Therapy for Vertigo

DooDad

It's been 2 years since I completed my chemo and radiation treatments for cancer in left tonsil and lymph nodes in left neck. My surgery was in June 2020. My neck scar is still sensitive at times and I have slight numbness around my ear. None of that bothers me. My last scan in Sept 2022 shows no cancer. I've done a bit of research on vertigo and apparently it can be a side effect of radiation. I saw an ENT about the vertigo and he recommended physical therapy. The therapy is designed to shift these weird little crystals back where they belong in the inner ear. Has anyone else had this problem and done this type of therapy. I'm skeptical, but mostly tired of doctors and tests.

Thanks - Peggy

wbcgaruss

Hello, Peggy, glad you are here and hope you can get some help with this. Truthfully I have never heard of this and it is quite amazing that we have little crystals in our inner ear among all the amazing ways it is already created to let us hear sounds. That in itself sounds like science fiction but it's true, I looked it up and it's called Benign paroxysmal positional vertigo (BPPV). As the Bible says "We are fearfully and wonderfully made" right down to the fact that we have these little crystals in our inner ear. Sorry you are being bugged by this, going through cancer treatment is enough but then many times we get an after-effect or multiple effects over the years such as this from radiation which many on here say "the gift that keeps on giving". As far as numbness that is not as bothersome. I too had lymph nodes and tissue removed in an operation and the left side of my face is pretty numb and my ear is also. I am so glad your recent scan was clear or NED as it is referred to on here (No Evidence of Disease). And some doctors use the term "unremarkable" for a clear scan. This is truly a blessing when our scans are clear, it takes such a load off our minds and our anxiety goes away. I still have some scanxiety when my yearly scan is coming up.

Wishing You the Best

Take Care God Bless-Russ

I did find this from Johns Hopkins Medicine--

What causes BPPV?

BPPV occurs when tiny calcium crystals called otoconia come loose from their normal location on the utricle, a sensory organ in the inner ear.

If the crystals become detached, they can flow freely in the fluid-filled spaces of the inner ear, including the semicircular canals (SCC) that sense the rotation of the head. Otoconia will occasionally drift into one of the SCCs, usually the posterior SCC given its orientation relative to gravity at the lowest part of the inner ear.

The otoconia will not cause a problem when located in an SCC until the person’s head changes position, such as when looking up or down, going from lying to seated or lying to seated in bed, or when rolling over in bed. The otoconia move to the lowest part of the canal, which causes the fluid to flow within the SCC, stimulating the balance (eighth cranial) nerve and causing vertigo and jumping eyes (nystagmus).

BPPV Symptoms

People with BPPV can experience a spinning sensation — vertigo — any time there is a change in the position of the head.

The symptoms can be very distressing. People can fall out of bed or lose their balance when they get up from bed and try to walk. If they tilt their head back or forward while walking, they may even fall, risking injury. Vertigo can cause the person to feel quite ill with nausea and vomiting.

While the hallmark of BPPV is vertigo associated with changes in head position, many people with BPPV also feel a mild degree of unsteadiness in between their recurrent attacks of positional vertigo.

The onset of BPPV may be abrupt and frightening. People may think they are seriously ill; for example, they may fear they are having a stroke. A doctor’s diagnosis of BPPV can be reassuring, especially when people understand that help is available to relieve their symptoms.

Without treatment, the usual course of the illness is lessening of symptoms over a period of days to weeks, and sometimes there is spontaneous resolution of the condition. In rare cases, the person’s symptoms can last for years.

What brings on BPPV?

In many people, especially older adults, there is no specific event that causes BPPV to occur, but there are some things that may bring on an attack:

• Mild to severe head trauma
• Keeping the head in the same position for a long time, such as in the dentist chair, at the beauty salon or during strict bed rest
• Bike riding on rough trails
• High intensity aerobics
• Other inner ear disease (ischemic, inflammatory, infectious)

BPPV Diagnosis

Diagnosing BPPV involves taking a detailed history of a person’s health. The doctor confirms the diagnosis by observing nystagmus — jerking of the person’s eyes that accompanies the vertigo caused by changing head position. This is accomplished through a diagnostic test called the Dix-Hallpike maneuver.

First, while sitting up, the person’s head is turned about 45 degrees to one side. Next, the patient is quickly laid down backward with the head just over the edge of the examining table. This move can often bring on the vertigo and the doctor can observe to see if the person’s eyes show the jerking pattern of nystagmus. A positive response confirms the diagnosis of BPPV. An MRI or CT scan of the brain is usually unnecessary.

A doctor’s diagnosis of BPPV can be reassuring, especially when the patient understands that help is available to relieve the symptoms. Even without treatment, the usual course of the illness is lessening of symptoms over a period of days to weeks, and sometimes there is spontaneous resolution of the condition.

BPPV Treatment

The Epley Maneuver for BPPV

BPPV with the most common variant (crystals in the posterior SCC) can be treated successfully — with no tests, pills, surgery or special equipment — by using the Epley maneuver.

This simple, effective approach to addressing BPPV involves sequentially turning the head in a way that helps remove the crystals and help them float out of the semicircular canal. Several repositioning maneuvers performed in the same visit may be necessary.

The Epley maneuver and other bedside physical therapy maneuvers and exercise programs can help reposition the crystals from the semicircular canals. Recurrences can occur, and repeat repositioning treatments are often necessary.

After Epley maneuver treatment, the patient may begin walking with caution. He or she should avoid putting the head back, or bending far forward (for example, to tie shoes) for the remainder of the day. Sleeping on the side of the affected ear should be avoided for several days.

If the crystals are in a location other than the posterior semicircular canal, slightly different maneuvers may be used, but they are based on the same principle of moving the stones out of the offending semicircular canal. BPPV of the anterior canal is exceedingly rare, since debris in this canal (located at the top of the inner ear) easily falls out on its own.

Other Treatments for BPPV

Usually no medications are required for BPPV unless the patient has severe nausea or vomiting. If extreme nausea is present, the doctor may prescribe or administer anti-nausea medications, especially if the person would not be able to tolerate repositioning maneuvers otherwise.

Surgery is seldom necessary to treat this condition. In rare cases, the doctor may recommend a surgical procedure to block the posterior semicircular canal to prevent stones from entering and moving within the canal. While the surgical plugging procedure cures the problem, it carries some risk, including hearing loss.

Over the long term, BPPV recurs in about half of people who experience it. For those who experience frequent recurrence, home exercises can help them manage symptoms themselves.

Here is the page link--

https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-positional-vertigo-bppv

And here is a link to Cedars Sinai covering it. Quite a bit of info about it, I am surprised I never hear of it.

https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/benign-paroxysmal-positional-vertigo.html

DooDad

Russ - Thank you so much for all the information. I truly appreciate you. I've read many of your posts, you always present a positive attitude. You are a blessing to all of us. The first episodes of vertigo were almost a year apart. But starting around May this year, they are more frequent. The worst was in my dentist office when they raised me back to a sitting position. I thought it was age related - I'm 76. Then I found out it is a fairly common side effect of radiation. I had also started getting headaches that felt like a mild sinus headache. That is also a side effect of radiation. I just wish one of my doctors had mentioned this possibility.

But now that I know and have lots of information, I'm going to tackle this problem like everything else. Pray and do my best to find the best help possible.

Again, Russ, thank you so much and may God bless you.

wbcgaruss

Peggy, thank you so much for the feedback. It makes it all worthwhile that the information was a help to you and hopefully others.

Take Care God Bless-Russ

paulawork0404

I have partial hearing loss from chemo and terrible ringing in the ears. I also had to have my esophagus stretched. That's a side effect of radiation. Has anyone else had to have this done?

wbcgaruss

Hello Paula and welcome to the CSN H&N forum. Glad to have you on board. What you describe are both all too common side effects experienced from chemo and radiation treatments.

The hearing loss and tinnitus you describe come from the platinum-based chemotherapies such as Cisplatin, Taxotere, and Fluorouracil or more commonly known and loved by the name 5 FU.

Can chemotherapy cause ringing ears?

Some types of chemotherapy can damage your inner ear. These include platinum-based drugs such as cisplatin (Platinol) and carboplatin (Paraplatin). Tinnitus is often the first sign of this type of damage. You might also lose hearing when the drug damages the inner ear cells.

Does tinnitus go away after chemo?

Hearing loss may start slowly in the first 2 years after treatment. Radiotherapy or the chemotherapy drug cisplatin may cause ringing in the ears (tinnitus). It often gets better as your ears recover from the effects of treatment. But it can sometimes be permanent.

As far as dilations, I have known of a few in here getting them.

Radiation therapy can also cause swallowing problems. The effects of radiation — including scarring and fibrosis — build over time, and can reduce the ability of the throat muscles to function properly, even long after treatment is finished. Radiation can also cause narrowing of the swallowing passage — a problem known as "stricture."

Paula, I have had both of these, dilations after radiation and tinnitus from chemotherapy. The tinnitus is ongoing. I notice it at times but I guess you sort of get used to it over time, and that is usually what happens with most people. It can diminish or quit for some people. Mine does not bother me too much anymore, either I have just gotten used to it or it has diminished a bit over time, or maybe a little of both. There is no cure or treatment for tinnitus only adapting to it or masking it with a radio playing in the room, or say maybe a fan noise running seems to subtract from it. Below is a link to The American Tinnitus Association if yours is really bothering you help may be found there possibly.

https://www.ata.org/about-tinnitus/therapy-and-treatment-options/

As far as dilations I had four following my treatment of 2013 throat cancer. I had gotten a piece of turkey stuck in my throat and it wouldn't go down or come back out so I had to go to the emergency room and a Gastroenoligist on duty removed it. At that time I asked him if he thought dilations would help me and he said yes. So I got a total of four over time. As you probably know they can only stretch a little bit at a time over time because going too far poses a risk of tearing the esophagus.

Yes, you are certainly not alone on this. Could you give us a little information on your cancer like location, stage it was at, where you got treated, how you realized something was wrong, and basically your story, it may help others?

Wishing You the Best

Take Care God Bless-Russ