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I had BPPV in my right ear 10 months ago which was resolved…

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Hello, I had BPPV in...
Hello, I had BPPV in my right ear 10 months ago which was resolved with the Epley. I still suffer from positional type episodes. The balance testing revealed I have some weak LB nystagmus which signifies some right ear imbalance or uncompensation. My question is: since BPPV is not known to damage the inner ear, does the uncompensation come from the brain “not recognizing that the BPPV has resolved”? or is it because the ear is not functioning properly?Also, around the same time 10 months ago, I started getting left ear headaches or otalgia. The pain/headaches are consistently in the same spot and while I am having an epiosode my left shoulder feels very tired. My ear also clicks to high frequency noises. If put strain on that side of my body or even bend my neck forward too far, my left ear will pop or the pressure will equalize.I’ve had:MRI without contrast normal (head)
CT scan head normal
Vestibular testing + hearing test normal (except for weak left beating nystagmus and some cervical nystagmus, coincidentally when turned to the left).What could cause this?
Submitted: 3 months ago.Category: Neurology
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Answered in 2 hours by:
3/26/2018
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago
Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,758
Experience: Neurology & Int Medicine (US Trained): 20 yrs experience
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Hello. Nystagmus as an adult can be normal if mild, or the result of a central nervous system disorder, metabolic disorder, alcohol or drug toxicity, stroke, multiple sclerosis, trauma, or inflammation of the inner ear. Recurrent BPPV can be from debri or small stones developing in the semicircular canals of one or both ears.

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Customer reply replied 3 months ago
I don’t have either. The nystagmus was 3 seconds, left beating. When the medical community says the ear has not compensated from BPPV.. are they suggesting the brain hasn’t adapted?
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago

When tiny stones (otoliths) or debri form in the semicircular canals of the inner ear, they stimulate tiny hairs that send signals to the brain about the position and movement of the head. These signals are bad information, essentially, in that they don't correspond to the signals coming from the other ear and the eyes. This confuses the brain, and it can take time to "adjust" to the discrepancies. If the ear continues to produce debri, the symptoms of BPPV can persist or recur time and again.

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Customer reply replied 3 months ago
But I don’t have bppv anymore.. so why would I still have a 3 second nystagmus when doing the dix hallpike?
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago

The nystagmus could be from something else, unrelated to the BPPV. It may have been present since birth or early childhood and you never noticed it. I see brief nystagmus in many patients who are otherwise healthy. Sometimes it goes away after awhile, sometimes it persists. In the presence of normal MRI and CT scans, as well as normal blood tests, it is typically monitored but not necessarily acted upon.

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Customer reply replied 3 months ago
The person who did the testing said I may have uncompensated weakness in right ear from having bppv. I’m confused only because bppv doesn’t damage the ear... she said it was left beating which would signify the right ear is problematic. What else could cause left beating positional nystagmus?What about the headaches in my left ear? They are always in the same place..
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago

I'm not sure what "uncompensated weakness" means. That is not a medical term. Perhaps they were suggesting that you had damage to the inner ear that had not yet completely healed. This could possibly be a cause of nystagmus without BPPV symptoms. Other than that, it is difficult to explain your nystagmus, given the negative studies. The problem is likely too subtle or too small to be detectable by our tests. In cases like this, the symptoms are typically mild and the clinical significance trivial. As for the headaches, there is a fairly long list of possibilities that would require a careful exam and complete history. Your description of it affecting your shoulder would suggest strain in the sternoclidomastoid muscle that connects the back of the ear (and muscles of the side of the head) to the collar bone. It can be strained from heavy lifting or overuse from activities involving flexing the neck or turning the head. A physical therapist could probably pinpoint the problem and develop a home program of stretching and strengthening that would help with this.

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Customer reply replied 3 months ago
Thanks. The dizziness usually happens like this: I start to feel dizzy, it's not spinning, just a very strange and dizzy feeling. If I move my head around, I will get dizzier. This is followed by anxiety or a dreadful anxiety feeling and then it passes. Could seizures present this way?
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago

Atypical seizures can cause dizziness, but this shouldn't get worse with head movement. That typically localizes the problem to the inner ear. If seizures were suspected, a 24 or 48 hour video EEG might catch one and provide evidence of what part of the brain is involved.

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Customer reply replied 3 months ago
Could anxiety mimic these symptoms since vestibular testing is pretty much normal?
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago

Anxiety, stress, fatigue, inadequate sleep can all cause a myriad of unusual or unexplained neurological symptoms. This is probably because they can all affect the quantity, quality and balance of neurotransmitters in the brain.

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Customer reply replied 3 months ago
I’ll give you an example. Today I woke up ok but as the day progressed, I start to feel off balance and particularly more dizzy if I move my head around. Then I blow dried my hair which involves using the neck and arm muscles. Immediately after my left ear started to feel funny, with shoulder weakness and left side of neck weakness.. I started to feel increasingly dizzier at the table and it ended with having an anxiety attack. I notice the clicking in my ear is worse now.. I wouldn’t say it’s an ear fullness but a funny feeling from ear down to the shoulder. Could the scm cause this type of dizzy episode?
Neurologist: Dr. Bob, Neurologist (MD) replied 3 months ago

Yes, this is possible, particularly with something like blow drying your hair, which also requires turning of the head. In this context, it might make sense to also get an MRA (magnetic resonance angiogram) of the neck and head. This could rule out or rule in a vascular cause. For example, the vertberal arteries that run up the back of the neck can get pinched when the head is in an extended position, partially imparing blood flow to the brain and often resulting kin dizziness. This would not show up on other testing.

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