Explaining stations Flashcards
What is Benign Paroxysmal Positional Vertigo?
The organ responsible for balance is located inside your ear. It consists of 3 semi-circular canals on each side which act like a gyro to detect motion.
In Benign Paroxysmal Positional Vertigo or BPPV, calcium crystals can be dislodged from elsewhere and enter the balance organs. Turning the head can cause movement of these crystals. These interfere with signals sent to the brain which causes brief sensation of spinning or vertigo.
In most cases, the reason for developing BPPV is unknown. But it can occur if you’ve suffered a blow to the head or if you’ve had surgery in the ear.
BPPV: What is the Epley manoeuvre?
The Epley manoeuvre is a set of head movements which pushes these crystals out of the balance organs. This improves your sensation of spinning.
BPPV: Why would I need to do the Epley manoeuvre?
You can have a one-off Epley manoeuvre in the clinic. You may not get an appointment on the day. Doing the Epley manoeuvre yourself at home regularly is a safe alternative for symptoms of BPPV.
BPPV: What happens before the Epley manoeuvre?
They are best done on a bed as they can make you feel dizzy afterwards. Dress comfortably and have a pillow handy to place under your shoulders. This is to allow easier neck movements.
BPPV: What are the risks of doing the Epley manoeuvre?
Whilst the Epley manoeuvre itself is quite safe, you may feel your spinning sensation or vertigo getting worse during the exercise. For this reason, you may find it reassuring to have someone with you in the room. You should also avoid driving while you still feel dizzy.
You may need to avoid using the Epley manoeuvre if you have certain problems with their neck, joints, heart, and eyes. Ask your doctor to confirm if the exercises are safe for you before doing them.
BPPV: What should I expect after the Epley manoeuvre?
Sit upright for the rest of the day and avoid sleeping on the affected side for the next few days. This is to prevent the calcium crystals from going back into the balance organ.
Half of people find their spinning sensation or vertigo improves after just one manoeuvre. Others may need to repeat these daily for a few weeks.
Will the Epley manoeuvre cure my BPPV?
Although the Epley manoeuvre is effective at treating vertigo from BPPV, there is still a chance the symptoms may return weeks or even years later. This can be due to another crystal getting trapped in the balance organs.
BPPV: What if my symptoms don’t improve?
If your symptoms don’t improve after 4 weeks, please contact your doctor for a review.
ABOUT THE CONDITION
What is Benign Paroxysmal Positional Vertigo?
Epley: AFTER THE PROCEDURE
What should I expect after the Epley manoeuvre?
Will the Epley manoeuvre cure my BPPV?
What if my symptoms don’t improve?
Epley: ABOUT THE PROCEDURE
What is the Epley manoeuvre?
Why would I need to do the Epley manoeuvre?
What happens before the Epley manoeuvre?
What are the risks of doing the Epley manoeuvre?
- Spinning sensation or vertigo getting worse during the exercise
- You should also avoid driving while you still feel dizzy.
- Avoid using the Epley manoeuvre if you have problems neck, joints, heart, and eyes.
How do the balance organs work?
The balance organs of the two ears work together to send signals to the brain which maintains the balance of the head and body.
What symptoms may I have?
If one or both balance organs are not working well, you will feel off balance. This may present as vertigo or a spinning sensation. Other people describe the sensation of giddiness or of being drunk. They may also feel sick (have nausea) or are sick (vomit).
These symptoms can feel quite scary, and some people may lose their confidence. Please be reassured that, although scary, this condition is not life threatening
What are Cawthorne Cooksey’s exercises?
These are a set of balance retraining exercises. The aim of these exercises is to build your tolerance to these abnormal balance signals in the brain.
The more you do these exercises and try and get back to your normal activities, the sooner the symptoms will disappear.
What do I expect to see after doing these Cawthorne Cooksey’s exercises?
Your symptoms will not disappear overnight. It is important to persist with the exercises. You will notice the following over time:
The neck and shoulder muscles no longer feel tense.
The movements that provoke vertigo will cause less and less vertigo over time.
You will be able to move your eyes without moving your head or body.
Your symptoms and coordination will improve.
You will be practicing good posture and balance in everyday life.
How quickly your symptoms improve will vary from person to person. Be patient!
How often should I do the Cawthorne Cooksey’s exercises?
It is generally recommended to do these exercises three times every day in three sets of five. It works out at around 10 minutes each time.
You may wish to grade the severity of your symptoms before and as you do the exercises to help you keep track of your improvement. You can use the following scale:
0 - no symptom at all
1 - mild symptoms
2 - moderate symptoms
3 - severe symptoms
Tips for Success for Cawthorne Cooksey’s exercises?
Make sure you are in a safe environment before you start any exercises to reduce the risk of injury.
When you first start the exercises, you may wish to have someone else around to help you and to give you reassurance.
You should perform the exercises daily for maximal benefit.
Begin with exercise 1. Work your way down the list of exercises.
All exercises should be performed slowly to begin with and gradually progress to faster movements.
Perform the exercises as directed. Do not proceed with the other exercises until you are able to comfortably do the exercise in question without symptoms.
Should an exercise make you feel off balance, dizzy or unstable, practice this exercise for the remainder of the 10 minutes.
Do not overdo the exercises. If your symptoms become too severe, take a break.
Make a conscious effort to put your head in positions and do movements that cause your symptoms as far as you can tolerate. This is to encourage the brain to compensate more quickly.
Follow the advice given until you are able to perform all exercises and keep active in the long term.
Try to incorporate some of the principles in your everyday life if possible.
You could restart exercises if your symptoms ever return.
Ear surgery potential dangers or complications
The main risks are those of total hearing loss in the operated ear. Dizziness and tinnitus
Paralysis or weakness of the muscles of the face
disturbance of taste to one side of the tongue.
These complications may be either temporary or permanent. With modern techniques of surgery the risks are low.
After ear surgery what to expect
head bandage in order to compress the area of the operation and prevent the collection of blood underneath the wound.
Will remain in place for 24 or 48 hours
there will be ‘packing’ in the ear canal which will also need to be removed.
Stitches from the incisions are generally removed between one and two weeks postoperatively at the same time as removal of the packing if the stitches are not dissolvable.
Describe normal Balance
All three of these systems give information to the brain about the position of the body in space.
Generally people can keep their balance if two of the three systems are working, but they cannot cope with only one system working. This is why most people tend to become more unsteady as they get older, because they may have arthritis in their legs and their neck or poor eyesight.
About glue ear
Glue ear is when the space behind the eardrum is filled with liquid instead of air. It is also called otitis media with effusion, or OME. Glue ear can develop when there is not enough air getting to the middle ear. This can be because the tubes (called the eustachian tubes) which help bring air into the middle ear don’t work as well in childhood.
If your child can’t hear well, you can try these tips to help:
Call your child’s name to get them to look at you before you speak.
Make sure he or she can see your face when you speak.
Speak clearly and wait for your child to answer.
Let nursery and schoolteachers know that your child has a hearing problem.
It may help for your child to sit at the front of the class so as not to miss out.
Managing your child’s symptoms- AOM
Most cases of glue ear get better within a week. You can use paracetamol (such as Calpol) and/or ibuprofen to help with your child’s pain and fever. In more severe cases, your child may need antibiotics.
What does grommet insertion involve?
Surgery involves having an operation to put tiny plastic tubes called grommets into the eardrums. These let air get in and out of your child’s middle ear.
How can I help the grommets to work?
It is important to stop water getting into your child’s ears as much as you can. You need to do this until a doctor looks into the ears and tells you that your child’s grommets have come out.
When you wash your child’s hair, put a cotton ball covered in Vaseline into their ear to stop water getting in. Don’t let your child lie down in dirty or soapy bathwater.
Children with grommets can still go swimming. Use earplugs if they are playing a lot under the water or if they are swimming on holiday in other countries.
If swimming, it is important not to dive deeper than two feet. The water pressure at that depth (or deeper) can force water through the grommet.
Does Grommet operation involve risks?
16 out of 100 children with grommets may have discharge from their ears during the first two weeks after the operation.
22 out of 100 children with grommets may have discharge from their ears later on. This may need treatment with antibiotic ear drops.
In four out of 100 children with grommets, there is so much discharge that parents decide to have the grommet removed with another operation.
Four out of 100 children with grommets are left with a hole in the eardrum after the grommet falls out. Sometimes this needs an operation to fix it.
Other rare problems include damage to teeth from the anaesthetic tube.
The operation is carried out under a general anaesthetic, which means your child will be asleep during the surgery. Your child’s pre-assessment team will inform you about the risks of a general anaesthetic.
What happens after the grommets come out?
Grommets don’t last forever. They fall out by themselves after 6-18 months. This is a good thing because we don’t want them there forever.
Most ear problems get better by themselves with time.
If your child grows out of their ear problems before the grommets fall out, then the ear problems won’t come back.
Are there any options instead of grommets?
Most ear problems get better on their own with time. If your child’s problems are not too bad, it might be best to just watch and wait a bit longer.
If the main problem is hearing, you could try hearing aids. They will work fine as long as your child is willing to wear them. You will need to come to the hospital for regular appointments to get them adjusted.
About glue ear
How can I help my child?
Middle ear infections that keep coming back
Managing your child’s symptoms
Watchful waiting
What next? Making a decision about surgery
Deciding whether to have the treatment
How can I help the grommets to work?
Are there any options instead of grommets?
Does the operation involve risks?
What happens after the grommets come out?
Things to think about when deciding if surgery is the right choice for your child
What is important to you and your child?
