When hanging clothes, I suddenly looked up and my head turned dizzy. Is it "bad cervical spine"? Turn over in bed and feel dizzy for a few seconds. Is it "poor sleep"? Bend down to tie your shoelaces, and suddenly feel dizzy. Is it the change of body position that causes "unstable blood pressure"? When you work at your desk, your brain is "black screen" for a moment. Is it insufficient blood supply to your brain? These "dizzy moments" in life have added a lot of troubles to people.
In fact, it is probably related to the ear!
Chief physician Zeng Xiangli, vice chairman of China Branch of International Association of Otologists and director of Otolaryngology Department of the Third Affiliated Hospital of Sun Yat-sen University, reminded people who often have transient dizziness to be careful of "otolith". For patients with recurrent otolith and stubborn otolith accompanied by symptoms of Meniere’s disease, such as deafness, tinnitus and swelling in the ear, we should also be alert to the possibility of hearing loss or even deafness.
Text/Guangzhou Daily All-Media Reporter Ren Shanshan Correspondent Zhou Jinan Zhen Xiaozhou Ye Zhangxiang
Deciphering "Otolithiasis": Pay attention to these dangerous signals
What is otolith? Zeng Xiangli pointed out that it is actually the common name of "benign paroxysmal positional vertigo (BPPV)", which is a temporary vertigo caused by the falling off of the "otolith" located in the inner ear, so it is called "otolith".
The biggest feature of this disease is that vertigo attacks are related to changes in head position, and symptoms can appear or worsen with changes in body position. Outpatients often encounter some "otolith" patients. At the initial onset, they mistakenly thought that the causes were cervical spondylosis, poor sleep quality, unstable blood pressure, etc. After turning to several specialties and poor treatment results, they learned that there were "otolith" behind these dangerous signals, and finally went to the otology clinic for help.
Attending physician Yin Gendi, a young member of the Vertigo Rehabilitation Committee of the Chinese Rehabilitation Medical Association, pointed out that the main clinical manifestations of "otolith" are that when the head position or posture is changed (lying down, turning over in bed, lowering the head or raising the head), recurrent and short-lived vertigo may occur, lasting for several seconds to about 1 minute, and may be accompanied by symptoms such as nausea, vomiting and sweating. "Otolithiasis" is often asymptomatic during the intermission, and some patients may have dizziness, fatigue, top-heavy and floating feeling after the vertigo attack.
Zeng Xiangli pointed out that "otolith" is a carbonate crystal of the inner ear and belongs to the normal structure of the inner ear. Under normal circumstances, "otolith" is attached to the otolith membrane of the oval sac. When some pathogenic factors cause the "otolith" to detach, these detached "otoliths" move into the semicircular canal, dragging the flow of lymph in the semicircular canal, stimulating the hair cells of the semicircular canal, and causing dizziness.
A variety of diseases
Associated with "otolith"
The occurrence of otolith is related to many factors. It is often secondary to systemic basic diseases, such as arteriosclerosis, hypertension, diabetes and other adverse factors can cause blood supply disorders in the inner ear and peripheral neuropathy. The otolith membrane on the cyst spot of the oval capsule becomes thinner due to malnutrition, and the otolith located on the otolith membrane falls off and deposits in the semicircular canal due to "unstable foundation".
osteoporosis
Yin Gendi pointed out that the incidence of osteoporosis among middle-aged and elderly women with otolith in foreign countries is as high as 75%, while the normal control group is only 4%. This shows that osteoporosis may be inextricably linked with the occurrence of otolith, and its pathogenic mechanism needs further study.
Head trauma or ear surgery
Stop immediately after the head is hit by an external force or the head accelerates, such as whiplash-like injury can cause this disease; Some middle ear and inner ear operations, such as stapes operation, can cause this disease because of local pressure or otolith falling off after the stapes foot plate is inserted into the vestibular window.
Other ear diseases
"I am not only dizzy, but also have tinnitus and hearing problems. Before, a doctor said that I had Meniere’s disease, and now I have been diagnosed with otolith. What kind of disease do I have?" This is a question often asked in vertigo clinics. Such a disease course and experience of diagnosis and treatment have really troubled many people.
The reason is that "otolith" can be secondary to the following kinds of otological diseases, in order of incidence: sudden deafness with vertigo, Meniere’s disease, vestibular neuritis, viral labyrinthitis, middle ear mastoid infectious diseases, external lymphatic fistula and other diseases, all of which are easy to cause otolith particles to fall off and agglutinate and induce this disease.
The otolith secondary to Meniere’s disease has the characteristics of Meniere’s disease and otolith at the same time, with a high recurrence rate and a relatively long course of treatment.
Manual reduction therapy
The effective rate can be as high as 890%
Generally speaking, the treatment effect of otolith is very good, and the first choice of manual reduction, supplemented by drug treatment, often has immediate results — — This is the reason why it is called "benign" and is legendary as "easy to govern". However, about 1% to 20% of patients have recurrent vertigo, especially those secondary to diabetes, Meniere’s disease and female menopause. Zeng Xiangli pointed out that for these stubborn "otolith" patients, the cause is more complicated.
Some people are "otoliths" and fall off too much at one time. For example, "otolith" caused by trauma is easy to be repeated. It is often due to severe trauma that otolith falls off too much and is widely dispersed in the semicircular canal. It is difficult to reset otolith and excessive otolith is not easy to absorb, so the disease is prolonged.
Some people are "otoliths" that keep falling off. The failure to improve the microcirculation of the inner ear is also the cause of repeated diseases. The otolith has insufficient blood supply and malnutrition, which leads to the "unstable foundation" and the otolith repeatedly falls off into the semicircular canal, which can eventually lead to the recurrence of otolith.
There are still some people who have "otolith" and the residual symptoms persist. About 10% patients continue to feel dizzy and weak, top-heavy and floating after reduction. The reason for the persistence of this residual symptom may be related to the existence of trace otolith particles in the semicircular canal, the dysfunction of elliptical capsule and the mental and psychological disorders caused by long-term dizziness.
Zeng Xiangli said that most of the "otoliths" have good treatment effects, and the effective rate of manual reduction treatment can be as high as 79.4%-92.7%, but there are still 12.8%-15.3% patients who need two or more reductions. If the symptoms are relieved after the first manual reduction treatment, but there are still dizziness, instability, dizziness and heaviness, you need to go back for a week to judge the treatment effect, and consider re-reduction treatment, supplemented by vestibular rehabilitation training.
Vestibular rehabilitation training is a physical training method, which can improve patients’ vestibular function and reduce the sequelae caused by vestibular injury through central adaptation and compensation mechanism. Vestibular rehabilitation training can be used as an auxiliary treatment for otolith reduction in patients with BPPV, and it can be used for patients with poor reduction effect and dizziness or balance disorder after reduction.