【Local Medical】The movement of the inner ear caused BPPV to spin around

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Text: Chen Qiulei Picture: Liang Yingxiu

(Kuala Lumpur) Vertigo refers to a person who feels that the surrounding environment or the body suddenly spins, shakes back and forth, and at the same time the body loses balance, cannot stand still, and sometimes has symptoms such as nausea and vomiting and cold sweat.

Vertigo is a symptom, not a disease. Can be divided into two types, namely peripheral vertigo (peripheral vertigo) and central vertigo (central vertigo).

Women are 3 times more likely than men

Dr Kong Min Han, consultant otolaryngology and head and neck surgery, said that central vertigo is very rare and is usually caused by diseases, such as stroke, tumor of posterior fossa, migraine, multiple sclerosis (multiple sclerosis) sclerosis) and taking specific drugs, etc. The most common type is peripheral vertigo, which occurs when there is a problem with a person’s inner ear or vestibular nerve, which help improve balance.

“The 4 major diseases that are more common in vertigo,

benign paroxysmal positional vertigo

(Benign Paroxysmal Positional Vertigo, BPPV),

Meniere’s disease,

persistent postural vertigo

(Persistent Postural-perceptual Dizziness, PPPD)

and vestibular migraine;

Among them, vestibular migraine belongs to central vertigo.

According to research in Korea,

The cases of each disease are as follows: BPPV is 24%,

PPPD and vestibular migraine were the same 20.8%,

Meniere’s disease was only 7.2%;

Data from Thailand shows that BPPV accounts for more than 52.5%.

Meniere’s disease is only 14.6%. “

As for Malaysia, he said that there is no data for the whole country, but according to the vertigo patients received by the medical center, 30% of them are BPPV diseases; women are mostly, 3 times higher than men, and the older , the higher the risk of disease.

BPPV mostly occurs when getting up

“BPPV, also known as otolithiasis with a high incidence rate, is the well-known imbalance of ear water. When patients face changes in the head position, such as sitting up from the bed, turning the head, etc., they will Sudden dizziness, feeling like the space you’re in is spinning.”

He noted that BPPV is triggered when calcium carbonate particles, or otoconia, commonly known as “stones,” “float” in the semicircular canals, which control the structural balance of the inner ear.

“The cochlea and semicircular canals are the structures of the inner ear. The former is used for hearing, while the latter controls the balance of the human body. Therefore, when the position of the human head changes, the otoliths move or “float” in the inner ear, and the patient will feel dizzy. “

“The attack is usually at the moment of waking up, such as getting up in the morning, getting up in the middle of the night to go to the toilet, etc. Some patients also have an attack at work. Once the attack occurs, some people can only lie flat and cannot move, and even feel nauseated and nauseated.”

Another less common form, Meniere’s disease, is a condition that affects balance and hearing, he said. The pathology is that the endolymph in the vestibular system edemas, causing earplugs, tinnitus and hearing loss. Generally, hearing is affected during seizures and then recovers on its own later, but frequent seizures may cause permanent deafness.

According to typical cases, the onset of Meniere’s disease can last for several hours, and BPPV usually lasts for several seconds to several minutes or longer.

Whether it is BPPV or Meniere’s disease, so far there is no strong evidence to prove the real cause or risk factor of the two diseases. For the former, there are discussions that the cause of the disease may be related to infection or trauma, but there are also patients who are not affected by these two and suffer from BPPV. As for Meniere’s disease, there are theories that it is related to autoimmune diseases.

Check for nystagmus to confirm BPPV

“As far as the diagnosis is concerned, there are various methods. For example, a patient who presented with dizziness had symptoms that occurred when the position of his head changed. But what we want to know is whether he is accompanied by other symptoms. Symptoms, such as tinnitus, earplugs, hearing loss; or nausea and vomiting in severe cases. If there are no symptoms above, it may be BPPV.”

After a detailed questioning and a general understanding of the condition, another test is performed to check the characteristics of the patient’s nystagmus (nystagmus for short). Nystagmus is an involuntary, rhythmic, back and forth eye movement. The direction of nystagmus can be rotational, vertical, or horizontal.

When checking for nystagmus, the doctor instructs the patient to stare directly at one index finger, slowly turn the eyes to the left and then to the right, and observe the direction and duration of the nystagmus during the process. If it is an upbeat-torsional nystagmus, Most of them are BPPV.

Another examination is the Dix-Hallpike test, that is, let the patient sit or lie down, turn the head 45 degrees, observe the direction of the nystagmus, and judge the disease.

When conducting an examination for Meniere’s disease, the doctor will use his medical history as one of the methods of diagnosis. That is to say, it is necessary to rule out whether the symptoms are related to other diseases and drugs, such as stroke, tumor, infection, orthostatic hypotension (orthostatic hypotension) and whether taking aminoglycoside antibiotics, etc., so a scan must be performed to confirm Whether it is Meniere’s disease.

vestibular function test etiology

In addition to a physical examination, hearing tests are an essential step in diagnosing the disease. Under the test, it can be inferred from the patient’s hearing that he may have Meniere’s disease.

He gave two examples. Some patients with acute attacks found that their hearing was indeed damaged after being tested, and it returned to normal when they were re-examined; The hearing test results showed that he was hearing impaired, so the doctor diagnosed Meniere’s disease.

Accurately diagnosing vertigo is not easy, he noted. Because most of the time, patients come to see a doctor after the attack and the condition has improved a little. When the doctor makes a diagnosis based on the history of the attack, the patient sometimes cannot elaborate on the duration of the vertigo attack and the condition at that time. It increases the difficulty of diagnosis.

Therefore, the doctor will also use the vestibular function test to find out whether the cause of any vertigo is related to the health of the vestibular function. This test includes several test items, the more commonly used items include Video nystagmogtaphy (VNG) to check eye movement, and Cervical Vestibular Evoked Myogenic Potential (Cervical Vestibular) to detect electrical responses to ear stimulation. Evoked Myogenic Potential, cVEMP).

No complications but attacks occur without warning

Any vertigo, including BPPV or Meniere’s disease, cannot be prevented because the true cause has not yet been identified.

Some patients no longer have attacks after taking medicine and recovering, while others are entangled again within three to five years.

The recovery speed of BPPV is relatively fast. Clinically, doctors often use the Epley maneuver (Epley maneuver) to help patients adjust the position of otoliths in the ear that may cause vertigo, so as to relieve the symptoms of patients; but this method is only applicable to BPPV.

“If you’re still feeling dizzy after using the Epley Maneuver, you can seek physical therapy, which may help reduce your symptoms.”

Medication to increase blood supply to the ear

Kang Minghan said that in the treatment of these two diseases, most of them will prescribe two types of drugs, one is inner ear labyrinthine sedation (labyrinthine sedation) to relieve the patient’s vertigo symptoms; the other is vestibular vasodilator (vestibular vasodilator), the commonly used drug is betahistine (betahistine).

This medicine increases the blood supply to the ear, allowing the blood to circulate more and speed up recovery. Betahistine can be used in the treatment of both BPPV and Meniere’s disease.

Excessive fluid in the endolymph leads to edema leading to Meniere’s disease. Patients need to take diuretics to expel excess water from the body. At the same time, high salt increases the water content, so doctors also advise patients to reduce their salt intake.

In fact, these two diseases do not cause complications to the human body, but what is worrying is that their attack period is completely without warning. Especially in outdoor activities, such as seizures while driving, it may cause accidents, or fall and injury, etc., which will also have a negative psychological impact on patients invisibly.

lie down and rest immediately

He suggested that lie down and rest immediately when an attack occurs, like BPPV patients, who will vomit in severe cases. If the condition does not improve after rest, you can go to the emergency department of the hospital immediately; if your physical condition permits, you can go to the nearby medical center for treatment.

One thing that must be reminded is that the situation of the older elders is different. They may suffer from comorbidities, such as diabetes and high blood pressure. If dizziness is accompanied by other symptoms such as weakness in limbs and heart pain, you must be sent to the hospital immediately.

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