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Dizziness and Benign Positional Vertigo
Benign positional vertigo refers to small displaced crystals of calcium carbonate which called otoconia, otoliths, or canaliths. These crystals are typically attached to the otolithic membrane within the utricle of the inner ear. Sometimes due to trauma or aging, the otoconia can separate from the utricle, and become displaced in the semicircular canal within the inner ear. With head movements, the detached otoconia can stimulate sensitive nerve endings. The brain receives fall signals, which in turn, causes a spinning sensation or dizziness. Symptoms typically occur less than a minute and are precipitated by specific head movements against gravity.
The ear exam is typically normal. Physical examination, however, will typically elicit nystagmus or jerking eye movement indicating the affected ear.
Treatment involves repositioning the otoconia so as to stop false signals of movement to the brain. Canal positioning procedure, also known as the Epley maneuver, will move the canaliths or otoconia from the semicircular canals back to the utricle. Hopefully, the otoconia will then re-adhere to the otolithic membrane, dissolve, or disintegrate and therefore relieve patient’s chronic debilitating symptoms. The Epley maneuver is performed by a trained professional. Following the procedure, appropriate precautions are provided so as to prevent the otoconia from returning back into the semicircular canal. The Epley maneuver has a success rate of 80%. The recurrence rate is relatively low and more likely in patients that have spontaneous onset of BPV rather than related to trauma.
Brandt-Daroff exercises are also recommended for patients with BPV. They are done multiple times while at home until 2 days after the bouts of positional vertigo have ended.Read more
Meniere’s disease refers to a condition typically manifested by severe dizziness with vertigo, roaring or ringing tinnitus, fluctuating hearing loss, and a sense of ear pressure or fullness that is sometimes painful. Meniere’s can occur bilaterally in 25% of patients. It is more common in adults in their 40s and 50s. There are about 600,000 people in the United States that have a diagnosis of Meniere’s disease. About 50,000 cases new cases are diagnosed every year. Dizziness may occur suddenly following an aura of roaring tinnitus and muffled hearing. Sometimes the dizziness is severe enough that patients are unable to ambulate. On the other hand, patients may complain of moderate to severe ear pressure and fullness with a sensation of ear fluid that is not evident on physical exam suggesting normal middle anatomy. This would therefore suggest inner ear pathology.
Meniere’s disease is caused by excess fluid within the inner ear or the labyrinth. The membranous portion of the labyrinth contains endolymph which is responsible for sending balance Read more
The Pregnant Tourist
It was a beautiful Saturday morning, and I was in the mood to do some gourmet cooking. Somehow, it makes me relax and feel like I am in the kitchen with my Mom who cooks delicious meals. Alas, she never taught me how to cook, always telling me to go study instead. After marriage, I had to make some quick adjustments, and started collecting cook books. Fortunately, my husband has been very supportive although he did once call my pancake a “Frisbee” – something I have never forgiven him for. Over time, I have amassed quite a few books, and they appear pretty stunning sitting on the shelves. But there was one recipe that caught my interest described as chicken rolls filled with crushed dates, lemon juice, and chili peppers. So here I was cutting and preparing, when I got called to the Emergency room for a nose bleed. Oh well, I thought, shouldn’t take too long before I return and continue my cooking project. I was so very wrong!!
I walked in to find a sweet young pregnant lady holding a big basin filled with blood. It continued to pour out of her nose without any intention of stopping. Read more
The Abscess That Wasn’t
It was blistery cold outside, and the strong winds shattered against our windows. Yes it was winter, and fairly close to Christmas. The office was lit up with decorations in anticipation for the holiday season, and my staff worked like little elves trying to get everyone taken care off. We were almost there. I still needed to do my Christmas shopping and was hoping to get to the stores after work. A far as the BIG Christmas dinner was concerned, my kids insisted on a complete homemade meal rather than catering this year. We came to a pact – ‘Home-Made’ – YES! – but with LOTS of help in cooking and cleaning up after dinner. Now, all I had to do was to make the grocery list; hopefully my sweet husband would do the shopping.
Things were moving along smoothly in the office when my staff informed me of a call asking if I would see a patient with a peritonsillar (throat) abscess. I hesitated for a split second but then agreed knowing this person too would want to enjoy a good meal during the holidays. Read more