Sunday, January 29, 2012

What Is Secondary BPPV?

I believe secondary BPPV is BPPV caused by another vestibular dysfunction. For instance, neuritis may cause swelling around the nerve, which could push on arteries that supply blood to the otoliths. This could cause the system to become necrotic and now the person is more likely to get BPPV. Meniere's slowly destroys the otoliths and the rest of the inner ear causing one to be more likely to develop BPPV. A person who has TIAs may not only have poor circulation to their brain, but also to the inner ear...this could be an example of secondary BPPV. In this last case, BPPV would not really be so benign because it's cause is actually life threatening. 

Saturday, January 28, 2012

Vestibular dysfunction is a process

that may occur over time.  There are some who experience vestibular dysfunction once or twice over the period of several years while there are others who battle the problem much more often.   When it comes to helping these individuals, I believe we need to be careful how we educate people regarding what they should expect for the future.  Sometimes I think looking at vestibular dysfunction one day in the clinic may be like looking at a digital picture of the following:

Snow: is it melting or freezing?
(Is the inner ear in the process of getting worse or better?)

Rain: just began or stopping?
(Is the inner ear problem at it's early stage or is it almost done running its course?)

Building being built: is it a home or office (Is the inner ear problem BPPV or is it signs of Menieres, Vascular Insufficiency or Autoimmune Dysfunction?)

Thursday, January 26, 2012

A question about really fast nystagmus

I recently had a colleague in the Acute Care setting ask me the following question: "I had a BPPV patient today who had definite left torsional nystagmus when I did the Hallpike. Treated it with Epley's, and when I retested the Hallpike again it was positive (which was not unexpected), but the nystagmus was beating much faster than the first time. Does that mean anything, or was it just a weird coincidence? We ended up doing Epley's two more times, but I think we got it."

The following are some possible answers to her question:
Interesting. Perhaps the torsional nystagmus was more intense the second time because:
  1. More caclicum crystals dumped out during the first Dix Hallpike and Epley.
  2. The first Epley "mobilized" any adhered calcium crystals (silent debris) so there were more actively available for the second Dix Hallpike. This adherence with a possible "bottle neck" in the canals prevented them from returning the first time. If this "bottle neck" theory were true, whatever caused it during the first CRM must have been gone if the second and third CRMs were a success.
  3. The first Epley/Dix Hallpike was not done as quickly as the second...thereby, the first did not create enough momentum to reposition the otoconia the first time. The second may have been faster, caused more nystagmus, but did a better job of shooting the otoconia through the tubes and back to their happy homes.
  4. The first Epley/Dix Hallpike caused otoconia to be repositioned into the client's lateral canal.  This may have caused a more intense lateral nystagmus with the subsequent retest. 
  5. The second Dix Hallpike may have caused otoconia to dump out into her lateral canal.
Were the following re-tests after the second CRM better?

Sunday, January 1, 2012

My Top Interests In Vestibular Rehabilitation for 2011

Here are some of my greatest contemplated topics in vestibular rehab for 2011:
1.  HINTS to diagnose stroke
2.  Pseudospontaneous nystagmus
3.  Multicanal BPPV treatment
4.  Implications of GERD, Panic Attacks, History of Syncope when treating clients with BPPV
5.  Secondary BPPV
6.  Stages of BPPV: Dumping, Dumped and Recovery
7.  Motion Sickness and BPPV
8.  Vertebral Artery Dissection prediction
9.  Migraine and other central causes of dizziness
10.  Timing of vestibular rehabilitation and neck therapy working with clients with dizziness.
11.  Over 200 words used to describe dizziness
12.  Nystagmus suppression during normal activities of daily living
13.  Spatial disorientation training in younger and older adults
14  Tai Chi to help teach people to relax when off balance
15.  Many balance disorders seem to manifest themselves in hyperactive balance performance
16.  Imagination, memory and central preprogramming in clients with dizziness
17.  Post Concussion Syndrome in the elderly
18.  The Highly Sensitive Person with vestibular dysfunction
19.  Cardiovascular causes of central and/or peripheral vestibular dysfunction
20   Vestibular Rehab as an examination tool
21.  Evaluating the vestibular system using the video eye movement recording device over time to track changes in vestibular function
22.  Toxic, metabolic and hormonal causes of peripheral and central vestibular dysfunction
23.  Sensory processsing disorders in the adult