Dizziness like riding a roller coaster... Try this trick, simple effect is good!

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Have you ever taken a roller coaster? Remember how it felt to ride the roller coaster last time?

Aunt Zheng (not her real name), who is just over 50 years old, recently fell into the pain of "riding a roller coaster".

3 days ago, when Aunt Zheng got up to get dressed, she suddenly felt that the sky was spinning, like riding a roller coaster, which lasted for a few seconds and disappeared, but there was still a groggy and top-heavy feeling, and it took about 1 hour to slowly get better.

Later, Aunt Zheng took several "roller coasters" one after another, most of which happened when she got up and turned over, which was really unbearable.

Therefore, Aunt Zheng came to Zhejiang University Shaw Hospital, did cranial magnetic resonance and did not find any major problems, but the electric eye shock map prompted that the shaking test saw a rapid left horizontal eye shock.

After further examination, Aunt Zheng was eventually diagnosed with "benign paroxysmal positional vertigo.".

After the doctor did a manual reduction for Aunt Zheng and added some medication, Aunt Zheng finally felt much more comfortable.

Manual reset, what is this magical operation?

Benign paroxysmal positional vertigo (BPPV), commonly known as "otolithiasis", is the most common cause of vertigo.

Although it can recover and heal on its own, it is prone to recurrence.

It is related to the change in the position of the head in the direction of vertical gravity, such as suddenly standing, looking up, lying down, squatting, and turning over. There is often a sudden, transient vertigo (usually lasting a few seconds to 1 minute), and there may be uncomfortable manifestations such as nausea and vomiting.

Note: Otolith is not ear feces, it is a calcium carbonate crystal (small stone) located in the vestibule of the inner ear, which maintains the balance of the human body.

Dizziness and dizziness can not be distinguished?

1

Dizziness: refers to the feeling of impaired or impaired spatial orientation, excluding the illusion of movement.

2

Vertigo: Refers to the illusion of movement of oneself or the external environment, including rotation and other illusions, such as rocking, pouring, floating, bouncing or sliding.

3

Pre-syncope state: refers to the feeling of blackening in front of the eyes, about to lose consciousness, and about to faint. It is often accompanied by symptoms such as dizziness, chest tightness, panic, and lack of strength.

What diseases can cause dizziness?

1

Vestibular perimeter system (inner ear)

Benign paroxysmal positional vertigo, Meniere's disease, labyrinth fistula, superior canal cleft syndrome, vestibular neuritis, otitis media, labyrinthitis, sudden deafness, ear tumors, etc.

2

Vestibular central system (brain)

Stroke, vestibular migraine, transient ischemic attack, demyelinating disease, central nervous system infection and degeneration, posterior fossa mass, etc.

3

other

Cardiovascular diseases (arrhythmias, orthostatic hypotension), cervical spondylosis, psychiatric disorders (panic attacks, anxiety), ophthalmic diseases (glaucoma, cataracts, fundus lesions), drug side effects, etc.

How is otolithiasis diagnosed?

· 1 ·

Recurrent, transient dizziness or dizziness (usually lasting no more than 1 minute) occurs after changing the head position relative to the direction of gravity, such as standing, looking up, lying down, squatting, turning over, etc.

· 2 ·

Vertigo and characteristic positional nystagmus (tremor of the eyeball in one direction) occur in positional tests (e.g., Dix-Hallpike tests).

· 3 ·

Exclude other diseases, such as vestibular migraine, vestibular paroxysmalism, central positional vertigo, Meniere's disease, vestibular neuritis, labyrinthitis, superior canal cleft syndrome, posterior circulatory ischemia, orthostatic hypotension, psychopsychiatric vertigo, etc.

For this reason, some additional tests are required, such as: vestibular function test (including video eye shock electrography, etc.), audiology examination, imaging test (including CT and MRI, etc.), balance function test, etiology test (blood test), etc.

How is otolithiasis treated?

At present, the treatment of otolithiasis includes otolith reduction, drug therapy, surgical treatment and vestibular rehabilitation training.

＋

Otolith reduction

Otolith reduction is currently the main method of treating otolithiasis, which is easy to operate and has good results. When resetting, the corresponding method should be selected according to the problematic semicircular canal. Generally, manual reset (such as Epley method, etc.) will be tried first, and if the manual reset operation is inconvenient, you can choose the otolithic reset instrument to assist the reset.

＋

drug therapy

The drug is only adjunctive and does not reduce the otolith.

●When the patient has other diseases at the same time, such diseases should be treated at the same time.

● When the patient has dizziness, imbalance and other uncomfortable conditions after reduction, some drugs that improve microcirculation in the inner ear can be used, such as betahistine and ginkgo biloba extract.

＋

Surgical treatment

If it is clear which semicircular canal problem has been determined, and after more than 1 year of standardized otolith reduction and other comprehensive treatment is still ineffective or the activity is seriously affected by the difficult to cure patient, may consider surgery such as semicircular canal obstruction.

＋

Vestibular rehabilitation

This is a physical training method that improves the patient's vestibular (balance) function and alleviates sequelae caused by vestibular injuries. It can be used as an adjunctive treatment for the reduction of otolithiasis in patients with otolithiasis, and is used in patients who still have symptoms such as dizziness after reduction. Some patients may feel uncomfortable during reduction therapy, and vestibular rehabilitation can enhance the patient's ability to tolerate otolith reduction. Or when the patient does not want to reduce polyglolitus, this method can be used instead of treatment.

summary

Otolith reduction is the main way to treat otolithiasis, most patients can recover their health after 1 to 2 times of reduction, and a small number of patients need multiple reductions. Some patients will still relapse after being cured and need to be treated again.

Some patients have a bad effect after multiple otolith reduction treatment, and there will still be dizziness and other uncomfortable times, so they can go to the hospital for further treatment, such as vestibular rehabilitation training, surgical treatment, etc.

Otoliths should not be active vigorously after reduction, and be careful of head trauma (including slapping the head). In addition, you need to get enough sleep to avoid exertion and mood swings.

After the patient's otolith is reset, he should follow the doctor, see the doctor again on time, review, and further treatment and efficacy evaluation.

bibliography:

1． Editorial Board of Chinese Journal of Otolaryngology Head and Neck Surgery, Chinese Medical Association Otolaryngology Head and Neck Surgery Branch. Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo (2017).Chinese Journal of Otolaryngology Head and Neck Surgery.2017,52(3):173-177.

2． Chinese Medical Association, Journal of Chinese Medical Association, General Medicine Branch of Chinese Medical Association, et al. Guidelines for Primary Diagnosis and Treatment of Dizziness/Vertigo (2019)[J]. Chinese Journal of General Practitioners,2020,19(3):201-216.

3．Evangelos A , Ioanna K , Konstantinos S . Diagnosis and Treatment of Anterior-Canal Benign Paroxysmal Positional Vertigo: A Systematic Review[J]. Journal of Clinical Neurology, 2015, 11(3):262-.-267．

Source: Department of General Medicine, Run Run Shaw Hospital

Author: Pan Bintao Instructor: Zhang Jia

Original works, reprinted please indicate the source and source

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