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BPPV

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hi. I am a 46y/o male. good physical condition, not over weight. have had a bout of bppv (when waking up on left side) in October 2013, again on January 9. had epley done and also in crp chair at ent's office. this last time in January, two weeks after repositioning maneuvers, I became very dizzy (lightheaded, like on rollercoaster when it goes down real fast) with sick stomach (no vomiting). I have tinnitus, but have since my teens. Dizzy mostly when looking down or turning head side to side. Also tiredness. no other assoc symptoms. went to ent again, did complete hearing tests (auditory, caloric, pressure, vng). nothing found to be wrong. Doctor ruled out Meniere's. Had an mri that came back clear. I do have a hx of degenerative disc in c-5, c-6, with dried up disc c-5. C-6 was 50% dried (no fluid). I have some narrowing of spinal canal at those levels (to about 9mm). narrowing of foraminal openings and bone spurring of affected areas. With this in the past, I had developed serious headaches that were cleared up with p.t. Question, knowing all this, what can be causing dizziness/nausea? Can it be related to neck issues? And with nausea could it be hypothyroid? (eating does help subdue dizziness a lot). Recently had blood work done, all was ok, fasting bgl was 82. (did not include metabolic work up). If it is neck related what can be done?
Thanks
Steve

Category: Neurosurgeon

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Category: Spine Surgeon
 23 Doctors Online

Hello,

Thank you for choosing DoctorSpring.

The two above mentioned descriptions by you regarding the dizziness

"I became very dizzy (lightheaded, like on rollercoaster when it goes down real fast)" "Dizzy mostly when looking down or turning head side to side."

suggests that the dizziness originates from the inner ear without any doubt. These features are typical.

- I do not think any of these symptoms are related to the degenerative neck diseases

- Nausea again is likely to be linked to the inner ear problem. However considering its relation with food, an ulcer peptic disease has to be ruled out. A quick diagnostic test would be to take an OTC anti ulcer pill like Prilosec and see whether there is resolution. Hypothyroidism is unlikely to cause it. So if there are stomach symptoms (like he heartburn or belching the nausea could be from a Gastrointestinal problem.

So what be done next -

1. Well, I would like to know whether you have taken any medication for this dizziness (like vestibular sedatives). If not, you should try medical management.

2. A complete ENT diagnosis. I do not agree with your current ENT Doctors opinion that there is nothing wrong the Ear. The symptoms are highly suggestive of an innner ear pathology

3. Nause could be a part of it, but as I said earlier I could be from a GI disease. Consider a Prilosec trial

4. The degenerative neck disease thankfully does not appear to be causing any symptoms. Avoid sudden turning , twisting and carrying weight in the neck. Do not do weight training for upper arms

Hope this helps
You can reply as a followup
Thank you


Patient replied :

Hi Doctor. I have been taking homeopathic med called Vertifree. It does subdue the dizziness (about 70%). When I eat, it helps subdue the dizziness too. But I still feel hungry and have constant ache/burn between xiphoid process and belly button. Not gassy or burping. Any idea? Also will dizziness subside on its own and should I do vest. rehab? I will give Prilosec a try. When I see my doc, should I try a round of anti-biotics?
Thanks again
Steve


Hello Steve,

Antibiotics are not necessary. The gas/ stomach pain is suggestive of stomach ulcer. So do take Prilosec just before sleep, wihtout food. Vertifree might not work as a vestibular sedative. You will need a proper vestibular sedative like prochlorperazine or cinnarizine. A response to these medication will also confirm the diagnosis. You can request your Doctor for these and I am sure with the pattern of symptom you are having he/she will give you a prescription.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Hi Doctor. I went to see oto-neurologst, results from audiology tests here also show nothing (except 12%weakness in right ear). He sat me in chair and twisted chair side to side while i maintained my head inline with my torso (no dizziness noted). But when i sit still and turn my head side to side/up and down (head on neck movement) i get dizzy. He diagnosed me as cervicogenic dizziness. (given my hx of degen disc disease and damage as listed in first email). At a losss at what to do next and if I can be helped. Also i started Prilosec 2 days ago, seems to be helping my stomach. It did help my dizziness too for a brief period, but that didn't last..any suggestions?
Thanks again
Steve


Hello Steve,

Continue Prilosec.
My recommendation would be a vestibular sedative like prochlorperazine or cinnarizine. Atleast as a trial. I think your GP can be of help here. Cervicogenic dizziness is possible if ALL the ENT tests are negative. However do consider vestibular sedatives.

Thank you


Dr. Goutham Cugati
Category: Spine Surgeon
Experience: 
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
Dr. Goutham Cugati and 4 other Medical Specialists are ready to help you

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