full web hosting account and the latest versions of PHP, MySQL, and cPanel. Sign up for free from our main website, no strings attached, no billing information needed.
Please use newer version of your browser or visit Internet Explorer 6 countdown page for more information. One of these chambers, the cochlea, is responsible for converting sound vibrations into nerve impulses. As you can see, these 3 canals (named anterior, lateral, and posterior) are oriented at roughly right angles to one another.
However, in some patients, these crystals become trapped in the fluid of the balance chamber and periodically cause symptoms, as gravity and head movements cause them to repeatedly strike against the cupula.


As you can imagine from looking at the illustration above, this is because the posterior canal hangs down like the water trap in a drain pipe, allowing the crystals to settle in the bottom of the canal. A patient with dizziness or vertigo without hearing problems suggests the diagnosis of BPPV.
Usually, medications like Antivert (meclizine), Dramamine, Valium, or Phenergan are not recommended because they cause sedation.
The Otolith Repositioning Procedure of Semont and Epley has become well accepted and is based on using gravity to move the crystals away from the nerve endings into an area of the inner ear that won’t cause any problems. The goal of this surgery is to expose the canal through the ear and to cut this tiny nerve.
Risks include hearing loss, tinnitus, facial nerve weakness, spinal fluid leakage, and meningitis. If dizziness does not disappear over time with medication or with the physical therapy techniques described above, surgical therapy may be an option and should be discussed with your physician. Boyle's law describes how the volume of the gas decreases when pressure increases, if the amount (mass) of gas and the temperature remain the same.
The movement of the fluid within these canals allows the brain to sense rotation of the head through all three directions in space (e.g. Then the examiner brings the patient’s head down over the edge of the table and turns the head to one side. By carefully avoiding the provocative position, patients can usually avoid bringing about the symptoms. Following the maneuver, patients must not lie flat for 48 hours, meaning they should sleep in a recliner or propped up on pillows.
After this is done, if the crystals strike the nerve endings, the patient has no symptoms because this information no longer reaches the brain.
The balance center is then uncovered and the posterior semicircular canal is opened, exposing the delicate membranous channel in which the crystalline debris is floating. Instead, the entire balance nerve is cut to prevent its distorted information from reaching the brain. Although rare, these serious complications are important to recognize and acknowledge prior to proceeding with surgery. A simple positional test, performed in the doctor’s office, is usually all that is needed to confirm the diagnosis of BPPV. If the patient has BPPV, the examiner will witness a characteristic movement of the eyes, call nystagmus, that begins after a few seconds. Also, after 48 hours, patients should not lay down on the affected ear for at least one week following the treatment. The canal is then gently, but firmly packed off with tissue so the debris can no longer move within the canal and strike against the nerve endings. In successful cases, after an initial period of several weeks, the dizziness gradually disappears.
So when pressure increases, the only way for the volume to decrease is the bowing of the eardrum toward the middle-ear cavity (unless gas is added to the space). If the nystagmus is seen and the patient becomes dizzy, then the ear which is pointing toward the floor is the one with the loose otoconia.
Occasionally, in order to confirm the extent of the inner ear dysfunction, an electronystagmogram (ENG) will be ordered.


In a small percentage of cases, the nerve is located in an unreachable spot and cannot be safely cut. After the eardrum stretches to its limits, further reduction of middle-ear cavity volume is not possible; if descent continues, the pressure in the middle-ear cavity remains lower than its surroundings.
If no nystagmus is seen the examiner will repeat the test, this time turning the head to the opposite side, thus testing the other ear.
The exact percentage of patients with some permanent hearing loss has not yet been firmly established. For this operation, a neurosurgeon exposes the nerve as it crosses from the ear to the brain, then sections the nerve under direct vision with an operating microscope. Modest pressure difference will cause leakage of fluid and bleeding from the eardrum and mucosa lining the middle-ear cavity (ear barotrauma O'Neil grade 1). In some cases, high frequency hearing loss and can occur because the balance nerve fibers (the vestibular nerve) and hearing fibers (the cochlear nerve) mix togther along the borders of the nerves. In addition, sudden and large pressure changes may cause inner-ear injury.So now you understand why during descent you must let more gas into your middle ear to keep the volume of the gas constant and equalize the pressure. A normal middle ear has only one physical communication with the source of additional gas, and that is the Eustachian tube that connects to the nasal cavity (rhinopharynx).
Under normal circumstances, the Eustachian tubes are closed, but every time we swallow or yawn, the muscles in our throat allow for a small transient opening that is enough to ventilate our middle ear and compensate pressure.Nothing challenges our ears and Eustachian tubes more than scuba and breath-hold diving. To become a safe scuba diver and avoid middle-ear injuries, it is essential that you understand the effects of Boyle's law and learn how to actively let air into your middle ears via the Eustachian tubes. In the following sections, you will find different equalization techniques for you to try.On ascent, the surrounding pressure decreases and the pressure in the middle remains higher if the gas has no way to leave the middle-ear cavity. Tips for Equalization Prior to descent, while you are neutrally buoyant with no air in your buoyancy control device (BCD), gently inflate your ears with one of the listed techniques.
The consequences of descending without equalizing could ruin an entire dive trip or cause permanent damage and hearing lossThe partial or complete loss of hearing from normal baseline.
Decongestants and nasal sprays may be used prior to diving to reduce swelling in the nasal and ear passages.
If your doctor agrees with your decision to use decongestants, take them one to two hours before descent. They should last from eight to 12 hours, so you don't need to take a second dose before a repetitive dive.
Nasal sprays should be used approximately 30 minutes before descent and usually last 12 hours. Take caution when using over-the-counter nasal sprays; repeated use can cause a rebound reaction resulting in increased congestion and possible reverse block on ascent.
If at any time during the dive you feel pain, experience vertigo or note sudden hearing loss, abort the dive.



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