Study suggests dizzy whiplash and widespread pain cases could respond well to middle ear grit repositioning measure. This is being able to see way outside the box…
Iglebekk, W., Tjell, C., & Borenstein, P.
Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain.
Scandinavian Journal of Pain, 8, 1-7; 2015
- took subjects with at least 1 year of neck and widespread pain and dizziness
- Used dizziness handicap inventory to document dizziness:
- scores ranged from 20-72 with average 48; people with score >60 are more likely to fall
- Questions on vertigo included Nautical Vertigo = sensory illusion reminding of movements experienced on board a ship in waves.
- vertigo in general was the sensation of spinning or whirling motion – definite sensation of rotation of subject in any plane.
1) specific history of vertigo or dizziness provoked by acceleration/deceleration
(2) nystagmus and symptoms during at least one of the test positions =
(1) in sitting position; (2) in side-lying position, head turned 45 ◦ upwards; (3) in sitting position again. (less strain on neck)
“Because of the possible long latency before nystagmus was evoked in some patients, they were kept for 2 min in each position during the diagnostic procedure.”
Treatments included modified
Modified Canalith Repositioning Maneuver (CRP) technique:
The head was held in each position as follows:
- The subject sat on the long side of the mat table.
- The investigator turned the subject’s head 45 degrees away from the involved side and tilted the patient en bloc into a side-lying position through the coronal plane, with the nose pointing upward.
- Ten seconds after the cessation of vertigo, the subject was tilted nose-down toward the uninvolved side and held there until 10 seconds after the cessation of vertigo.
- Keeping the head turned toward the uninvolved side, the patient was assisted to sit up and remained in that position for 10 seconds after the cessation of vertigo.
- This variation from the original description, eliminating the premedication and shortening the interval between head movements, is associated with significant reductions in vertigo
Anterior Canolith Problem
- They thought it represented 26%- 65% of Benign positional vertigo
- Unfortunately above repositioning manouvers best for the posterior canal but not the anterior canal.
- The anterior canal canoliths give a vertical nystagmus – a”downbeat/torsio or eventually an isolated downbeat nystagmus in one of the test positions.”
- Elsewise, the diagnosis of anterior canoliths can be based on lack of improvement with usual repositioning procedures.
- To treat the latter, Author build a summersault chair – where people are slowly rotated forward completely over.
5 or more repositoning sessions were necessary
Results – “repositioning of otoliths in the SCC’s in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms.” 57% reported complete resolution of TMJ region pain after treatment. Of those with widespread pain, 19% were free of symptoms, 29% were much improved, and 14% were some improved; that left 25% unchanged. Nausea was gone in 39% and much better in 36%, Fatigue was gone in 16% and much better in 36% Neck pain was gone in 17% and much better in 33% -indicating a 50% relief of whiplash. 90% had some improvement.
Comment – this would suggest that among dizzy FM/whiplash/TMJ patients 1/2 could be much better with this treatment. Unfortunately, author built own chair so you cannot get one off ebay…