Positional Vertigo: Symptoms, Causes, and Treatment Options - Otolaryngology

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Positional vertigo, often referred to as Benign Paroxysmal Positional Vertigo (BPPV), is a common condition that can cause episodes of dizziness or vertigo when the head is moved in certain positions. Your symptoms, particularly the episodes of dizziness when bending over, turning your head, or changing positions, align with typical presentations of BPPV.
BPPV occurs when tiny calcium carbonate crystals (otoconia) become dislodged from their normal location in the utricle of the inner ear and migrate into one of the semicircular canals. This can lead to false signals being sent to the brain regarding head position, resulting in the sensation of spinning or dizziness. The episodes can be triggered by specific head movements, such as looking up or down, rolling over in bed, or bending down.

Given your history of experiencing similar symptoms in the past and having undergone an ear stone repositioning procedure, it is plausible that your current symptoms could be related to BPPV again. The fact that you have had episodes of dizziness that improve with certain head movements supports this possibility.
You mentioned that you have previously consulted with specialists in neurology and cardiology, and all tests returned normal results. This is encouraging as it suggests that more serious conditions, such as neurological disorders or cardiovascular issues, are less likely to be the cause of your symptoms. However, since your symptoms have recurred, it would be advisable to revisit an ear, nose, and throat (ENT) specialist, particularly one who has experience with vestibular disorders.

Regarding your question about whether to visit a private ENT clinic or a larger hospital, both options can be valid. However, larger hospitals may have more resources and specialists who are specifically trained in vestibular rehabilitation and can perform diagnostic tests to confirm BPPV. They are also more likely to have the equipment necessary for performing the repositioning maneuvers if needed.
As for your use of a sedative (Anxiolytic) like Alprazolam (安邦), it is essential to consider that while these medications can help with anxiety and sleep disturbances, they may also have side effects that can contribute to dizziness or balance issues. Sedatives can affect your central nervous system and may lead to feelings of drowsiness or disorientation, which could exacerbate your vertigo symptoms. It would be wise to discuss this with your prescribing physician, especially if you suspect it may be contributing to your dizziness.

In summary, your symptoms are consistent with BPPV, and it would be prudent to consult an ENT specialist for a thorough evaluation and potential treatment. They can perform specific maneuvers to reposition the ear crystals and provide guidance on managing your symptoms. Additionally, discussing your medication with your doctor may help clarify whether it is impacting your dizziness. Maintaining a journal of your symptoms, including when they occur and any associated activities, can also be beneficial for your healthcare provider in diagnosing and treating your condition effectively.