Benign paroxysmal positional vertigo-BPPV

This disease, also referred as 'benign paroxysmal positional vertigo-BPPV'', is the most common cause of ENT related dizziness.

Under normal conditions, we all have crystal particles called otolith in our ear. These crystals are not placed within the semicircular channels when they are placed in a gel layer on the hairy cells in utricle and saccular structures. If these crystals get in semicircular channels in a way, vertigo occurs in the patient. Typically this vertigo comes out while turning right or left side on the bed, trying to reach something from the shelf or climbing stairs. It lasts very short as seconds, may be very severe and can be accompanied by nausea-vomiting. Then, there may be a 'sneaky feeling' which is expressed as 'dizziness'. Hearing loss or tinnitus is not seen. These crystals are most frequently known to get in the back semicircular canal. Injuries of head, extended bed rest, sudden positional movements and some ear surgeries can be included among the reasons of disease. It has also been reported that frequency of crystal sliding increases after a diseases called as vestibulerurinitis. However, when the patients are examined, the reasons mentioned above are rarely encountered.

History is very important in the diagnosis of Crystal Sliding Disease. One of the most recent and accurate diagnostic methods today is the VHIT method (Video Head Impulse Test). Video head impulse test (VHIT) applied in our unit provides high analysis capability of the vestibular system in inner ear. The system enables to pinpoint the crux of the problem with the help of a detailed computer analysis system and glasses with high resolution video camera. The most important feature of the video head impulse test is the possibility of evaluating and analysing the semicircular channels, of which three are present in each ear. Lateral semicircular channels, left and right posterior and anterior channels are evaluated individually and 3-D graphics are obtained. In this way, semicircular channel with crystal sliding is detected with VHIT. Maneuvers are very important at that point. Although mostly the epley maneuver is applied, there are also different maneuvers. These maneuvers are selected and performed according to which semicircular channel is affected. It is also very important that the maneuvers are done correctly. No result will be obtained if not done correctly. We carry out our maneuvers with the help of special tools by navigation. Thus, achieving regulations in complaints reach 95% only with correctly performing the maneuvers. Accurate diagnosis, detailed detection and correct maneuver are the key point of treatment.

If patient has excessive nausea-vomiting, anti-nausea medicines can be used. In treatments and follow-up periods; rehabilitative maneuvers, life coaching in patient-doctor relation, LFr-TMS (Low frequency repetitive transcranial magnetic stimulation) and r-TMS can be applied. It is important for the patient to rest and avoid sudden movements at acute phase. Our patients come normal in about 1 week with our treatments. In case of resistant situations, supplementary treatments are provided and patients can return to their normal lives after a while.