BPP Vertigo 耳水不平

Hello everyone, sorry for the delay of this post. I've spent too much time drawing the schematics for this one, hope you like it though 😁.

One of the commonest complain that I receive in my clinic is vertigo. (No, I don't mean complain about my clinic)

So, the complains normally goes like this:

"Doctor, it feels like the whole world is spinning"
"I couldn't balance myself properly this morning, but after a while i could"
"I feel very dizzy and even nauseous when I lie down"
"It spins when I turn my head"

A lot of times, but not always, it is due to a problem that occurs in the inner ear, and we name it Benign Paroxysmal Positional Vertigo.

Benign - not cancer, not malignant, you won't die from it directly

Paroxysmal - It happens as it likes, suddenly.

Positional - very much to do with your head position

Vertigo - spinning dizziness

OK, that's a pretty simple explaination to the name, and to save you (and me) from this intimidatingly long name, I will use "BPPV" after this.

Although not officially, Chinese often calls it 耳水不平 (Literally translates: Ear Water Not Balance), and that pretty much explains a lot.

The above picture is the anatomy of a ear 👂. 

Both of the Cochlea and Semicircular Canals makes up most of the inner ear (Also the nerves connected to them) and they are connected to each other and are embedded in the skull bone (Temporal Bone to be exact).
Cochlea is the hearing organ. The sound passes from the outer ear to the tympanic membrane, conducted via the 3 little bones (which are the smallest bones in the human body) to the Cochlea.

The interesting part for us here today is the Semicircular Canals which is the balancing organ.
There are altogether 3 on each side, arranged in the pattern of 3 planes (XYZ planes, back to maths and physics class), so together they can sense the tilts and turns of the head in all directions.
Inside the canals (and the cochlea also) is a fluid called Endolymph (unofficially 耳水 ear fluid) that levels itself after any movement (same as all other liquids), then Cilia that lines the inner wall, senses the different position of the endolymph.
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So, BPPV happens when any of the canals is "blocked", usually by otolith (a kind of crystal in the ear, floating in the endolymph), the debris from the epithelium of the canals itself, or possibly sediments in the fluid. When one of the canal is blocked, the endolymph cannot flow properly, and therefore sense of balance from the whole organ.

The dizziness is due to the movement of the otolith or debris after the movement of your head. While your head is not moving, the otolith movement is sensed by the cilia as movements in the canal, then it gives the wrong information to the brain, and so your brain thought your head is turning/moving while it is not.

In short: Canal --> blocked --> cannot sense properly

And for the above blockage to happen, there are thousands of possibilities, including trauma, temperature, drugs, food, hormone etc...

Without treatment, normally it will resolve by itself without complications in a few days to a couple of weeks. Just try to avoid fast movements, or changing of position too fast.
Treatment is mostly conservative with medicine that some can even buy over the counter. Or one may find certain maneuvers (a specific way of tilting and turning the head) that can help unblock the blocked canals. This proves to be the best way of treatment, provided there is no neck or back injury or such concern.

But I certainly will advise you to make a trip to the doctor, because there are also other diseases that can have similar symptoms, for example: stroke, infection etc.
That's all for now.
If you have any medically related question, feel free to comment to me or email me, I will try my best to explain it in a way that is understandable for everyone.