Khalid Bashir - DizzyClear: Understanding dizziness and vertigo, their management and home treatments

Easy to understand dizziness and vertigo and their management, including home treatments.

Mr Khalid Bashir MD

Consultant and Head of Emergency Medicine Department

Bronglais General Hospital, Aberystwyth, United Kingdom

Specialist in otolaryngology, sports medicine and pre-hospital care

Fellow of College of Emergency Medicine (UK)

Fellow of Royal College of Surgeons (Edinburgh)

Fellow of Royal College of Surgeons (Glasgow)

Diploma in Immediate (pre-hospital) care, Royal College of Surgeons (Edinburgh)

Diploma in Sports Medicine (Cardiff)

Certificate in Aviation Medicine (London)

GMC Specialist register of emergency medicine and general practice

Part 1

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Part 2

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Poem

I had dizziness for two years

This brought forth my tears

Someone said it is your ears

Depression was stated by my peers

Stroke was one of my fears

I spent money on pills for years

And then I discovered Dizzyclear

Then my dizziness stopped

By a dizzy patient

I would like to dedicate this book to my parents, who have contributed significantly in my life and helped me achieving the highest position in my field.

Doctors and other medical personnel commonly come across patients with dizziness. The incidence of dizziness increases as one gets older. Patients with dizziness can present with and without vertigo sensation. It is quite a disabling symptom, although mostly there is no serious underlying cause. In the past, people suffered and lived with this condition, as care providers found it difficult to deal with it properly; however, with recent advances in technology and proper management of this condition, most people can get very effective treatment. The treatments are usually provided by ear nose and throat specialists, GPs or physiotherapists in the form of various exercises and short term medication.

Dizzyclear has been written by Mr Khalid Bashir, who has vast experience in treating these patients. For the last eleven years, he has successfully treated many patients in Bronglais General Hospital, Aberystwyth. This book also contains many easy to understand illustrations. There is currently a research project being undertaken in this hospital to look into the effectiveness of Epleys manoeuvre and home exercises for the treatment of benign paroxysmal positional vertigo. Initial results have shown significant benefit to these patients in this area of Wales. We feel this book, in simple format and basic structure on this subject, will benefit hospital doctors, GPs, practice nurses, medical students and physiotherapists dealing with dizzy patients on a regular basis.

Dr L Pandya MRCP (UK), MRCP (Ireland), Consultant Physician

Dr M Akram MRCP (UK), Specialty Doctor in Medicine

Important note

Every effort has been made to check the drugs and their doses. The readers are encouraged to consult the drug companys literature before administering any drugs listed in this book. The exercises recommended in this book should be performed in a safe environment, preferably supervised by a clinician or at least in the presence of a relative or a carer.

BPPV (Benign paroxysmal positional vertigo). This is a type of dizziness where surroundings appear to spin. It is associated with nausea with various head and neck movements (chapter 23).

Dix-Halpike manoeuvre This is a test for diagnosing BPPV. The head is brought in to various positions to induce dizziness (chapter 26).

Proprioception This is a subconscious sense that enables us to know where our limbs are in space with out having to look. The proprioceptive system consists of nerve receptors in muscles, ligament and tendons around the joints.

Nystagmus A repetitive and involuntary movement of the eyes. If it is present during vertigo diagnostic tests, then the vertigo is very likely due to an inner ear problem.

Grommet A grommet is a small tube inserted into the eardrum, mainly to prevent accumulation of mucus in the middle ear. However, one rare indication of grommet insertion is vertigo due to Menieres disease.

Inner ear Called labyrinth due to its complex shape, the inner ear is situated in the bone behind the ear (petrous part of the temporal bone). It consists of a bony part, called osseous labyrinth and a membranous part, called membranous labyrinth. The labyrinth consists of three parts: 1) cochlea is the anterior part of the labyrinth. It is coil-shaped and is responsible for hearing 2) vestibule is the central part 3) semi-circular canals are the posterior part of the labyrinth. There are three semi-circular canals named according to their position: superior, posterior and horizontal. The semicircular canals and vestibule are concerned with balance.

Vestibular system The part of the inner ear concerned with balance is called the vestibular system. It consists of semi-circular canals and otolith organs. Otolith organs are fluid-filled pouches that lie between the semicircular canals and the cochlea. They are called the utricle and the saccule. These inform the brain when our body is moving in a straight line, such as when standing up or riding in a car. They also inform the brain about the position of our head in relation to the ground, for example, whether we are lying down or sitting

Vestibular rehabilitation therapy (VRT) This is an exercise-based treatment offered to patients for both acute and chronic dizziness. The following exercises are most commonly used:

Cooksey-Cawthorne Exercises (chapter 24)

Gaze Stabilisation Exercises (chapter 25)

Canalolith repositioning manoeuvres, such as Epleys manoeuvre, Semonts manoeuvre and Brandt Baroffs home exercises (chapters 27&28)

CT scan (Computerised tomogram) This is a special type of X-ray using a scanner and a computer to take pictures and analyse them. It produces scans in cross-sections. Some scanners are able to turn images into 3-D images.

MRI scan (Magnetic resonance imaging This is a special type of scan which uses strong magnetic field and radio waves and computers to take and analyse detailed pictures of the brain and spine. It is excellent in differentiating between normal and abnormal soft tissues. There is no radiation exposure to the patient, hence, it is.

Do you ever feel dizzy when you get up too quickly, when you change position in the bed, following travel by air, boat or road, or a head injury, or when you turn your head suddenly? You are not alone! Millions of people suffer from dizziness, but few know that effective treatment is available. There are many books available in the market about dizziness that deal with various aspects of dizziness and vertigo. Some of them are difficult to understand by non-medical personnel and others provide much more detail.