Audiology/Otolaryngology/BPPV, vertigo, tinnitus and disc problems
QUESTION: I have had tinnitus for over 10 years in my right ear. Almost a year ago I started having vertigo approximately 1x per week. Dix-Hallpike maneuver confirmed right side vertigo and I was told I have BPPV. I have tried Epley maneuvers, Semont manuevers, both at home and with a PT. For 4 months April-August I had NO episodes but now once every 3-4 days. The last two episodes were quite severe, and lasted about 4 hours even while medicated with Valium. My ENT told me there was nothing more that could be done for me. I also get cold sweats, nausea, vomiting, weakness when the episodes occur. It happens at random times with seemingly only minor head motion setting it off.
I am not able to function like this so am seeing my GP in a few days to ask for a new referral to another ENT. However, I am wondering if the two bulging discs in my neck C-3 and C-5 that I was told about over 10 yrs ago, might have something to do with all of this. 2 or 3x that I had tipped my head forward or back (causing vertigo) I got a "zapping" feeling in the back of my neck that preceded the vertigo.
I'm a 57 yr old menopausal woman 5'4" 155 lbs with no other health issues; don't smoke, and other than this have always had good reports on my health. Should I be asking more questions about my discs which might now be herniated after all these years? Should I ask for an MRI or xray of my neck?
ANSWER: Dear Margaret,
It is difficult to know what if any impact your neck problems have on your vertigo. With bppv, neck problems can make diagnosis and treatment more difficult because of limitation in neck movement. Also, you may tend to hold your head or sleep a certain way that increases collection of particles in the semicircular canals. In either case, the neck issue would not cause the BPPV, but rather add to the problem.
When you say the episodes last hours, do you mean that the vertigo is intermittent (provoked by head movement) over hours? Or do you mean that the vertigo is constant for hours? The former would be consistent with the BPPV, while the latter COULD be something else (such as vestibular migraines, Meniere's, or other irritation or inflammation of the inner ear/nerve). It is often the case the BPPV follows another vestibular problem (which can dislodge/disrupt the otoconia particles). Alternatively, there is another form of BPPV which leads to more constant vertigo whenever the head is in a certain position and is more difficult to treat as the particles have become "stuck" to the membranes which react to head movement and get "pulled" down by gravity. Treatment requires vibration or maneuvers which "liberate" the particles.
Finally, I believe a second opinion is a wise decision. You should seek a clinic/hospital which specializes in balance diagnosis and treatment. If BPPV is still active, that should be treated to resolution, then additional testing may be conducted--especially if you still have symptoms.
I hope this helps you.
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QUESTION: This does help me and will help me ask the pertinent questions when I see my doctor. In response to the question, yes, the vertigo (spinning, nystagmus, nausea) last for 2-4 hours constant.
Thank you very much!
You are very welcome. I did want to add something called vertebral basilar insufficiency (VBI), which can be a vascular cause of vertigo related to neck position. These cases are pretty uncommon, but become more likely with atherosclerosis and high cholesterol. Basically, the arteries that run the back of your neck to your skull, and supply your inner ear among other things, can start to become restricted and certain head/neck positions can "squeeze off" the supply further and produce vertigo while in that position and a short time after. I really don't think you have this as it usually occurs in the older population, but was thinking of vertigo/neck related diagnoses.