Vertigo

[jcapano]

Has anyone developed vertigo AFTER using a CPAP?

[JDS74]

I haven't but it is possible that extra pressure on the eustachian (spelling?) tube could move fluid into the inner ear and cause that.

[avi123]

from NEJM:

Dated: March 20, 2014

The Clinical Problem

Benign paroxysmal positional vertigo (BPPV) is by far the most common type of vertigo, with a reported prevalence between 10.7 and 64.0 cases per 100,000 population and a lifetime prevalence of 2.4%.1,2 The condition is characterized by brief spinning sensations, usually lasting less than 1 minute, which are generally induced by a change in head position with respect to gravity. 3,4 Vertigo typically develops when a patient gets in or out of bed, rolls over in bed, tilts the head back, or bends forward.3 Even though patients with BPPV occasionally report persistent dizziness and imbalance, a careful history taking almost always reveals that their symptoms are worse with changes in head position.4 Many patients also have nausea, sometimes with vomiting. Attacks of BPPV usually do not have a known cause, although cases may be associated with head trauma, a prolonged recumbent position (e.g., at a dentist's office or hair salon), or various disorders of the inner ear.3 Spontaneous remissions and recurrences are frequent; the annual rate of recurrence is approximately 15%.5 Patients with BPPV are at increased risk for falls and impairment in the performance of daily activities. 6

Dated: 2010

Benign paroxysmal positional vertigo is a common peripheral vestibular disorder. It is caused by loose otoconia, which detach from the utricular macula and fall into any one of the three semicircular canals. Patients report brief episodes of rotary vertigo triggered by changes in head position. The most common form of the disorder affects the posterior semicircular canal and is diagnosed with the Dix–Hallpike maneuver. A positive Dix–Hallpike test is manifested as upbeating torsional nystagmus with a fast component that rotates toward the undermost ear (video). This nystagmus may be seen with the unaided eye but is often more pronounced if fixation is eliminated with the use of Frenzel lenses or video-oculography goggles. Treatment of benign paroxysmal positional vertigo is directed at returning the displaced otoconia to their proper location in the inner ear. Various effective particle-repositioning maneuvers have been developed and are curative in most cases.

The specialists who deal with it are here:

http://www.vestibular.org

p.s. OSA and Vertigo and Tinnitus are related as they are manifestations of a vestibular system going caput.

If you have it forget about being a Blue Angels pilot

[ClayL]

I had Benign positional vertigo last winter and the Epley Maneuver worked for me.
A few years ago I had vertigo for two mornings that seemed to be related to unequal pressure in the Eustachian tubes because of inflammation in them.

Since there are several causes for vertigo including a tumor, it might be worthwhile to get it checked by a doctor.

[Amazeballs]

Yes, I developed vertigo after the second night on the AutoPAP. I was eventually diagnosed with Superior Canal Dehiscence, which can cause memory loss, cognitive deficit (like losing IQ points, you get stupid and can't make sense out of things-eventually I even had trouble reading for pleasure), dizziness, and balance issues. I was referred to a specialist ENT who diagnosed me through specialized CT and MRI scans. Eventually I had two surgeries to repair the missing/broken bones in my inner ear and was recovering well. Unfortunately a few months after resuming use of the AutoPAP I experienced another superior canal dehiscence and am scheduled for surgery next week.

SCD was only identified within the last 25 years (I think it was the late 1990s when the first paper on it was published), and very few specialists can perform the surgery required to fix it. There are reasonably good articles on the internet (including one from the Mayo Clinic) so if you search for "superior canal dehiscence" you can find more information.

[chunkyfrog]

An interesting situation, but was there any connection with cpap use?
Besides timing, that is?

[robysue]

"Superior Canal Dehiscence" brings back memories. Back during my Great Crash & Burn of Fall 2010 when I started PAPing, my vertigo was also out of control. After a first round of testing that eliminated BPPV as the cause, my ENT was strongly suspicious that I might have Superior Semi-Canal Dehiscence (SSCD) since the results of my hearing test and the description of my symptoms fit SCD very well. So I was sent off to get an MRI and CAT scan of my semi-circular canals and my head.

I was both sad and glad that the MRI and CAT scan eliminated SSCD from the diagnosis. Sad because it would have explained a lot of vertigo and sound sensitivity issues I've been plagued with most of my life and it is "fixable." And glad because the standard treatment for SSCD is a very scary sounding surgery. At the time tha SSCD was under consideration, I did a fair amount of research into SSCD. It's a pretty rare condition, and everything I found indicated that the underlying problem is though to be a developmental abnormality---i.e. something you're either born with or develop in very early childhood.

From Vestibular Disorders Association's web page on SSCD, we get this information about the causes of SSCD:

These findings support the notion that SSCD is due to a developmental abnormality. Temporal-bone histopathological studies suggest that 1–2% of the population have abnormally thin bone overlying the superior canal (Carey et al. 2000). Disruption of this thin layer (as may perhaps occur with trauma or over time due to the pressure of the overlying temporal lobe of the brain) leads to the onset of symptoms and signs. - See more at: http://vestibular.org/superior-canal-de ... 7BGzs.dpuf

I suppose that it's possible that the pressure from a PAP might manage to trigger SSCD symptoms in a person who already has an overly thin temporal bone, but PAP pressure is not going to cause the overly thin bone in the first place.

Best of luck to Amazeballs in dealing with getting the SSCD taken care of.