1.Dizziness & Vertigo:Evaluation and Treatment Options Al Turri Au.D Hearing and Dizziness Wellness CenterOrlando, Clermont and BELLEVIEW www.fixmyhearing.com [email_address]

2. Overview

Dizziness

• Multiple Causes

Vertigo

• Inner Ear Problems

Imbalance

• Multiple Causes

3. Vertigo

Vertigo hallucination of spinning

85% of all vertigo is caused by an inner ear problem Johns Hopkins University

4. 5. Inner Ear Problems and Vertigo

Menieres Disease

• Vertigo lasting 30 minutes 24 hours

• Hearing Loss & Tinnitus

Vestibular Neuritis

• Vertigo lasting 24-72 hours

• Nausea & Vomiting

Benign Paroxysmal Positional Vertigo (BPPV)

• Vertigo lasting seconds

• Provoked by change in head position

6. Menieres Disease Too much inner ear fluid 7. Vestibular Neuritis 8. Vestibular Rehabilitation

Menieres Disease

• Medicine during worst symptoms

• Possibly surgery

• Vestibular Rehabilitation

Vestibular Neuritis

• Medicine during worst symptoms

• Vestibular Rehabilitation

9. Vestibular Rehabilitation:Gaze Stabilization 10. Vestibular Rehabilitation: Adaptation/Habituation & Substitution 11. Benign Paroxysmal Positional Vertigo (BPPV)

Positional Vertigo:

Most common cause of vertigo

#1 cause of vertigo in individuals 50 years and older

50% of patients> 70 will experience BPPV

May trouble patient for years

May contribute to imbalance

12. Calcium Carbonate Crystals -- Stones Positional Vertigo 13. Utricle Gravity Detector (Stones are supposed to be here) 14. Stones from Utricle show both small and large crystals Close-up of crystals showing cylindrical forms Electron Micrograph (Lim, 1969) 15. Stones in the Wrong Place

Stones move from correct part of inner ear to the wrong part

Why does this happen?

• Inner ear infection

• Head Trauma

• Multiple Medications

• Cardiovascular Problems

• Diabetes

2007 American Institute of Balance Education Foundation 16. Symptoms:

Change in head position

• Looking up

• Lying down

• Getting hair washed

Short duration (less than 1 minute)

May be accompanied by imbalance

17. Oghalai, J., Manolidis, S., Barth, J., Stewart, M., & Jenkins, H. (2000).Otolaryngology Head and Neck Surgery , 122, 630-634. 18. BPPV Treatment

BPPV does not respond to medicine

Surgical management includes singular neurectomy or posterior canal occlusion

Habituation - (Brandt & Daroff, 1980)

Repositioning Maneuvers - (Semont et al, 1988; Epley, 1992; Roberts, Gans, & Montaudo, 2006)

19. Progression of Stones through Posterior Canal Step 1. Posterior Canal Vertical Step 2. Posterior Canal Horizontal Step 3. Posterior Canal Rotated Step 4. Posterior Canal Returned to Vertical 20. Canalith Repositioning (left ear) Patient kept in each position for 1-3 minutes 21. Case Study

76 Year Old Male

Initial event followed by 2-3 months of dizziness turning to Right

Nausea & disturbance of balance in the A.M.

Hearing Loss, Tinnitus

22. Case Study 23. Treatment Outcomes

Goal: Extinguish Positional Vertigo

80-96% + success with all types oftreatments

24. Imbalance

Problem at any point may create tendency to fall

25. Keeping Seniors Safe From Falls Act

Balance problems may lead to:

• Hip and Limb Fracture

• Head Trauma

• Reduced Mobility

• Decreased Independence

Falls leading cause of injury deaths among individuals whoare over 65 years of age

110 thSession of Congress, 2006 Hospital Admissions for Hip Fractures among the Elderly 1988 1999 2040 231,000 332,000 >500,000 26. Balance Intervention Program

Balance Retraining Therapy

Weight Training

Fall Prevention

27. Balance Board 28. Walking Outside 29. Walking Without Help 30. YouDo Nothave to Learn to Live With It www.fixmyhearing.com Hearing and Dizziness Wellness Center