Causes of BPPV:

Timothy C. Hain MD of dizziness and balance.com states The most common cause of BPPV in people under age 50 is head injury . The head injury need not be that direct – -even whiplash injuries have a substantial incidence of BPPV (Dispenza et al, 2011). There is also a strong association with migraine (Ishiyama et al, 2000). BPPV becomes much more common with advancing age (Froeling et al, 1991) and in older people, the most common cause is degeneration of the vestibular system of the inner ear. Viruses affecting the ear such as those causing vestibular neuritis and Meniere’s disease are significant causes(Batatsouras et al, 2012).

Occasionally BPPV follows surgery, including dental work, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear (Atacan et al 2001). While gentamicin toxicity is rarely encountered, BPPV is common in persons who have been treated with ototoxic medications such as gentamicin (Black et al, 2004). In half of all cases, BPPV is called “idiopathic,” which means it occurs for no known reason. Other causes of positional symptoms are discussed here.

Web MD points out tiny calcium “stones” inside your inner ear canals help you keep your balance. Normally when you move a certain way, such as when you stand up or turn your head, these stones move around. But things like infection or inflammation can stop the stones from moving as they should. This unfortunately sends a false message to your brain and causes the vertigo. About half the time, doctors can’t find a specific cause for BPPV.

When a cause can be determined, BPPV is often associated with a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back. BPPV also has been associated with migraines. In many cases the doctors can’t figure out the cause.

Know The ear’s role

Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.

Other structures (otolith organs) in your ear monitor movements of your head — up and down, right and left, back and forth — and your head’s position related to gravity. These otolith organs — the utricle and saccule — contain crystals that make you sensitive to gravity.

For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you’re lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy. Depending what section of the semicircular canal the problem is in will be a factor with the actual result on the crystals or rocks flowing freely or become stuck together causing a blockage in one of the canals. The other factor that determines this is the etiology for it occuring (ex. Dehydration or blow to the head).

Complications of BPPV:

Benign paroxysmal positional vertigo occurs most often in people age 60 and older, but can occur at any age. Aside from aging, there are no definite factors that may increase your risk of benign paroxysmal positional vertigo. However, a head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.

Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. In rare cases, if severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration. The dizziness of BPPV can put you at greater risk of falling. It is more of a headache in going through the time to resolve the vertigo possibly affecting people in doing their regular activities of living for a week to several weeks. For some it never comes back but for many it does after several months depending on what the cause is.

“In general; Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder. A person with BPPV experiences a sudden spinning sensation whenever they move their head. BPPV isn’t a sign of a serious problem. If it doesn’t disappear on its own within six weeks, a simple in-office procedure can help ease your symptoms.”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv)

If one day you start the day going to work than come home feeling like a sinus infection that appears to be spreading to the ears and after going to bed several hours upon wakening I sat up on my bed finding yourself pulling to one side that you think the cause is an ear infection but it could be something else.  When I was getting up and feeling dizzy but made it downstairs to eat a meal but due to the dizziness I vomited causing dizziness to increase terribly (like if sea sick or even like too much alcohol followed with vomiting and now everything’s spinning to the point you can’t get up from the ground) and got my self safely to the ground and couldn’t get up.   This all happened to me one year and when going to the MD that night I was sent to the ER for being ruled out initially of a stroke or transient ischemic attack.  I was aggravated and went.  I than was finding out in the ERmit wasn’t a stroke or TIA, which is what I thought would be the result, but their still was a reason for it.  What might this be?  I was diagnosed with BPPV for severe dehydration and it took me a week through exercises and taking meclizine, also known as antivert, that took my dizziness away.

This could be an ear infection with BPPV or just BPPV itself; this abbreviation stands for BPPV-Benign Paroxsymal Posterior Vertigo (highly probable if its feeling clogged, no draining from the ear canal, no wax build up after checked with an otoscope by an ENT or Neurologist and the symptoms listed above present that I mentioned= Vertigo, Nausea; Possibly vision disturbance with lethargy) including a nystagmus (described below). This is how you feel after a concussion (with or without a nystagmus) in varying intensities depending on the impact after a blow to the head. How do these symptoms arise with no infection in the ear?

This involves the inner ear causing the brain to pick up miscommunication signals in detecting or reading what is happening going on giving the ending result of vertigo =dizziness, causing your balance to be off, which again I reenforce is due to the condition that is going on in the middle ear. It is the sensitivity detection by ear sensitivity hairs picking up what shouldn’t be there, which in turn is causing the symptoms. This can be due to inner ear particles clumped together in the ear or particles in the inner ear floating freely depending where the are located in the inner ear. We will discuss this more in detail shortly, just know these particles are called “rocks”.

If your having these symptoms this should be checked for BPPV and (I do recommend you go to MD to be evaluated first):

Benign paroxysmal positional vertigo (BPPV) is probably the most common cause of vertigo in the United States. It has been estimated that at least 20% of patients who present to the physician with vertigo have BPPV. However, because BPPV is frequently misdiagnosed, this figure may not be completely accurate and is probably an underestimation. Since BPPV can occur concomitantly with other inner ear diseases (for example, one patient may have both Ménière disease and BPPV at once), statistical analysis may be skewed toward lower numbers.

BPPV was first described by Barany in 1921. The characteristic nystagmus and vertigo associated with positioning changes were attributed at that time to the otolithic organs. In 1952, Dix and Hallpike performed the provocative positional testing named in their honor, shown below. They further defined classic nystagmus and went on to localize the pathology to the proper ear during provocation.

It deals with the inner ear.

The patient is placed in a sitting position with the head turned 45° towards the affected side and then reclined past the supine position.

BPPV is defined as an abnormal sensation of motion that is elicited by certain critical provocative positions. The provocative positions usually trigger specific eye movements (ie, nystagmus). The character and direction of the nystagmus are specific to the part of the inner ear affected and the pathophysiology.

BPPV is a complex disorder to define; because an evolution has occurred in the understanding of its pathophysiology, an evolution has also occurred in its definition. As more interest is focused on BPPV, new variations of positional vertigo have been discovered. What was previously grouped as BPPV is now subclassified by the offending semicircular canal (SCC; ie, posterior superior SCC vs lateral SCC) and, although controversial, further divided into canalithiasis and cupulolithiasis (depending on its pathophysiology).

Although some controversy exists regarding the 2 pathophysiologic mechanisms, canalithiasis and cupulolithiasis, agreement is growing that the entities actually coexist and account for different subspecies of BPPV. Canalithiasis (literally, “canal rocks”) is defined as the condition of particles residing in the canal portion of the SCCs (in contradistinction to the ampullary portion). These densities are considered to be free floating and mobile, causing vertigo by exerting a force. Conversely, cupulolithiasis (literally, “cupula rocks”) refers to densities adhered to the cupula of the crista ampullaris. Cupulolith particles reside in the ampulla of the SCCs and are not free floating.

Classic BPPV is the most common variety of BPPV. It involves the posterior SCC and is characterized by the following symptoms:

• Geotropic nystagmus with the problem ear down
• Predominantly rotatory fast phase toward undermost ear
• Latency (a few seconds)
• Limited duration (< 20 s)
• Reversal upon return to upright position
• Response decline upon repetitive provocation. The purpose for this appears to be the brain acquires a response in getting used to this vertigo as normal by picking up wrong messages from that affected ear due to improper messaging by the pick up of how the rocks in the inner ear canal are situated (free floating or residing in a canal portion with how the ear hairs are picking up by sensitivity their presence giving wrong messages to the brain causing vertigo, nystagmus, with or without vomiting.
• Because the type of BPPV is defined by the distinguishing type of nystagmus, defining and explaining the characterizing nystagmus are also important.
• Nystagmus is defined as involuntary eye movements usually triggered by inner ear stimulation. It usually begins as a slow pursuit movement followed by a fast, rapid resetting phase. Nystagmus is named by the direction of the fast phase. Thus, nystagmus may be termed right beating, left beating, up-beating (collectively horizontal), down-beating (vertical), or direction changing.
• If the movements are not purely horizontal or vertical, the nystagmus may be deemed rotational. In rotational nystagmus, the terminology becomes a bit more loose or unconventional. Terms such as clockwise and counterclockwise seem useful until discrepancies regarding point of view arise: clockwise to the patient is counterclockwise to the observer. Right versus left terminology is poorly descriptive because as the top half of the eye rotates right, the bottom half moves left.
• Rotational nystagmus also can be described as geotropic and ageotropic. Geotropic means “toward earth” and refers to the upper half of the eye. Ageotropic refers to the opposite movement. If the head is turned to the right, and the eye rotation is clockwise from the patient’s point of view (top half turns to the right and toward the ground), then the nystagmus is geotropic. If the head is turned toward the left, then geotropic nystagmus is a counterclockwise rotation. This term is particularly useful in describing BPPV nystagmus because the word geotropic remains appropriate whether the right or the left side is involved.
• These 2 terms are useful only when the head is turned. If the patient is supine and looking straight up, these terms cannot be used. Fortunately, the nystagmus associated with BPPV usually is provoked with the head turned to one side. The most accurate way to define nystagmus is by terming it clockwise or counterclockwise from the patient’s point of view.

The tympanic membrane where no doctor can open that and further the problem is in your semi-circular canal and if not resolving the problem it will damage the ear.

“Mal de débarquement syndrome (MdDS) — which means, “sickness of disembarkation” — is a rare condition that makes you feel like you’re moving, even when you’re not. “Disembarkation” is a word to describe getting off of a boat or aircraft. This can cause a change in your stability or balance.

MdDS commonly occurs after boating or sea travel, though it can happen after air travel, extended land travel and even sleeping on water beds. In some cases, MdDS can occur after non-motion events (like surgery or childbirth), or for no known reason (spontaneous mal de débarquement syndrome).”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/24796-mal-de-debarquement-syndrome-mdds)

woman feeling rocking dizziness from mal de debarquement after cruise ship vacation

Mal de debarquement (MDD) is a rare and poorly understood disorder of the vestibular system that results in a phantom perception of self- motion typically described as rocking, bobbing or swaying. The symptoms tend to be exacerbated when a patient is not moving, for example, when sleeping or standing still.

When you head out to sea on a cruise ship, your brain and body have to get used to the constant motion. It’s called “getting your sea legs,” and it keeps you from crashing into a wall every time the ship bobs up or down.

When you get back on shore, you need time to get your land legs back. That usually happens within a few minutes or hours, but it can take up to 2 days. With mal de debarquement syndrome, though, you can’t shake the feeling that you’re still on the boat. That’s French for “sickness of disembarkment.” You feel like you’re rocking or swaying even though you’re not.

It can happen to anyone, but it’s much more common in women ages 30 to 60. It’s not clear if hormones play a role.

People who get migraines may be more likely to get it, too, but doctors aren’t sure how the two conditions are linked.

What Are the Symptoms?

Mainly, you feel like you’re rocking, swaying, or bobbing when there’s no reason for it. You might feel unsteady and even stagger a bit.

Other symptoms include:

• Anxiety
• Confusion
• Depression
• Feeling very tired
• Having a hard time focusing
• Nausea

Your symptoms may go away when you ride in a car or train, but they’ll come back when you stop moving. And they can get worse with:

• Being in a closed-in space
• Fast movement
• Flickering lights
• Stress
• Tiredness
• Trying to be still, like when you’re going to sleep
• Intense visual activity, like playing video games

What Causes It?

It happens most often after you’ve been out on the ocean, but riding in planes, trains, and cars can lead to it, too. It’s even been caused by water beds, elevators, walking on docks, and using virtual reality.

While almost any kind of motion can cause it, doctors don’t know what’s really behind it. In most cases, you get it after a longer trip. But there’s no tie between the length of your trip and how bad the symptoms are or how long they last.

In trying to diagnose this condition through ruling out other problems since no one test diagnoses this condition.  It’s a rare condition, so it may take a few visits to figure it out. Your doctor probably will want to rule out other causes for your symptoms with things like:

Some Facts on Blood:

“01 Up to 3 lives are saved by one pint of donated blood.
02. Between 8-12 pints of blood are in the body of an average adult.
03. One unit of blood is ~525 mL, which is roughly the equivalent of one pint.
04. A newborn baby has about one cup of blood in their body.
05. The average transfusion patient receives 3 units of red blood cells.
06. A, B, AB and O are the four main types of blood types. AB is the universal recipient, O negative is the universal donor.
07. Blood centers often run short of types O and B blood.“

70 Rock River Valley Blood Center (Saving lives 70 years.) – (https://www.rrvbc.org/)

Your blood carries oxygen and nutrients to all of the cells in your body. Blood cells also fight infection and control bleeding.

Most blood cells are made in your bone marrow. They are constantly being made and replaced. How long a blood cell lasts before being replaced is called its lifespan.

Your blood is made up of 4 parts: red blood cells, white blood cells, platelets, and plasma.

This information explains the different parts of your blood and their functions.

Your blood carries oxygen and nutrients to all of the cells in your body. Blood cells also fight infection and control bleeding.

Most blood cells are made in your bone marrow. They are constantly being made and replaced. How long a blood cell lasts before being replaced is called its lifespan.

Your blood is made up these 4 types of cells, lets review:

Parts of Your Blood

1-Red blood cells (erythrocytes)

Red blood cells carry oxygen from your lungs to your tissues. They also bring carbon dioxide back to your lungs.

Red blood cells make up almost half of your blood. The lifespan of a red blood cell is around 120 days.

2-White blood cells (leukocytes)

White blood cells fight infection and are an important part of your immune system. They make up a very small part of your total blood (less than 1%).

There are 3 types of white blood cells: I granulocytes, II monocytes, & III lymphocytes. Each type has an important role.

• I There are 3 types of granulocytes: A.Neutrophils help fight bacterial and fungal infections. B. Basophils are part of your body’s immune response/responses to allergens. Basophils are implicated in multiple human diseases including autoimmune disorders, inflammatory disorders, cancer and allergies and asthma. However, the contributions of basophils to the development of human disease states remain poorly defined. Their exact function isn’t well known.  C.Eosinophils their main action is to help fight infections caused by parasites.  A high number of eosinophils (eosinophilia) are often linked to a variety of disorders. A high eosinophil count may be due to: Adrenal gland deficiency. Also it could mean allergic disease, including hay fever.
• II Monocytes break down and remove foreign organisms and dying cells from your body. Main action against bacterial infection.  They have subsets no Types (too much for this topic).  Clevaland Clinic states “Monocytes are a type of white blood cell (leukocytes) that reside in your blood and tissues to find and destroy germs (viruses, bacteria, fungi and protozoa) and eliminate infected cells. Monocytes call on other white blood cells to help treat injury and prevent infection.
• III Lymphocytes make up your immune system.  Lymphocytes are a type of white blood cell. They help your body’s immune system fight cancer and foreign viruses and bacteria. Your lymphocyte count can be taken during a normal blood test at your healthcare provider’s office. Lymphocyte levels vary depending on your age, race, sex, altitude and lifestyle.
  

Memorial Sloan Kettering Center in NYC states “White blood cells have a wide range of lifespans, from hours to years.”.

3-Platelets (thrombocytes)

Platelets are small parts of cells. Their main function is to control bleeding. They make up a very small part of your blood (less than 1%). The lifespan of platelets is about 9 to 12 days.

4-Plasma

Plasma is the pale-yellow liquid part of your blood that holds all of your blood cells. It makes up a little over half of your total blood.

Plasma helps move water, nutrients, minerals, medications, and hormones throughout your body. It also carries waste products to your kidneys. Then your kidneys filter out the waste products from your blood. Plasma is made up of water, protein, lipids (fats). It carries water, fat-soluble nutrients, and other substances to and from the different organs.

Resources

Johns Hopkins Medicine
www.hopkinsmedicine.org/health/wellness-and-prevention/facts-about-blood
This website has facts about blood, blood cells, and blood cell count.

American Red Cross
www.redcrossblood.org
The American Red Cross offers a variety of information about the different parts of blood and what blood cells do.

• Function of Blood and Blood Cells: www.redcrossblood.org/local-homepage/news/article/function-of-blood-cells.html
• Facts About Red Blood Cells: www.redcrossblood.org/donate-blood/dlp/red-blood-cells.html
• Facts About White Blood Cells: www.redcrossblood.org/donate-blood/dlp/white-cells-and-granulocytes.html
• Facts About Platelets: www.redcrossblood.org/donate-blood/dlp/platelet-information.html
• Facts About Plasma: www.redcrossblood.org/donate-blood/dlp/plasma-information.html

Stanford Children’s Health
www.stanfordchildrens.org
Stanford Children’s Health offers a variety of information about the different parts of blood and what blood cells do.

• Function of Blood and Blood Cells: www.stanfordchildrens.org/en/topic/default?id=overview-of-blood-and-blood-components-90-P02316
• Facts About Red Blood Cells: www.stanfordchildrens.org/en/topic/default?id=what-are-red-blood-cells-160-34
• Facts About White Blood Cells: www.stanfordchildrens.org/en/topic/default?id=what-are-white-blood-cells-160-35
• Facts About Platelets: www.stanfordchildrens.org/en/topic/default?id=what-are-platelets-160-36
• Facts About Plasma: www.stanfordchildrens.org/en/topic/default?id=what-is-plasma-160-37

“Everyone deserves the opportunity to lead a full and healthy life. Sadly, systemic issues contribute to health disparities, including for those facing lung cancer. Individuals of color who are diagnosed with lung cancer face worse outcomes compared to white individuals living in America because they are less likely to be diagnosed early, less likely to receive surgical treatment, and more likely to not receive any treatment. Close to two-thirds of the 28 million uninsured people living in America are people of color, and research is clear that having health coverage impacts people’s medical care and ultimately their health outcomes. Addressing racial disparities in healthcare coverage is critical to addressing racial disparities in lung cancer care. Black individuals with lung cancer were 15% less likely to be diagnosed early, 19% less likely to receive surgical treatment, 11% more likely to not receive any treatment, and 16% less likely to survive five years compared to white individuals.”                                                                                        American Lung Association (https://www.lung.org/research/state-of-lung-cancer/racial-and-ethnic-disparities)

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The rates of death by diabetes for each race and ethnicity in the United States in 2005.

Heart disease and stroke disproportionately affect African-Americans.   Why?  One this race is highiest in B/P&high in stroke(one main cause of stoke=high b/p).

Black Americans and High Blood Pressure Heart Disease & Stroke

“What sets the stage for the more aggressive and higher incidence of heart disease in African-Americans is a very high incidence of high blood pressure,” Yancy says. “This predisposes African-Americans to more heart disease, kidney disease, and stroke. This makes us focus on high blood pressure as it forces heart failure.”

Know the facts of how to get High B/P.  Factors are:  Obesity, High Sodium intake, Lack of Exercise, and Genetic History in the family.

Clinical Trials show blacks and whites respond differently to treatments for high blood pressure. Indeed, treatment guidelines suggest that doctors should consider different drugs based on a patient’s race.

But Yancey says that a closer look at the data shows that race tends to be a marker for more complicated high blood pressure treatment.

This ethnic group has factors for complicated B/P.  Non-compliance with the Rx they should be doing and not going to follow up visits.  Ignoring symptoms till they have to go to the ER.  In America if you go to an ER of hospital government assisted they can’t say No we can’t take you for no insurance.   Lack of having medical insurance is another factor.

Unfortunately if no insurance due to inability to afford it and can’t go to doctors for a office visit.  There is help.  What is available is free clinics to provide medical service to any person who can’t afford a bill due to lack of insurance with no fee.  Check out freeclinics.com to find where your free clinics are available in the area you live.

Health care differences between African-Americans and white Americans.

Clinical Trials show blacks and whites respond differently to treatments for high blood pressure. Indeed, treatment guidelines suggest that doctors should consider different drugs based on a patient’s race.

But Yancey says that a closer look at the data shows that race tends to be a marker for more complicated high blood pressure treatment.

“Data suggests that all therapies do equally well — but patients at higher risk need more intensive therapy,” he says.

A similar situation exists for heart failure. A promising treatment for heart failure didn’t seem to be working — until researchers noticed that it worked much better for black patients than for white patients. A study of black patients confirmed this finding — and provided tantalizing evidence that the drug will help patients of all races with certain disease characteristics.

“Diabetes offers a perfect model for tackling a major killer within the Black population and demonstrating the role of social determinants of health. More than 37 million Americans (about one in 10) have diabetes, and more than 90 million American adults are prediabetic. In 2018, Black/African American adults were 60% more likely to be diagnosed with diabetes than whites.”

U.S. News (https://www.usnews.com/news/health-news/articles/2022-02-22/black-history-month-battle-health-inequity-by-addressing-social-determinants)