What is otolithiasis?
Otolithiasis, the academic name for benign paroxysmal positional vertigo, is the most common inner ear disorder that causes vertigo, and can occur in anyone, but is more common in older adults.
Benign paroxysmal positional vertigo, as the name implies.
Benign: Although the vertigo is intense and causes fear and pain to the patient, it is not life-threatening.
Paroxysmal: the onset is sudden and the duration of vertigo is short.
Positional: attacks are triggered by specific head positions or movements, and may be triggered by turning over, getting up, turning and lifting the head.
How is otoliths caused?
Most otoliths have no known cause. Possible causes include trauma, migraines, other inner ear disorders, diabetes, osteoporosis, prolonged unilateral sleep, and prolonged bed rest due to surgery or illness.
Otoliths are calcium carbonate crystals normally found in the human inner ear and play an important role in maintaining our body’s motor balance. The otolith is normally located in the center of the inner ear. When the otolith is dislodged from its normal position, it floats in the semicircular canal of the inner ear or attaches itself to the wrong position of the balance receptors. When we change the position of our head or body and these dislodged otoliths move in the wrong direction with gravity, our brain receives the wrong signals induced by the dislodged otoliths and we get the illusion that our body or surrounding objects are spinning fast.
What are the common symptoms of otoliths?
The main symptoms of otoliths are
Posture-induced transient severe vertigo, spinning sensation or unsteadiness (usually within 1 minute)
Nausea and, in severe cases, vomiting
Feeling of unstable balance or floating
The clinical presentation is not exactly the same for each person’s condition. Patients with otolithiasis usually experience dizziness or a feeling of instability after a few seconds to minutes of intense vertigo that lasts for a longer period of time. Some patients, especially the elderly, may have vertigo that is not particularly intense and only feel a brief feeling of unsteadiness when getting up, tilting the head, bending over, or lowering the head. Otolithiasis only occurs when the head position changes and does not cause continuous severe dizziness, affect hearing, or go so far as to cause coma. However, dizziness during an otolith attack can increase or decrease the risk of a fall.
How is otolithiasis diagnosed?
An experienced physician can make a definitive diagnosis by simply taking a medical history and examining your body. Your doctor will determine if you have an otolith by turning your head to move the dislodged ear stone, inducing a sensation of dizziness, and looking into your eyes. The most common tests for otoliths are the Dix-Hallpike test and the supine roll test, both of which are non-invasive and easy to perform.
How is otolithiasis treated?
The preferred treatment for otoliths is manual repositioning, which can be done with the bare hands or with the help of an instrument, and can be done in just a few minutes by an experienced physician with an efficiency rate of over 80%. The purpose of manual repositioning is to reset the dislodged otolith to its original position so that it does not cause vertigo, not to remove it. After a doctor’s diagnosis, you can also have home rehabilitation treatment at home under the guidance of your doctor.
Medication.
In principle, medication does not reset the otolith, but in view of the fact that BPPV may be related to degenerative disease of the inner ear or combined with other vertigo diseases, medication may be considered as an adjunctive treatment in the following cases
1. When combined with other diseases, such diseases should be treated at the same time.
2.When there are symptoms such as dizziness and balance disorders after repositioning, drugs to improve inner ear microcirculation, such as betahistine and ginkgo biloba extract, can be given.
3. Because vestibular inhibitors can inhibit or slow down vestibular compensation, they are not recommended for routine use.
Surgical treatment.
For refractory patients with clear diagnosis, clear responsible semicircular canal, still ineffective after more than 1 year of standardized comprehensive treatment such as otolith repositioning and severely restricted activity, surgical treatment such as semicircular canal obstruction can be considered.
Vestibular rehabilitation training.
Vestibular rehabilitation training is a physical training method to improve the patient’s vestibular function through central adaptation and compensatory mechanisms and to reduce the sequelae caused by vestibular injury. Vestibular rehabilitation can be used as an adjunct to otolith repositioning in patients with BPPV, in cases where repositioning is ineffective and dizziness or balance disturbances persist after repositioning, or before repositioning treatment to increase patient tolerance to repositioning. Vestibular rehabilitation can be used as an alternative treatment if the patient refuses or does not tolerate the repositioning treatment.
Can otolithiasis heal on its own?
Even without treatment, otolithiasis usually heals within a few weeks. The symptoms are usually most severe during the first episode and gradually decrease thereafter. It is important to note that in addition to nausea and motor discomfort, otolithiasis can also cause a feeling of instability that may result in a fall. Elderly people or those with other balance disorders are at higher risk of falling and it is recommended to seek medical treatment as soon as possible.
How long does it take to fully recover from otolithiasis?
During otolith repositioning treatment, you may experience vertigo, nausea and vomiting, and disorientation. Most patients will experience these symptoms immediately after repositioning, but a small number of people may still feel a sense of instability. Older patients with a history of falls need to seek medical help as soon as possible.
Why do otoliths need to be reviewed?
The effectiveness of otolithology treatment with manual repositioning ranges from 79.4% to 92.7%, but 12.8% to 15.3% of patients need to be repositioned twice. If the symptoms are relieved after the first treatment, but do not disappear completely, it is necessary to follow up after 1 week to determine the effectiveness of the treatment and to consider repositioning again.
Patients whose symptoms do not resolve after two repositionings need to be reviewed. The purpose of the review is to assess again whether the diagnosis of otoliths is accurate, because many CNS symptoms can have similar symptoms to otoliths, but reset treatment for CNS disease is ineffective, and there are studies that prove that about 1.1-3% of this group of patients have CNS pathology.
Therefore, it is recommended that most patients with otolithiasis be reviewed regularly after repositioning treatment, especially if they do not achieve complete remission after treatment, not only to speed up the recovery process, but more importantly to rule out potential CNS pathology.
How can otolithiasis be prevented?
Unfortunately, otoliths can recur, and the chance of recurrence may be related to factors such as trauma, inner ear and systemic status, and age. Although the cure rate for otoliths is high, medical research currently has no reliable method of preventing recurrence. Follow-up is especially important if there are persistent symptoms of vertigo and unsteadiness.
What can patients do on their own to help their recovery?
Try to move as much as possible and avoid too much bed rest as long as it is safe to do so.
Avoid vestibular depressants that sedate and stop dizziness.
Patients who are able to do so can undergo vestibular rehabilitation training. Vestibular rehabilitation is a physical training method that improves the patient’s vestibular function through central adaptation and compensatory mechanisms to reduce the sequelae caused by vestibular injury.