Amy Nett: Next question from Chi. Chi asks, “What tests should I consider to get to the root cause of benign paroxysmal positional vertigo?” Which from now on we’re just going to call BPPV. “This client is 80 years old and has had a couple of minor strokes.” Then she gives me a little more detail and she says, “GI and SIBO testing. I’m looking at inflammation markers. They’re already at the top of my list, and he’s on proton pump inhibitors for GERD. He’s had gout in the past, though no flare for the past three to four years, and was previously on medication for gout. He also has histamine issues, reacts to most probiotics and fermented foods. His wife makes everything from scratch including kombucha, kimchi, and kefir, but he tends to eat very large amounts of fruit and often eats biscuits and chocolate.” No, not the biscuits. It sounds like you might have to wean him off of those.
This is a great question. BPPV, for those of you, just to clarify, I’m not sure everyone knows what BPPV is, but basically benign paroxysmal positional vertigo is probably the most common form of vertigo, but at least it’s a very common form of vertigo, and it accounts for probably about half of all patients with peripheral vestibular dysfunction. Again, BPPV, remember the “B” there stands for benign. This isn’t generally a cause of vertigo that we worry about, and if you can clinically diagnose it as being BPPV, you really don’t need to send patients for MRI or further workup because the symptoms are just diagnostic.
We think that BPPV is due to calcium degree located within the semicircular canals, so these are basically a little calcium stones in most commonly the posterior semicircular canal. The symptoms are certainly alarming if patients have never had vertigo before, and I think one of the most important things once you know it’s BPPV is really just to reassure patients. Emphasis on benign. We just need to get the crystals out of the ear, and there is a maneuver, I believe it’s called Epley’s maneuver that can be done to really just get the crystals out of that posterior semicircular canal so that the symptom resolves almost almost always, but not in every case. BPPV can be recurrent, but it usually responds to treatment with these particle repositioning maneuvers. You can even teach patients how to do this at home, and since I see a lot of patients just over phone or video, I directed some patients just to YouTube videos showing them how to do this sort of head movement at home to get the crystals out of that posterior semicircular canal, and it tends to work pretty well.