Horizontal canal BPPV

Newsflash: Dr. Foster to appear live on Sirius XM’s Dave Nemo show on Tuesday, August 16 at 7:30am CT / 6:30am MT.  Listen LIVE on SiriusXM’s Road Dog Trucking Channel 146

We’ve talked about BPPV in the videos and prior postings.  The semicircular canals are the ring-shaped sensors for spinning, and there are three in each ear, so this system is fully 3D.  You can sense spinning in any direction thanks to this set-up.  Most BPPV affects a vertical sensor, the posterior semicircular canal.  However, rarely you can get BPPV in another of these rings, the horizontal canal.  This ring is set nearly level or horizontal in your head, and controls responses to side to side head movements.  It’s also stronger and more used than the other canals, so it causes a more intense spinning when it is involved.

H-BPPV is the form of BPPV in which crystals enter this horizontal sensor.  It’s similar to the more common classic BPPV in that spells happen when lying down or rolling over in bed, however the room spins more quickly and it spins horizontally, like a turntable. It often leads to vomiting, and it can make it miserable to just turn your head. 

Classic BPPV is treated with maneuvers, like the Epley maneuver and the Half Somersault maneuver.  H-BPPV requires a different maneuver.  To apply the right maneuver, you need to know which ear has the problem.  This is tricky to figure out in H-BPPV.  In classic BPPV, the bad ear is usually the one that is down when the dizziness happens in bed.  In H-BPPV, lying on either side causes dizziness, so this simple test doesn’t work well. 

Most of the time, H-BPPV comes on after you’ve had a bout of the classic BPPV, and is especially likely if you’ve had maneuvers done for it.  In that case it’s pretty easy to figure out the involved ear—it’s the same one that was treated for classic BPPV. 

Another clue is that, although you will be dizzy when lying on the right and on the left, one side will feel stronger.  Most of the time, the stronger side will be the bad ear.  If you’re most dizzy lying with the right ear down, the right ear may be the culprit, for example.     

Sometimes this way to determine the side doesn’t work.  A person can have a bad left ear, and yet be more dizzy when the right ear is down.    The simplest way to deal with this is to do a treatment for the ear you think is the problem, and if that doesn’t work, then try treating  the other ear.  We’ll show you how in the next post.

Published by Vertigone

I translate the medical world of dizziness for non-medical people

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