Vitamin D Deficiency Associated with BPPV Occurrence and Recurrence

There is increasing evidence that Vitamin D deficiency may be a risk factor for BPPV as well as its recurrences. BPPV is a condition whereby a person may suffer from brief but severe vertiginous attacks with head position changes that occur due to displaced otoliths (calcium crystals) within the inner ear.

Although easy to treat with precisely defined head position maneuvers (, i.e. Epley maneuver for posterior canal BPPV), its occurrence let alone recurrence can be alarming for patients. Although viral infections as well as head trauma are known risk factors for BPPV, these afflictions are not something a patient has any voluntary control over. However, vitamin D deficiency has also emerged as another potential risk factor for BPPV and IS something that a patient may have some control over.

Only in the past few years, increasing number of research has been published showing that:

• Osteoporosis is associated with increased risk of BPPV. [link]
• There appears to be an association between BPPV and decreased serum vitamin D. [link]
• During months when Vitamin D levels are historically low (May), BPPV occurs/recurs more frequently whereas during months where Vitamin D levels are historically high (Sept), BPPV occurs/recurs less frequently. [link]
• Improvement of serum 25-hydroxyvitamin D3 levels with vitamin D supplementation is associated with substantial decrease in BPPV recurrences. [link]

The theory that explains Vitamin D's relationship to BPPV goes something like this... The matrix found within bone and otoconia are similar. Calcium is the main component of otoconia and Vitamin D is required for calcium regulation. Therefore, a correlation between Vitamin D and BPPV is theoretically possible by its effect on calcium.

SO... at least for an individual who has suffered from BPPV with osteoporosis and certainly for those who suffer from BPPV recurrences, it may be worthwhile to take Vitamin D supplementation especially if serum levels are low.



References:
Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol. 2003 Oct;112(10):885-9.

Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope. 2013 Nov;123(11):2813-6. doi: 10.1002/lary.24099. Epub 2013 Apr 8.

Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013 Mar;260(3):832-8. doi: 10.1007/s00415-012-6712-2. Epub 2012 Oct 25.

Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016 Jun;43(3):237-41. doi: 10.1016/j.anl.2015.08.009. Epub 2015 Sep 16.

The Seasonal Variation of Benign Paroxysmal Positional Vertigo. Otol Neurotol. 2017 Aug 8. doi: 10.1097/MAO.0000000000001534. [Epub ahead of print]

Solar Eclipse 2017 in Virginia

Solar Eclipse on Aug 21, 2017
as would be seen in Virginia

To preface, this blog post has nothing to do with ENT... but given a total solar eclipse is such a rare event that will occur on August 21, 2017, I thought to post today... 10 days prior to the event to ensure as many people can enjoy viewing this spectacular astronomical event

FIRST, at least in Virginia, it will NOT be a total solar eclipse (which can only be seen in certain parts of the United States). It will be an 86% solar eclipse and will occur at 2:41PM. On the East Coast, a total solar eclipse will occur in South Carolina.

The maps below outlines the timetable throughout the United States and where a TOTAL solar eclipse can be seen.

After knowing the time for your location (click here to figure out the exact time for your location)...

NEXT, in order to fully appreciate the eclipse, you need to purchase specially filtered glasses so you don't damage your eyes when you look at it. Buy one now because they are already beginning to get sold out in many locations including Amazon... 3rd party sellers in Amazon still carry, but probably for not much longer.

Click HERE to find solar eclipse glasses for purchase!

Video Showing How Allergy Vials are Made for Allergy Shots

Our office has created a new video showing how allergy vials are made for patients undergoing allergy shots. Check it out!

There are essentially 3 steps:

Step 1:

Create graded dilutions of all allergic items (i.e., cats, dogs, trees, grasses, ragweed, etc). This is called the allergy board.

Step 2:

Based on allergy test results, the actual serum used to inject into patients is made. The more severe the allergy, the more dilute the initial concentration used. The more mild the allergy, the more concentrated the initial solution used.

Step 3:

Weekly allergy shot injections are performed. Over time, more and more concentrated serum is created for allergy injections (period known as buildup) until the maximum concentration of all the different allergies is used to create the serum. At this point, known as maintenance, allergy shots may continue for years until the patient becomes tolerant. Once tolerance is achieved, the patient is symptom free and is no longer considered allergic. Furthermore, the patient will no longer require any allergy medications.

Advanced Balance Exercises for Dizziness

There are basic balance exercises for dizzy patients who suffer from vestibular dysfunction which are safe even for a 90 years old... and than there are advanced balance exercises that will challenge even the healthiest 20 years old.

Here are some of the advanced balance exercises ballerinas and gymnasts perform in order to achieve a supernormal sense of balance that allow them to maintain perfect balance even under the most challenging of balancing situations.

The main point is that in order to resolve vestibular dizziness, vestibular rehabilitation through physical therapy is highly effective, but requires time and repetition that challenge and eventually strengthen the inner ear sense of balance, even if initially dysfunctional. This treatment strategy applies to the dizzy 90 years old as well as the 8 year old gymnast struggling on the balance beam.

Here's a lengthy YouTube video showing the balance exercises gymnasts perform to do well on the balance beam. Start watching from 3:40 minutes in.



Let's not forget about the ballerinas... Here are a few from Kathryn Boren, a member of the American Ballet Theater as part of the corps de ballet. These are all videos from her instagram's account. Click to play each of the videos.

A post shared by Kathryn Boren (@katieboren1) on Aug 4, 2017 at 3:55pm PDT

A post shared by Kathryn Boren (@katieboren1) on May 5, 2017 at 7:00am PDT

A post shared by Kathryn Boren (@katieboren1) on Feb 26, 2017 at 1:07pm PST

A post shared by Kathryn Boren (@katieboren1) on Jan 12, 2017 at 4:37pm PST

A post shared by Kathryn Boren (@katieboren1) on Mar 6, 2016 at 10:14am PST

Honey May Help With Chronic Eczema of the Ear Canal

Image from Amazon. Please note that
this honey was NOT used in the study
described

There was an interesting paper from the Netherlands regarding treatment of chronic recurrent eczematous otitis externa (ear canal skin inflammation) with honey ear drops with good success in 15 patients. Although it did not cure the problem, it did improve symptoms without the use of "medications."

Eczematous otitis externa (which should NOT be confused with acute otitis externa or swimmer's ear) is characterized by scaly, itchy, and inflamed skin involving the outer ear and ear canal. Secondary bacterial infections are not uncommon. Standard treatment involves repeated use of steroids and antibiotics which do help temporarily, but ultimately causes problems over the long-term so alternative treatment options would be ideal.

Such alternative treatment that have been tried in past include vaseline, sweet oil, mineral oil, etc in an attempt to avoid steroids and antibiotics. Now honey may potentially be considered as well.

The honey that was used in this study was called "Otomel" and is a medical grade honey produced by BFactory Health Products in Rhenen, the Netherlands. As such, there is no information in what type of honey this is, where it is produced, how it is prepared, etc.

But if you can manage to get your hands on one, the study called for using it 3 times per day for 2 weeks.


Reference:
Treatment of Recurrent Eczematous External Otitis with Honey Eardrops: A Proof-of-Concept Study. Otolaryngol Head Neck Surg. 2017 Jul 1:194599817718782. doi: 10.1177/0194599817718782. [Epub ahead of print]

Dr. Chang Quoted in SELF Magazine Article

In June 2017, SELF magazine published a story online that quoted Dr. Chang regarding earwax and its cleaning. He is mentioned in the last paragraph.

The ear canal is generally self-cleaning, so "the majority of folks don’t have to do anything," Christopher Chang, M.D., an otolaryngologist, previously told SELF. In fact, sticking a cotton swab in your ear is a recipe for disaster.

Source:
Watch This Earwax Extraction Video and Try Not to Look Away. SELF 6/26/17