by Dr David Ho

Australian and Hong Kong registered Specialist in Ear, Nose and Throat Surgery.

davidhoent@hotmail.com

 

I recently saw a patient whom presented to me with 3 weeks history of vertigo (dizziness with a spinning sensation).

He was working at his desk with the computer when he started to feel the whole room spinning. He then felt nauseous and vomited. He couldn’t stand up and had difficulty walking around in the office. He then called an ambulance and was brought to hospital. Previously he has been well with no colds and flu.

He had been admitted to hospital for 5 days. He had a brain scan, which was normal. No other abnormality was found and he had been given medications and discharged. He was told that he has Meniere’s Disease and the dizziness would eventually go away. After being at home for more than 2 weeks, he still feels dizzy every time he moves (walk around, turning in bed) with no improvement, so he came to see me.

After further discussion, he seems to experience this vertigo sensation only when he moves. If he lie down and stay still, the spinning sensation would go away and once he moves again, the spinning sensation would come back. He had no other associated symptoms of hearing loss (blocked ear) or tinnitus (ringing noise).

On examination, his ears, nose and mouth are normal.

Clinically from his story, he has a classical presentation of Benign Parasoxymal Positional Vertigo (BPPV). This disease can be confirmed by a bedside test called Dix-Hallpike test. In this case, my patient tested positive on the left inner ear. The treatment for BPPV is not with medication but with Epley’s manoeuvre (a head turning technique to cure this disease).

BPPV is a disease with abnormal precipitation of particles called otoliths in the semicircular canals of the labyrinth (which is part of the inner ear). This problem usually does not affect the cochlear (hearing). The otoliths excessively stimulate the labyrinth nerves in the semicircular canal and this leads to the spinning sensation. The most common symptoms are vertigo (spinning sensation) with turning in bed, lying back at the hairdressers for hair washing and when looking up or down. This Epley’s manoeuvre will reposition these particles away from the nerve endings and the patient will then have no more dizzy symptoms. Most patient usually will need multiple Epley’s manoeuvres to recover. I usually perform this treatment for my patients every 5-7 days and the symptoms usually will subside in a few weeks with no medications.

My patient has had repeated treatment and has almost recovered. This dizziness is commonly misdiagnosed by Medical General Practitioners in Hong Kong. As most people think dizziness is due to Meniere’s Disease, but in reality, majority of patient’s vertigo are due to BPPV.