A friend with severe vertigo

[Pastelart]

I have an elderly friend who is suffering terribly with very severe vertigo to the point where she can hardly walk, has to lie down all the time and is now suicidal. Can anyone make any suggestions?

[SeasideSusie Remembering]

Pastelart

What is her GP doing about the vertigo?

Has she had B12 checked?

[Jazzw]

Has her doctor done the obvious tests — ones for postural hypotension (blood pressure ups and downs related to changes of position), blood sugar, checked for atrial fibrillation etc?

If so, and all obvious things ruled out, there are drugs like stemetil that can sometimes help.

Back to the doctor’s, I think. I’m afraid it’s not easy to suggest things that might help without knowing the cause.

[Marz]

Make sure they check the basics -B12 - Folate - Ferritin - VitD. They are not routinely tested and need to be requested - sigh ! Thyroid ? Many elderly have Low T3 ...

[Pastelart]

Thank you for your suggestions. As far as know, they haven’t done much apart from sending her to physio. She is on stemetil, doesn’t seem to be helping much. She has an appointment on Friday and have told her to ask them to test for vitamins etc and thyroid, in fact to ask for every test going till they get to the bottom of it. This has been going on for years, but getting worse and worse.

[SlowDragon Administrator in reply to Pastelart]

She may need to get tests privately...like thousands on here

Obviously vitamins need testing

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[lisabax in reply to Pastelart]

Ménière’s disease? Have they considered that. It must be awful for her!

[Batty1 in reply to Pastelart]

Is she on any medications PRIOR to the vertigo or having hearing issues?

[mrsgreen]

Hi, it sounds like your friend needs an Epley maneuver - this needs to be done by an ENT doctor - I know as my mother suffered from vertigo & this was the only treatment that worked for her. Good luck!

[Fruitandnutcase in reply to mrsgreen]

Was just going to suggest that although I have know an elderly gentleman who has had that done a couple of times with no success, in fact he said he ended up feeling worse than ever which is the last thing your friend needs.

[mrsgreen in reply to Fruitandnutcase]

My mother is 74 years old & was diagnosed with BPPV and she found this treatment was the only thing that helped her in conjunction with exercises prescribed by the Professor. It really needs to be undertaken by someone with expertise in this treatment hence why I suggested the London Hearing & Balance Clinic. I hope they find a suitable treatment soon.

[Catou142 in reply to Fruitandnutcase]

With Eppley, it only works if the ocotonia (lose crystals which have become displaced in the inner ear tubes) is in the posterior canal. It could be that the elderly gentleman you know needs to do a different manoeuvre called the 'BBQ Roll' (yes, that's the official name!). This manoeuvre works when the crystals have moved into the lateral tubes. This has happened to me recently. Eppley used to work for years and years and then last May, it stopped. Shock horror! I had to do more research and found out about this BBQ roll. Look it up on youtube, there's lots of videos. I like / used this one: bing.com/videos/search?q=yo...

[Fruitandnutcase in reply to Catou142]

No, his was done in a proper hospital (Addenbrookes in Cambridge) he had lots of other problems as well - I don’t know that the Eppley works for everyone. Must look up the BBQ roll, never heard of that.

[Catou142 in reply to Fruitandnutcase]

I think the Eppley manoeuvre works if you have posterior canal BPPV. I was in ENT in Kettering and the ENT didn't diagnose my BPPV properly. He did the Eppley but in fact, I needed the BBQ roll. I found this online for you: 'Patients with lateral canal BPPV are usually very dizzy with their head turned to either side in bed. This is very different than the situation with posterior canal BPPVwhere one is dizzy only to the "bad side". In anterior canal BPPV, symptoms are often worse straight back.'

[Batty1 in reply to Fruitandnutcase]

It only works if that is your problem if you have same or worsening vertigo that’s probably not the problem.

BBQ Roll, is this where they put you on a table with head hanging over the edge and quickly roll your head from side to side ?

[Catou142 in reply to Batty1]

The inner ear tubes are a very complex system to understand. It could be that the wrong manoeuvre has been done. It could still be BPPV: crystals in the affected canal have not been moved, because the wrong manoeuvre has been carried out. The BBQ roll is actually a much more pleasant manoeuvre to experience as a patient. You just lie on your bed and roll around. Your head is NOT dangling at a 30degree angle or anything like that. I hate the Eppley.

[Batty1 in reply to Catou142]

Ok same thing essentially. I guess the only real test would be to do it and see if it helps or not. I was eventually diagnosed again by another ENT as possibly having autoimmune inner ear disease and to test his theory he wanted to pump me full of steroids (No thanks) but I do think he is correct because after my thyroidectomy my vertigo seemed to disappeared PRIOR to thyroidectomy I had vertigo spells so bad I would pass out.

[Catou142 in reply to Batty1]

I would not say they are the same at all. I've just experienced it myself: Eppley: 0 vs BBQ roll: 1. Yes, the real test is to perform both and see which one works, although a good ENT or specialist physio can see it in your nystagmus (in this case, my daughter filmed me!! Spooky to watch but effective). Yes, I am sure that this inner ear problem (BPPV) can be yet another auto-immune condition.

Here's the info: (source: pubmed.ncbi.nlm.nih.gov/250...

'There are few conditions in neurology that are diagnosed with such ease and certainty as benign paroxysmal positional vertigo (BPPV). Repositioning maneuvers are highly effective in treating BPPV, inexpensive, and easy to apply. Surgery has a very minor role in the management of BPPV, and although medications may transiently ameliorate symptoms, they do not treat the underlying process. There is good evidence to support treatment of posterior canal BPPV with Epley or Semont maneuvers and horizontal canal BPPV with Gufoni maneuvers or BBQ roll (also known as Lempert 360 roll or log roll); and weaker evidence for head hanging maneuvers in the least common anterior canal variant. Since the therapeutic efficacy amongst maneuvers for each canal is comparable, the choice of treatment is generally based on clinician preference, complexity of the maneuvers themselves, poor treatment response to specific maneuvers, and musculoskeletal considerations such as arthritic changes and range of motion of the cervical spine. Treating posterior canal BPPV with Epley or Semont manuevers is comparable as far as efficacy and the ease with which maneuvers are performed. For horizontal canal BPPV, the Gufoni maneuver is easier to perform compared to the BBQ roll, as it requires that the clinician only identify the side of weaker nystagmus (regardless of whether it's geotropic or apogeotropic) and not necessarily the side involved. Anterior canal BPPV is rare and generally short-lived, but there is weak evidence that deep head hanging and a variety of eponymous maneuvers may hasten recovery. The advantage of deep head hanging maneuvers is that they can be effectively performed without knowledge of the side involved.'

[Catou142 in reply to Batty1]

Most people have posterior canals affected. But it could very well be the lateral canal and that's a completely different treatment.

Another very interesting article pubmed.ncbi.nlm.nih.gov/325...

'Lateral canal BPPV is an important diagnosis to consider in all cases of BPPV. Its true incidence is still under blanket as many clinicians are not using supine roll test routinely in their practice while diagnosing BPPV. Many refractory cases of BPPV can be cured if the involvement of other canals in its pathogenesis is kept in the mind so that correct diagnostic and repositioning maneuvers can be applied. We also encourage more institutional studies on lateral canal BPPV so that a standard treatment protocol with clear indications can be designed for this entity as is available for BPPV.'

Full article:

'Abstract

Benign Paroxysmal Vertigo is one of the most common causes of vertigo. The most common semicircular canal involved in pathogenesis of BPPV is Posterior semicircular canal. However anterior and lateral semicircular canals can also sometimes be responsible for BPPV but their involvement in pathogenesis is still underrated. The incidence of lateral semicircular canal BPPV is in literature is around 10-12% while anterior canal is about 3%. The main objective of this study was to provide the database for incidence of lateral canal BPPV from a tertiary care hospital with the aim that more clinicians incorporate this entity into their differential diagnosis when their cases of posterior canal BPPV are refractory. This was an observational cross-sectional study of 300 patients of BPPV who were coming in ENT OPD as primum or as referral. All the patients underwent both the Dix-Hallpike maneuver as well as the supine roll test. The patients who were having upbeating torsional vertical nystagmus on Dix-Hallpike were treated on lines of posterior canal BPPV whereas those with horizontal nystagmus on supine roll test were treated on lines of lateral canal BPPV. The data was tabulated and analysed for the incidence of lateral canal BPPV. Out of 300 patients; 188 were males and 122 were females. Most commonly affected age group by BPPV was 40-50 years. Out of 300 cases 260 cases (86.6%) had posterior BPPV and 37 cases (12.3%) had lateral canal BPPV. 3 cases (1%) also had anterior canal BPPV. 30/37 cases of lateral BPPV had geotropic nystagmus while 7 cases had apo-geotropic nystagmus. Posterior canal BPPv was treated by Epleys maneuver. Superior canal BPPV was treated by Yacovino maneuver. The cases of lateral canal BPPV were treated by either Vannucchi-asprella; Gufoni; Lempert maneuver or by the combination of two maneuvers. Lateral canal BPPV is an important diagnosis to consider in all cases of BPPV. Its true incidence is still under blanket as many clinicians are not using supine roll test routinely in their practice while diagnosing BPPV. Many refractory cases of BPPV can be cured if the involvement of other canals in its pathogenesis is kept in the mind so that correct diagnostic and repositioning maneuvers can be applied. We also encourage more institutional studies on lateral canal BPPV so that a standard treatment protocol with clear indications can be designed for this entity as is available for BPPV.'

[mrsgreen]

lhabc.co.uk/#contact-us

[Sparklegrrl]

Whilst it could be a thyroid or vitamin related issues, it could also be BPPV (Benign Paroxysmal Postural Vertigo) or Menieres Disease which would likely need an ENT referral. I'm currently having my vertigo investigated (amongst other symptoms) at the hospital by ENT - so far they've done a hearing test and are booking a scan of my ear too. I'd suggest to your friend that she pushes for a referral.

[Batty1 in reply to Sparklegrrl]

I was diagnosed with Ménière’s disease years ago “ NO TEST” to diagnose this disease its pretty much a process of elimination. It was only the past 2 yrs that a new ENT said he believes my issues are probably Autoimmune inner ear disease. I do have autoimmune disease so it is possible.

I take this supplement called Lipo Flavinoid plus when my ears act up and had good results.....

[Sparklegrrl in reply to Batty1]

I was led to believe that it's a matter of tests to eliminate other potential causes rather than to diagnose the condition.

[Batty1 in reply to Sparklegrrl]

Yes after they eliminated everything else I was diagnosed with meineres disease .... roughly a 10yr process.

[topaz1]

My neighbour has been suffering from vertigo. I looked on the NHS website and eventually found some exercises on one of their hospital website, and the exercises seem to have worked. Sorry I cant be more specific!

[Catou142]

Hello, I am hypothyroid and also have recurrent BPPV. There are some manoeuvre you can do to get rid of the vertigo, if it is BPPV. When does her vertigo occur? Is it when she has her head in certain positions (mostly tilting head backwards or sideways?). Another one could be DDDP, which I have only recently learned about and sounds awful. Things CAN improve with vertigo. Please tell your friend this. There is a great group out there which I have only just found out about which is called Life on the Level. I was diagnosed in 2011 at the Leicester Balance Centre (part of Leicester Royal Infirmary) which is one of the best in the country. I think they no longer accept outside of county now...sigh! Your friend needs to see a good ENT (there are bad ones out there!!) Please signpost your friend to the group, they have a fantastic founder and great network. lifeonthelevel.org/

[Catou142]

I would check her Vit. D / Calcium - which has recently been found out to be connected with BPPV (South Korean research) Here's the link: peoplespharmacy.com/article...