What is BPPV?
BPPV is caused by dysfunction of the inner ear and it is a very common cause of dizziness. In BPPV, abnormal electrical signals are generated in the inner ear and these are sent to the brain. These signals result in the illusion of body movement when body movement is not actually occurring. Crystal deposits in the inner ear generate these confusing signals and are identified as the cause of BPPV.
Patients complain of brief episodes of spinning lasting 15-60 seconds. Sudden changes in body position, like rolling sideways in bed or head movements up and to the side may elicit an attack. Each episode of BPPV may be accompanied by nausea or vomiting, but patients generally do not complain of hearing loss, tinnitus, ear pressure or headaches.
The onset of BPPV may follow head trauma or an inner ear viral infection, however in most patients, BPPV develops for unknown reasons. BPPV resolves spontaneously in some individuals, but with persistent symptoms the patient may request treatment.
BPPV is diagnosed by history and by physical examination. The Dix-Hallpike maneuver confirms the diagnosis and is performed by rapidly laying the patient backward from a sitting position with the head turned. Reproduction of the symptoms of an attack with the Dix-Hallpike, combined with the observation of eye movements confirms the diagnosis.
Treatment of BPPV includes a repositioning maneuver performed in the clinic with a set of instructions to follow. Successful treatment is common but recurrence may necessitate subsequent maneuvers.
What is an Acoustic Neuroma/Vestibular Schwannoma?
An acoustic neuroma or vestibular schwannoma is a benign tumor (not a cancer or a malignant tumor) that develops on or about the nerves for balance and hearing as they travel between the inner ear and brainstem. This tumor ordinarily does not spread to distant parts of the body but because of its strategic location, is still a significant threat to life. If left alone, this tumor will slowly grow, destroying all hearing and balance and eventually paralyze the side of the face. With time, it will press against the brainstem and cause increased intracranial pressure and even death. For this reason, this tumor must be removed. There are several different surgical approaches to removal of this tumor, all of which share common risks. A good “surgical team” should be made up of an experienced neurotologist, a neurosurgeon, and an anesthesiologist who can base their surgical approach on the size of the tumor and the patient’s condition rather than on their surgical abilities.
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