For positional vertigo, otolithiasis should be considered first!

Speaking of dizziness, I guess many of you have experienced it. For example, if you squat on the ground for a long time and suddenly stand up, you suddenly feel dizzy and everything goes black in front of your eyes. This is a symptom of hypoglycemia. Then, you should pay attention to the dizziness caused by sudden movement, as it may be otolithiasis.

What is otolithiasis?

Otolithiasis, scientifically known as benign paroxysmal positional vertigo, refers to short-term, paroxysmal vertigo and horizontal or rotational nystagmus that are triggered when the head moves quickly to a certain position. The so-called benign means that it is treatable and self-healing; the so-called paroxysmal and positional means that the dizziness attacks are short-lived and are related to the rotation of the head and neck. Most patients experience symptoms of dizziness when they are resting or getting up, turning over in a certain direction in bed, causing dizziness, accompanied by nausea and vomiting, and they must maintain a forced sleeping position; some patients experience attacks when they get up or lie back in bed, but are normal when walking. Dizziness attacks are short-lived, a few seconds or tens of seconds, rarely more than a minute.

How are otolithiasis caused?

The reason why humans can move normally is because there are organs in both ears that regulate body balance. One of the important structures is the saccule and the ellipsoidal saccule. Because there are calcium carbonate crystals in the saccule and the ellipsoidal saccule that sense changes in the center of gravity and are shaped like stones, the latter is called otoliths and the former is called otolith organs. Some doctors call vertigo caused by otolith organ diseases otolith disease. The cause of benign paroxysmal positional vertigo is still under discussion. Some people believe that it is related to the shedding of otoliths in the otolith organ. Due to head trauma or local structural degeneration due to aging, the otoliths in the otolith organ fall off from their original positions and move to other balance structures. When the head position changes, vertigo occurs. It is like a ball maze played by children. In the maze, the ball moves disorderly, causing imbalance. The doctor's treatment is to turn the ball rolling in the maze back to its original position through manual manipulation.

What causes otolithiasis?

1. When the labyrinth undergoes senile or degenerative changes, the elliptical cyst macules degenerate, and the otolith membrane detaches and enters the semicircular canals, more commonly in the posterior semicircular canal, and occasionally in the lateral and superior semicircular canals.

2. Trauma and head surgery: Minor head trauma or accelerated head movement can cause this disease. For example, otoliths may fall off and enter the semicircular canals after sphenoid bone surgery.

3. Inner ear ischemia: Due to arteriosclerosis and high blood pressure, the inner ear blood supply is insufficient, the collagen membrane of the cystic macula becomes thinner, and the otoliths fall off and enter the semicircular canals.

4. Ear diseases: middle ear mastoid infection, Meniere's disease in remission, sudden deafness, bilateral vestibular asymmetry, etc.

Due to the above reasons, the otoliths in the otolith organ fall off from their original positions and move to other balance structures, causing dizziness when the head position changes. It is like a ball maze played by children, in which the balls move disorderly, causing imbalance.

What are the clinical features of otolithiasis?

Otolithiasis is the most common vertigo disease, accounting for 1/3 of vertigo patients. It can occur in all age groups, but is more common in middle-aged and elderly people. Otolithiasis often occurs when vertigo occurs when lying down, getting up, turning over, or looking up. Vertigo lasts for a short time, generally no more than one minute, and may be accompanied by nausea and vomiting. But it is not accompanied by tinnitus or deafness. Otolithiasis has self-healing properties, so it is called a self-limiting disease. Surgery can be performed if multiple reductions are ineffective.

Why is there no tinnitus or deafness in patients with otolithiasis?

The inner ear is composed of the otolith, semicircular canals, and vestibule. Otolithiasis is caused by the detachment of otoliths, which causes the flow of endolymph in the semicircular canals, and does not involve the otolith. Therefore, there are no audiological changes such as tinnitus and deafness. This is also the reason why patients ignore the choice of ENT department when they are sick.

How is otolithiasis diagnosed?

Interview: Detailed medical history collection. Make a preliminary diagnosis based on the typical medical history.

Vestibular function test: Doctors can use induced nystagmus experiments to determine 1. whether it is otolithiasis and 2. the location of the otolith detachment.

How is otolithiasis treated?

Although otolithiasis is painful, there is now a very good treatment method. This method does not require medication and has a magical therapeutic effect. This treatment method is called "manual reduction therapy." The specific method is that the doctor determines the patient's affected semicircular canal based on the positional nystagmus test, and gives the corresponding method of reduction, by changing the position of the patient's head, so that the detached otoliths return to their original position. Manual reduction of otolithiasis is generally effective once, and some patients need multiple reductions to be cured. General outpatient treatment is sufficient. Patients will induce dizziness during reduction, and occasionally vomiting will occur (family members must be accompanied), but it usually lasts for a short time and has no obvious adverse consequences.

How to prevent otolithiasis?

1. Actively treat post-circulatory ischemia. 2. Avoid trauma. 3. Get enough sleep. 4. Avoid bowing your head for a long time.