Audiology/Otolaryngology/BPPV

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Question
I contracted a bad virus over 2 years ago.  I have the ringing and noise in my ears. My Dr gave me nose drops and betahistine.  He said it was like one heardrum was sucked in and one protruded out and would take several weeks to recover.  After months of no relief, he sent me to a ears,nose and throat Dr that specialized in dizziness.  He diagonosed me with BPPV and said it would take about 3 treatments....Unfortunately he passed away after my second one and I still wasn't fixed.  Taking 6 more months to see antother seecialist, she took one look at me and said lift one leg then the onther, close your eyes and touch your nose...you don't have BPPV.  I said great what is wrong with  me.  She said I don't know and sent me for an MRI and told me to go to my family Dr for the results.  It came back fine.  I learned how to adjust to my way of life as wmall as my world had become.  Four weeks ago, I got really sick again with vomiting, uncontrollable spins and nausea.  My Dr. said to take the Betahistine, Larazepam and graval for 2 weeks till the virus left me.  Unfortunately, it is still very bad.  I found a wellness clinic that works with dizzyness again.  He said in all his practice, he has never had a patient with such severe Vertigo in BOTH ears, and nerve damage in my left ear. My first treatment was so horrific have thought I was having a bad nightmare.  He explained that until the crystal that was stuck, let loose, it will be such a horrific experience.  He said he has to work on one and get it right before he can do the other.  Then he would work with the nerve damage.  I feel very hopeful that things will work out.  My question is, do you think that I am getting the correct treatment or is there other, better treatments available?  Thank you so much for your help.  Katherine

Answer
Dear Katherine,

I am sorry that you have been dealing with your dizzy/vertigo symptoms.  The key aspects to realize in this case are that 1) the underlying cause is often not diagnosed correctly or at all and 2) BPPV can exist as a secondary condition to a separate vestibular insult (such as inflammation or infection of the inner ear). Also, some professionals/physicians who are aware of BPPV will give that dx without truly confirming it through ocular (eye) recording during dynamic positioning maneuvers (often called the Dix-Hallpike maneuver).  Without the eye recording in the dark or visualization through special lenses (which don't allow you to "fixate" your eyes on an object in the room), then BPPV and the canal that it is involving cannot be determined (you have 3 canals in each ear for 6 total!).

Some of what you reported here from Drs you have seen already holds a ring of truth, but I wanted you to understand what I wrote above.  If you do indeed have BPPV, that should be treated first.  Then re-tested and vestibular rehabilitation (usually by a specialized physical therapist) can be conducted to help your system compensate for any remaining/permanent vestibular deficit.  There are certain medications you should NOT be taking through any of the treatments or testing and definitely none that are vestibular suppressants!  

Finally, I would advise you to find a professional or group which approaches your diagnosis and treatment from a very evidence-based approach (proper eval and appropriate counseling and treatment).  Often, an audiologist and physical therapist are the key professionals who will work with you (and collaborate with your physician) to identify and treat your problem.

I hope this helps and I wish you well.

Audiology/Otolaryngology

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Dr. Clint D. Keifer, Audiologist

Expertise

I am qualified to answer all questions related to the diagnosis and rehabilitative treatment of hearing and balance disorders. This includes evaluation of hearing and balance, counseling, amplification (hearing aids and assistive devices), tinnitus (noises in head) evaluation and management, cochlear implants, and audiology in general.

Experience

I started my career as a hearing instrument specialist (on a trainee license) in 1998. After almost 2 years, I decided that I needed to pursue higher education if I was to provide the best care to hearing impaired patients that I could. In 2007, I completed my Doctor of Audiology and have been providing audiological care for almost 5 years. I have vestibular, cochlear implant, and pediatric experience along with prescribing, fitting, and verification of hearing aid amplification as part of comprehensive hearing loss rehabilitation.

Organizations
Audiology doctor and owner at Great Lakes Audiology in Toledo, OH. phone: 419 327-2273 website: www.GLAudiology.com American Academy of Audiology American Speech-Language Hearing Association Ohio Academy of Audiology

Education/Credentials
Bachelor of Science (B.S.), Western Michigan University, Speech Pathology and Audiology Doctor of Audiology (Au.D.), Ohio State University Certificate of Clinical Competence in Audiology (CCC-A)

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