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BPPV/Menieres/Vertigo

Old 5th Oct 2020, 19:58
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BPPV/Menieres/Vertigo

I am suffering from BPPV or Menieres or Vertigo, there seems to be confusion in the medical profession about the condition, but for the layman it is a condition of the middle ear which causes dizziness and nausea. The effect is like sea sickness or motion sickness and it varies in strength from a slight loss of balance to the whole world spinning on it's axis making the slightest movement most uncomfortable. The medical profession don't seem to know what it is caused by, the treatment is to take strong sea sickness tablets to deal with the symptoms and to hope the underlying cause goes away! There seems to be nothing effective at treating the cause.

I had a bout of the condition 18 years ago and was prescribed the strong sea sickness tablets, which I took for about 10 days as prescribed. During the course I was not allowed to drive or operate machinery/climb ladders etc and getting to work was not really on as the tablets made me drowsy. After a few days, when my balance had returned and I could walk without assistance my partner did drive me to the airfield and I serviced the brakes on a microlight aircraft.

The condition struck me again on 21st September. Due to Covid19 I had to "see" the doctor by telephone call. I was unable to do anything more demanding than lying in bed, despite taking Stugeron, and when I staggered to the loo, leaning against the wall all of the way, I would sit there leaning against the wall while the world spun around me until it slowed down enough to attempt the return journey. On the advice of the pharmacist I didn't take the prescribed Prochloperazine until late in the afternoon and the sensitivity to motion diminished during the evening and by bedtime I was back on an even keel. The tablets were allowed to be taken 2 at a time, up to 3 times a day. I managed to sleep right through the 2 in the morning dose time and then forgot when I got up for a pee in the early morning as I was still OK balance wise. My head did still feel a little full of soup but my balance was fine. When I got up I was still a little soup headed but my balance was good. I didn''t take the tablets. By mid morning I was even better so we loaded the car and set off for a planned holiday. I was fine for about 4 days and then I had a mild recurrence of the symptoms, again it was cleared up by one dose of the tablets. This has been the pattern for 2 weeks now, every 4 or 5 days I get a bit unbalanced and take 2 of the tablets and after a few hours I am steady on my feet. So far I have not been affected on any day I have needed to drive. I have not even thought about going flying.

And this is where the problem arises. I need to get in a couple of hours flying and then play chauffeur to a flying instructor before the end of the month to keep my licence valid. The aircraft is available, the weather is a bit variable but I don't know if the motions of flying will cause a return of the symptoms. I have been OK driving the car some 500 miles in the last two weeks but I did have my wife along and she would have been able to take over the driving should I have become unwell. I don't have the same luxury with the aircraft.

Has anyone any experience of this condition who can offer some advice regarding getting back in the cockpit at the soonest? The recurrences I have suffered so far have all started with the first stirrings as I woke up in the morning, I have not been struck later in the day. I am hoping that once I am up and about and steady on my feet I am set up for the day and flying won't have any effect but I don't know. Anyone?

Rans6.......................
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Old 5th Oct 2020, 23:47
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It's a subject I know a bit about. Rotten luck, whatever the cause. You'll probably find, if it's M้ni่re's related, that the problem is in the inner ear. The three loops coming out of the cochlea surprisingly have an inner-tube which carries a different fluid. Leakage from one tube to the other is seriously disruptive to the information being sent to the brain. Pressure in the cochlea is an issue, and it's surprising that it's no easy task to bleed that pressure off.

Have you any loss of hearing? Is it becoming evident that one side is being affected more than the other?

I'm not qualified to judge if it's M้ni่re's or 'just' a virus, but it does sound like an infection that may clear up. The long gap between the early episode and now does sound a bit virus-like; something that can lie hidden and inert for years.

When you're better from this era, make plans for a vigorous response to any further attack. Have your doctor's office/surgery very aware of the need for an aggressive and immediate course of antibiotics (if there's a chance it's bacteriological) , or steroids, or whatever a specialist deems appropriate.

I'm aware of one case where the patient must not have any salt. Travelling for him means careful planning of accommodation where he can rely on the staff, it is that critical. But that is M้ni่re's.
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Old 7th Oct 2020, 20:18
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If it is BPPV, it is treatable by a simple manoeuvre, (called the Epley manoeuvre), usually performed by a physiotherapist. The text below is straight from Wiki, but my sister suffered for ages with symptoms similar to yours until she had this done, which cured it in hours (been repeated 18 months later when it came back, but this manoeuvre sorted it out again)
”””””””””””””””””””””
The Epley manoeuvre or repositioning maneuver is a maneuver used by medical professionals to treat one common cause of vertigo, benign paroxysmal positional vertigo (BPPV), of the posterior or anterior canals of the ear. It works by allowing free-floating particles from the affected semicircular canal to be relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo. This maneuver was developed by Dr. John Epley and first described in 1980.
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Old 7th Oct 2020, 20:54
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Originally Posted by rans6andrew View Post
I am suffering from BPPV or Menieres or Vertigo, there seems to be confusion in the medical profession about the condition, but for the layman it is a condition of the middle ear which causes dizziness and nausea. There seems to be nothing effective at treating the cause.

Has anyone any experience of this condition who can offer some advice regarding getting back in the cockpit at the soonest?
rans6,

I have great empathy for your situation having had a form of it myself many years ago. I suspect my case wasn't as serious as yours ( a floating sensation vs spinning vertigo) but being an airline pilot, I immediately self grounded and set about dealing with it but in FAA land which may be different than your obstacles.

I initially dealt with ALPA Aeromedical people who told me they get a call a week about equilibrium issues. It's pretty common.

I don't think the medical profession can be faulted for their response to these cases because there can be so many causes that just takes time to be investigated. It took three months and many scans, visits to specialists who just couldn't seem to understand than I was an airline pilot and needed fast, intense response(one guy told me to call it quits and just retire), nastagmograms, countless Eply maneuvers, etc.

In the end, it just went away with no diagnosis of what it was or what if anything I did caused to stop but merely a statement of what it wasn't. My local FAA AME was very well known to the FAA and interceded with all the documentation I had accumulated to get my First Class medical reinstated. It never appeared again. Very frustrating.

The moral to my boring story is that this will likely take some time to investigate. If your income doesn't hang in the balance, you're far ahead of the game.

Best wishes. Hang in there.
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Old 7th Oct 2020, 22:10
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https://balanceanddizziness.org/be-i...ieres-disease/

Good luck with this.
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Old 8th Oct 2020, 19:10
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It is now a full week since I had any symptoms (still not taking the medication) and I resisted the temptation to go flying yesterday after recently landed aviators suggested that it was a bit rough and turbulent upstairs. I still don't know how to tell if I am fully back on an even keel and getting an attack while PIC doesn't bear thinking about. I might ask around for someone who is prepared to sit in as P2 although it is doubtful I will find one with any time on type, there is only 51 on the UK register.

Rans6.....................
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Old 8th Oct 2020, 21:50
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The thing about flying is that we might become reliant on instruments even though we set out to be VFR. Countering the effects of vertigo is I know, a great deal harder. It takes a lot of determination to believe the dials when the world is spinning across your field of view. The only time it happened to me was during the landing deceleration on a nice clear day. Stay on that white line! I grounded myself but it seemed to be a one off, at least for many years.

It is possible to fly IFR with a very basic panel but do you think you could override the messages going to your brain when they started spinning?
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Old 8th Oct 2020, 22:21
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https://www.caa.co.uk/Aeromedical-Ex...al-GM/#VestDis]

Looking over the (UK CAA) guidance, Meniere's is a show stopper sadly.
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Old 9th Oct 2020, 16:53
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I am reminded that last time I had a bout of this the GP said it was Labyrinthitis, which I had trouble spelling when I opened this thread! At the time, 18 years ago, I was a few hours into conversion training from PPL(H) to NPPL(M) and it delayed me by about a month. The NPPL uses a self certified medical and as it is signed by my own GP he knows I fly about a bit and he didn't say not to. I think it is OK to carry on, assuming I feel fine on the day, as usual.

I am not allowed to go IFR although I have proved I can do it in an emergency. Don't ask.

Rans6.........
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Old 11th Oct 2020, 20:35
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All the evidence I have so far, from this bout of trouble and the one eighteen years ago, points to the motion sickness striking me when I am laying down and/or asleep. As I observed previously in this thread, once I am up and vertical without symptoms I will be fine for the rest of the day. Researching the Eppley manoeuvre tells me it is a series of positions of the head which are taken and held for a while to allow the inner ear fluid and whatever is wrong with it to "drain" to a position where it does not cause issues with motion and balance.

Perhaps tossing and turning in the night can cause the opposite effect and put the dodgy fluid where it can wreak havoc as I get up?

I am fairly sure that the effects of a little bit of air turbulence do not spark me off as I "committed aviation" for a couple of hours today and I was absolutely fine.

Rans6..................
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Old 11th Oct 2020, 21:21
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The Eppley manoeuver is designed to reposition any of the calcium lumps (otoliths?) which may have detached from the sense hairs in the semi-cicular canals to the lowest of the three canals so that they may not overstimulate the balance hairs in the other canals. This is what produces the nausea and eye "flicking" when a sudden change in position of the head is made through 90 degrees. BPPV can happen without obvious cause and also tends to go away on it's own in time. I hope this helps you to make more sense of the condition?
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