1. Engagement in Meaningful Dialogue: Respond to a student peer and course faculty to further dialogue.
a. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources).
b. Student responds to at least one peer.
c. Student responds to all direct questions posed by faculty.
d. Post includes evidence from at least one scholarly resource to support interactive dialogue.
2. Professionalism in Communication: Present information in a logical, meaningful, and understandable sequence that is relevant to the discussion topic.
a. Grammar, spelling, and/or punctuation are accurate.
b. Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 10 words). The quote must add substantively to the discussion.
REPLY POST NEEDED FOR THE FOLLOWING POST:
The two disease processes that I will be speaking about are Benign Positional Vertigo and Meniere’s Disease. I had previously heard of Meniere’s Disease as well as worked with one patient in clinical who had this diagnosis, however, was not familiar with Benign Positional Vertigo. Throughout reading, I learned that while the two diseases do have similarities, they are very different.
I would consider Benign Positional Vertigo the lesser of two evils. BBPV presents with acute onset of vertigo, specifically occurring with every day movements of the head (looking up, looking down, etc.) Additional symptoms include dizziness, lightheadedness, inability to balance appropriately, nausea/vomiting and possible vision changes. Risk factors for BBPV include age (can occur at any time but is most common in adults 50 years and older), traumatic events such as falls and infection.
BBPV is considered a disorder of the inner ear and is directly related to the displacement of otoconia (calcium carbonate particles). Typically, otoconia house themselves within the utricle. BBPV symptoms occur when these particles move into the semicircular canals of the ear and irritate the cilia, which happens through the head movements listed above. Diagnosis of BBPV is done through a thorough HPI and the patient’s clinical presentation. Differential diagnosis include vestibular neuritis and acoustic neuroma.
Treatment of BBPV focuses on symptom management until symptoms resolve, which typically takes up to six weeks. Depending on the specific symptoms and severity that the patient is experiencing, medications that aim to treat nausea and/or motion sickness may be prescribed. Additionally, the patient can participate in non-pharmacological physical therapy which consists of “a series of physical movements that change the position of your head and body” (Benign paroxysmal positional vertigo (BPPV): Treatment, symptoms & causes 2022). For this reason, a physical therapist will likely be consulted. Patient education includes compliance with suggested exercises at home, eliminating risk factors (ex – wearing a helmet when riding a bicycle) and reducing falls risks in the home.
Like BBPV, Meniere’s Disease is also a disorder of the inner ear that presents with vertigo. However, the onset is more gradual and generally accompanied by tinnitus. Patients may also complain of increased anxiety due to the fears associated with new-onset vertigo. The average age of onset for Ménière’s disease is 40-60 years old, similar to that of BBPV.
While Meniere’s Disease also begins in the inner ear, it is directly caused by fluid retention. Endolymph (fluid contained within the inner ear) gradually builds up for unknown reasons and eventually puts too much pressure on the parts of the ear that control balance and hearing. Essentially, this fluid blocks the normal communication between the inner ear and the brain, causing the symptoms above. Meniere’s Disease is considered a very rare disorder, with an estimated 615,000 people in the US being diagnosed (Ménière’s disease: Symptoms, causes & treatment2022).
Being that this disease is uncommon, diagnostic criteria begins by ruling out other disease processes. This can be done by performing an MRI w/ contrast. If concerns such as brain tumors are ruled out, diagnosis can be confirmed by the patient having “two or more vertigo attacks, each lasting 20 minutes to 12 hours, or up to 24 hours; hearing loss proved by a hearing test and tinnitus or a feeling of fullness or pressure in the ear” (Meniere’s disease 2022). Differential diagnosis include autoimmune inner ear disease and otosclerosis.
Unlike BBPV, Meniere’s Disease does not resolve. In fact, there is no true cure. Many symptoms become so severe that the patients quality of life is decreased. Therefore, symptom management is certainly a primary goal. Similar to BBPV, management can include pharmacological options such as anti-nausea and anti-motion sickness medications. Additionally, diuretics may be recommended to help reduce fluid retention. Patients should be educated to decrease salt intake to also help avoid excess fluid. Similar to BBPV, patient education also focuses on safety factors due to vertigo and balance concerns. Patient’s with Meniere’s Disease experience flare ups and episodes of remission. Patients should be educated to rest both during and after attacks.
Other treatment options range from non-invasive to invasive surgeries, depending on the severity of the disease. Patients may be referral to physical therapy for balance related rehabilitation. Additional referrals may include audiology for evaluation for a hearing aid, as many patients lose hearing entirely. Invasive measures may be taken such as surgical procedures to remove the parts of the inner ear that are not operating properly, allowing the remaining “healthy” parts of the ear to take over.
References
Benign paroxysmal positional vertigo (BPPV): Treatment, symptoms & causes. Cleveland Clinic. (2022, June 16). Retrieved May 6, 2023, from https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv
Buttaro, T. M., PolgarBailey, P., SandbergCook, J., & Trybulski, J. (2021). Primary care: A collaborative practice (6th ed.). Elsevier Health Sciences (US)
Mayo Foundation for Medical Education and Research. (2022, December 30). Meniere’s disease. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/menieres-disease/diagnosis-treatment/drc-20374916Links to an external site.
Ménière’s disease: Symptoms, causes & treatment. Cleveland Clinic. (2022b, December 30). https://my.clevelandclinic.org/health/diseases/15167-menieres-disease
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