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Subs - BPPV Q

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Old 05-28-2007, 07:18 PM   #1
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Subs - BPPV Q

Hey Subs,

Just wondering what you make of the following:

I had a chat with a friend last night who has actually met Dr Epley. Epley believes that a diagnosis of MAV tends to be a throw away dx and has some advanced ideas about the nuances of BPPV (I wonder what Baloh would say about that?). Apparently BPPV doesn't always necessarily present with discrete nystagmus with a positional change. So then I started wondering if I have could have some sort of BPPV component to this? There's no question that stress is a trigger for such events as seen here:

Life events and benign paroxysmal positional vertigo: a case-controlled study.
Acta Otolaryngol. 2006 Sep;126(9):987-92.

"the results of this trial provide clinical evidence of a potential role of emotional stress connected to adverse life events as a trigger of otoconial dysfunction. High levels of anxiety.... were recorded and were significant psychogenic precursors of BPPV"

Given the emotional stress I had over the recent relationship breakup certainly provides the fuel. Lying in bed creates big positional problems for me: the right side is the worst, followed by the left and lying flat on my back creating the least amount of trouble. I then decided to try the MEP last night before bed for the right side. In two positions, I felt a big increase in heart pounding and a sinking feeling into the bed. I then went on to have a very lousy night of sailing on the high seas. It was worse than the usual.

So I'm wondering - have you come across any stuff where ear rocks cause trouble but without discrete nystagmus? Adam, being a clear cut MAV case, reckons he would feel just as bad doing the MEP. So hard to know what's what in this mine field.

At any rate I'm going to persist with the MEP. Nothing to lose really.

Thanks Subs.......Scott

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Old 05-28-2007, 07:26 PM   #2
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Re: Subs - BPPV Q

Hi Scott ans Subs

I add myself to the question, because this same statement (stress linked to BPPV) was told to my sister by a neurotologyst(dizzy family huh?).

Even as I do have a migraine story and my odd symptoms could easily match a textbook MAV case, the recentpositional vertigo episodes, and the initial stronger one, was indeed a BPPV like attack, who knows? maybe there is a variation, not easlily detected by Dix Hallpike(I always tested negative for it)

Old 05-28-2007, 11:59 PM   #3
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Re: Subs - BPPV Q

Hi Scotsman and everyone else,

I am new to this board but have been visiting the mvertigo board for a while now. I won't go into my story now, but I wanted to clarify what I said about BPPV to Scott. John Epley has developed a machine for diagnosing and treating BPPV. It can rotate the person 360 degrees in any direction and so can pick up BPPV that is very subtle that a Dix Hallpike might not. You do nevertheless still get nystagmus. That is the way he determines where the problem is. His machine allows him to closely pinpoint where the crystals are disloged or lodged. It also allows specific modifications of the Epley maneuvre to be applied to treat these variant forms of BPPV

Last edited by moderator2; 05-29-2007 at 04:56 AM. Reason: not allowed to post doctor's websites - as per the posting policy

Old 05-29-2007, 04:29 AM   #4
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Talking Re: Subs - BPPV Q

So I'm wondering - have you come across any stuff where ear rocks cause trouble but without discrete nystagmus?

No---have not.

That said---u sent me a research paper---where it was determined---that---the rocks are really (in most cases) fragments(fragmented)---and it takes "X" number of fragments before they reach a "critical mass"---i.e., before---the BPPV is pronounced.

My guess is---they do not know(still).

For me---if I thought the MEP---would help---I'd do it---following the MEP instructions---religiously....but that's just me....

Old 05-29-2007, 09:54 AM   #5
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Re: Subs - BPPV Q

Very interesting indeed. I'd think that Epley would be the world's expert on BPPV, but that's just me. At any rate, I'm now thinking that I have a relatively mild case of BPPV that just results in some off balance fellings occasionally, not related to head movement. Early on however, I definitely had a positive Hallpike test, so perhaps it has faded (is fading) away to a milder case. Either way, I'd love to be tested in the Epley chair/machine for a definitive diagnosis.


Old 05-29-2007, 02:51 PM   #6
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Re: Subs - BPPV Q

Hi all-
I was diagnosed with BBPV. When they tested me they said they couln't see a nystagmus response, yet they said that BBPV is what I had. (?) I do the Epley at night at least once a day, and have been for the last four months. I have noticed an improvement in my situation! It has been slow, but I have been feeling much more stable than I have in past months. Good luck to you!

Old 05-30-2007, 04:50 AM   #7
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Re: Subs - BPPV Q

Hey Scott and everyone else
Just to add to your interesting question on the affects of stress etc on BPPV..there is no question of the correleation for me. I have been going along very smoothly for over a year and out of the blue I got a small dose of the BPPV two weeks ago. I can tell you that helping my sister through her chemo treatments has been hell on wheels for me as she is single and I seem to be her dumping ground. It was really eating me up and then whamo! dizzy again. Did the MEP twice and it was gone again, but I am convinced that the stress has triggered it.
A few posts ago Subs quoted an article that there is a correlation between BPPV and migraine which I have suffered from in the past, before any of this crap hit. So looks like it is all connected somehow.
I don't think you can hurt yourself doing the MEP. What I do it when I am back in the first two positions I hold my watch about 18" from my face and focus on one number as I time my 30 sec per side, I can tell that if the numbers are jumping or I am having difficulty holding my gaze then something is off as was the case last time, it didn't present as an actual vertigo but perhaps just on the cusp (perhaps I only had 59 crystals loose!) if I can focus with no difficulty then I can tell its going to be fine.
Just my two cents.

Old 05-30-2007, 06:32 AM   #8
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Re: Subs - BPPV Q

Hi Terri,

Very sorry to hear about your sister. That must be really tough to go through for her - and you. But interesting to see that it looks like stress was the trigger for your attack which you have obviously nailed. I wonder what the mechanism is? I need to re-read the BPPV papers.

Just wondering, do you get or did you get clear cut nystagmus with your case? How were you able to deduce which ear? I believe it's because the eye's pulse toward the affected ear correct?

Take care.....Scott

Old 05-31-2007, 03:50 AM   #9
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Re: Subs - BPPV Q

Morning all.....I thoroughly enjoyed reading all of this as I have just been dx with BPPV. Had to fly recently and on the return flight got a horrible earache in my right ear. This was a first for me. It finally popped a little while after landing and I was fine. This was on a monday night. Had left shoulder surgery that Friday and was extrememly dizzy a couple of days alter. Blew it off as the meds and anesthesia. WRONG!!! 2 1/2 weeks later I woke one night with the bed spinning. I was able to see my PCP who sent me immediately to the ENT who made the Dx. He couldn't do his maneuver because of my shoulder but gave me the exercises to do at home. They have been somewhat successful but what scares me is that I never know when this will come on. ENT told me between the flight and laying on my right side for 2 hours during surgery moved the crystals. Now that I'm reading about stress I have to add this to the mix. flying and surgery within a couple of days. Lots of stress. How do you all cope with it? I am hoping the surgeon tells me I can drive again on the 12th when I see him but am a little afraid because of the BPPV. How do you know when you're safe if this comes from nowhere?


Old 05-31-2007, 05:17 AM   #10
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Re: Subs - BPPV Q

ICC, welcome to the turbulent world of BPPV!
I don't worry about driving too much as the vertigo is brought on by head position and when driving I don't move my head around enough to ever bring on an attack. What exercises did your doctor give you? The only one that worked for me was the Modified Epeley Maneuver..when I have had a recurrence of BPPV (twice in 4 years) I only have to do the MEP once or twice and it's gone again for a good long while, and each episode has been less and less. I am often left with some residual symptoms for a couple of weeks after, but no vertigo.
Sounds like you have a good diagnosis though which is good and I am guessing the ENT told you which ear is affected (the ear that was down during sugery?) which will help with the exercises (the MEP is done with the bad ear down first and then you progress to different positions to move the ear crystals out of the canal)

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