Effective Home Treatment for Benign Paroxysmal Positional Vertigo (BPPV)

A research article was published in July 2010 that found use of a device called "DizzyFIX" had cure rates for BPPV (benign paroxysmal positional vertigo) of ~88% which is similar to standard treatment (Semont and Epley maneuvers) performed by a physician.

Although there are YouTube videos on how to do the Epley and Semont maneuvers correctly, unfortunately, patients rarely do it correctly when doing it privately at home resulting in prolongation of their symptoms.

The "DizzyFIX" device can be used at home and takes the patient through the CORRECT maneuvers to cure them of the dizzy attacks if due to BPPV (Benign Paroxysmal Positional Vertigo).

Watch a video here on how this device works.

Reference
Efficacy of a New Home Treatment Device for Benign Paroxysmal Positional Vertigo. Archives of Otolaryngol Head Neck Surg 136(7):682-683, July 2010.

Bursts of Fast Irregular Clicking Noise in the Ear

Every once in awhile, I see a patient who complains of an irregular clicking (or vibration) noise in the ear that occurs in bursts and may last anywhere from a few minutes every few days to as long as days or weeks at a time.

Click.... click... click, click, click... 

CLICK... click, click... 

click... Click Click... click... ... ... ... CLICK

These irregular clicking noises in the ear should NOT be confused with tinnitus. Rather, irregular clicking noises in the ear are almost always due to muscle spasms... just like "eye twitching" or "facial twitching". BUT, instead of being able to "see" the twitching as with eye twitching, one hears the twitching instead since the muscles are located around or in the ear.

1) Palatal Myoclonus
2) Tensor tympani muscle spasms
3) Stapedius muscle spasms

The first potential cause (palatal myoclonus) can be diagnosed by seeing "spasms" of the soft palate that occurs in time with the clicking. Spasms of the soft palate can be visualized by simply looking in the mouth or by nasal endoscopy. Click here to watch a video of these spasms.

The reason one is able to "hear" the twitching is because the muscles of the soft palate extend up into the ear via the eustachian tube.

Treatment of palatal myoclonus is by botox injections to the muscles that are twitching.

Just like botox treatment anywhere else in the body, the effects are only temporary and needs to be repeated every 3-6 months.

Regarding tensor tympani and stapedius muscle spasms... these muscle are not able to be visualized as they are located within the middle ear. The tensor tympani attaches to the malleus ossicle (the "hammer" of the 3 middle ear bones) and the stapedius muscle attaches to the stapes ossicle (the "stirrup").

Image taken from wikipedia.

Just like any muscle in the body, these muscles can also "twitch" rapidly causing the clicking noise in the ear.

Unfortunately, there is no "test" once can obtain to diagnose this problem with absolute certainty. It is based purely on history and excluding palatal myoclonus as a diagnosis (no soft palate twitching seen even though the patient is able to hear it).

Even more unfortunately, the only way this problem can be treated is surgical... the muscle gets cut. Botox can not be utilized as one needs to be able to "see" or "feel" the muscle in order to inject botox. This surgery is performed by a neuro-otologic surgeon.

See the full list of surgeons who can perform this surgery here.

Read more about this problem here.

Doxycycline Helps Shrink Nasal Polyps

A new research study was published that showed that the anbitiotic doxycycline (as well as methylprednisolone steroid) significantly decreased nasal polyp size compared with placebo. The effect of methylprednisolone was maximal at week 3 and lasted until week 8, whereas the effect of doxycycline was moderate but present for 12 weeks.

What patients suffering from nasal polyps need to realize is that such effects from steroids and even doxycycline are temporary... the nasal polyps come back.

Read more about nasal polyps here.

Read the research here.

Reference:
Oral steroids and doxycycline: two different approaches to treat nasal polyps. J Allergy Clin Immunol. 2010 May;125(5):1069-1076.e4. Link

Facial Fracture Face Mask for Athletes?

I often see kids/adults with minor facial fractures that do not require any surgical intervention. These same kids/adults often play sports that often led to their initial facial fracture which they do not want to give up until complete healing has occurred (baseball, basketball, skateboarding, etc).

Here's one for nasal fractures:

Why Do People Have Morning Breath?

The answer is actually pretty straight-forward... The human mouth is actually considered one of the dirtiest mouths among animals. In fact the human mouth contains so much bacteria, a human bite is considered more "dangerous" from an infection standpoint that a bite from a dog.

During the day, we constantly swallow and eat/drink which washes away the bulk of the bacteria. We also brush our teeth and gargle our mouths which also helps.

Unfortunately, during the night, none of these activities occur which allow bacteria to proliferate and produce the smells associated with bad breath.

What makes this situation worse is that you can only smell other peoples' bad breath and not your own. Why is that? It's because our sense of smell becomes desensitized to smells that's around continuously.

In other words, if you smell someone's bad morning breath for a long enough period of time, you will no longer smell it!

Read more about morning breath in the Washington Post here.