BPPV

Entry by Carol

July 3, 2014.  

Today I took Mom to Phoenix for an appointment Linnette had set up for her dizziness at ABHA (Arizona Balance and Hearing Associates).  Linnette had suspected mom had BPPV (benign paroxysmal positional vertigo) and found a facility that performed a procedure called the Epley Maneuver.  We signed in on time and waited for about 45 minutes before we were called in by a student nurse and the technician, a lady named Dana L. Day, Au.D, CCC-A, MBA. I provided a list of episodes of dizziness Mom had experienced this year from my records and, of course, there were more.   [The ear normally uses small crystals called “otoconia” to determine the direction of gravity.  With BPPV, these crystals come loose and float around inside the inner ear. These crystal particles cause the sensation of vertigo (spinning) every time they are disturbed by head motion.]

The technician was very good with Mom, very calming, reassuring, explained everything she was going to do before she did it. She showed us a chart with the ear canal(s) and pointed out where the crystals get lodged and where they sometimes get stuck.    She tried to ascertain from Mom exactly what she was doing when the dizziness occurred.  That was hard for mom to answer, probably because the attack overpowered any thought of trying to associate the dizziness with activity.

The technician then began. She had mom sit on the table with legs extended and head facing toward one side or another. Then she quickly laid her down again while holding her head in a certain position. Each time she moved Mom to another position she had her remain there for a minute or so. Then she did the same thing to the other side.  Each time she moved Mom, she told Mom what she was going to do. Then she rolls Mom over on her side instructing her to look at the floor or the technician's face. Mom was very cooperative.  At one point during all of this, Mom suddenly went into the same behavior I saw in her the night we had her taken to the ER by ambulance. She screamed with fear and I knew she was having the dizziness. 

After each maneuver, she cupped Mom’s face in her hands and watched closely.  As they both peered into Mom’s face after each maneuver, I heard the technician say to the student, “Do you see it?”  I leaned forward to get a glimpse of what they were seeing.  It was the reaction of Mom’s eyes, which indicates the state of dizziness. The reaction is called “nystagmus,” which refers to the repeated and rhythmic oscillation of the eyes.  If I understood it correctly, it seems in order to diagnosis this correctly, they have to recreate the symptoms by having Mom make the head movements which would induce the dizziness and then check the eyes for predictable response. 

It usually only occurs in one ear and Mom’s right ear is the culprit.  The left ear is okay.  The technician said these are easily treated cases where the crystals just fall back into place and there are the more difficult cases where they sometimes get stuck and are more stubborn to remove.  At one point she may have said Mom’s case may be one of the more difficult cases because when she laid her on the table, Mom had a delayed reaction which might have indicated the crystals were stuck and took longer to fall. 

Mom has to sleep on a recliner for two nights, 45-degree position and cannot sleep on her right side. No bending over (e.g., tying shoelaces) and no looking up (e.g., to take something off the top shelf). Looking from left to right is fine but no looking up or down.  She can look with her eyeballs but she is not to move her head up and down.  After two nights she can lay on her right side.  When she gets out of the bed, she is to get off from the left side, just the opposite of how she does it now. So maybe she will have to switch sides of the bed or sleep with feet towards the top and head towards the bottom. 

The technician said there is a 50/50 chance that mom won’t have to come back but said if she does, don’t be discouraged because these cases have a high rate of success.  All I could think about during this thing was how thankful I am to Linnette for finding out this thing, in fact, my heart felt such gratitude towards her that I felt overwhelmed. 

Mom has an instruction sheet to follow and they will call her on Monday to get a progress report. Unfortunately, we have a very stubborn patient. She spent her first night in the recliner but this is the second night and I just woke up on the living room couch and looked over at an empty recliner with a missing mother.