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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. The dysfunction of the TMJ (Temporomandibular Joint) is called Temporomandibular Dysfunction or TMD. To identify and diagnose the TMJ disorder, one has to investigate the origin and source of the dilemma.
Any trauma, even a simple blow to the jaw, can be transferred to the ligaments and trigger a long and painful journey. Trauma, like whiplash, bad habits, bad bite, incorrect posture, grinding, and clenching can be the cause for TMJ dysfunction. The dentists at Chinese Dentists Hurstville Dental have done considerable post graduate study in the treatment of TMJ disorders.


Unfortunately, many patients that we see have had splint therapy before and still have little relief from pain. Migraine headaches can be very different from one person to the next, ranging from a throbbing pain to visual disturbance to nausea and vomiting.
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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. TMJs are the most active joint in our body and work hard during swallowing, speech, eating and even at rest.
The good news is that since the jaw and its joints are made of live tissue they can be repaired given the right opportunity, the right nutrition and time.
Approximately 80% of patients with a TMJ disorder complain of headache, whilst 40% complain of facial pain or neck pain. Complaints of clogged or muffled ears, made more painful during aircraft takeoff or landing. This is often unrelenting and can cause many patients to be depressed, especially with associated headaches. This may involve splint therapy, neuromuscular treatment or bite readjustments or buildups. 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. We may need the help of other professionals such as physiotherapists or chiropractors who are skilled in this area. 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. The nerve system involved is the trigeminal nerve and is responsible for  transferring the sensation of pain to the cortex of the brain.
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. 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. 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. Blom is trained and certified in the upper cervical procedure to detect and correct Atlas Subluxation Complex.



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25.02.2014 admin



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