JohnUC33

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Anybody who knows much about OMT, please comment.

Okay, I've been battling with episodes of vertigo and lightheadness for about 4yrs. now. I went to a few MD's, and they ran every test they could think of, and they still didn't know what was causing it. :idea: So, I went to a DO, and he helped me establish a sleep pattern. His treatment worked for about the last year and a half.

Moreover, I started a third shift job over a month ago. My sleep schedule got out of wack. Futhermore, I had a really bad episode of vertigo and lightheadness over three weeks ago. A MD checked some vitals and nothing seemed out of place. Well, its been almost a month and Mr. Vertigo :mad: (a mild version) is still hanging out with me (and I do have a good sleep schedule now).

Well, I made an appointment with an osteopathic ENT this upcoming week. I'm thinking about just going in and straight out asking for some OMT because nothing else seems to work. Would anybody be able to vouch for the effectiveness of OMT for vertigo?
 

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I'm interested in what other folks have to respond to this.

The only problem maybe that your DO might not do OMM on you. There aren't to many DOs using OMM actively.

But I might be wrong in this case, and I wish you the best :)

C&C
 

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JohnUC33 said:
Anybody who knows much about OMT, please comment.

Okay, I've been battling with episodes of vertigo and lightheadness for about 4yrs. now. I went to a few MD's, and they ran every test they could think of, and they still didn't know what was causing it. :idea: So, I went to a DO, and he helped me establish a sleep pattern. His treatment worked for about the last year and a half.

Moreover, I started a third shift job over a month ago. My sleep schedule got out of wack. Futhermore, I had a really bad episode of vertigo and lightheadness over three weeks ago. A MD checked some vitals and nothing seemed out of place. Well, its been almost a month and Mr. Vertigo :mad: (a mild version) is still hanging out with me (and I do have a good sleep schedule now).

Well, I made an appointment with an osteopathic ENT this upcoming week. I'm thinking about just going in and straight out asking for some OMT because nothing else seems to work. Would anybody be able to vouch for the effectiveness of OMT for vertigo?
When I interviewed at DMU a few weeks ago one of the OMM fellows claimed that OMT treated her vertigo with 100% success. She said she had major problems with vertigo and now with the therapy she is fine.
 

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There is a method of treating vertigo with manipulation, more a positional thing than actually moving bones, I think. Some DO ENTs know it- I think they move your body/head into different positions to get the otoliths in your inner ear to settle into a more comfortable spot.
 

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I may be competely wrong here, but my opinion is that ENT's might not be as well versed in OMM as the OMM specialist or an AOA trained Family Practice doc. You may be better off finding one of the latter two Doctors. For now, you can try doing a search on Medline or another such journal search engine for studies involving Osteopathic Manipulative Medicine and Vertigo. I haven't looked, but you never know.
 

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JohnUC33 said:
Anybody who knows much about OMT, please comment.

Okay, I've been battling with episodes of vertigo and lightheadness for about 4yrs. now. I went to a few MD's, and they ran every test they could think of, and they still didn't know what was causing it. :idea: So, I went to a DO, and he helped me establish a sleep pattern. His treatment worked for about the last year and a half.

Moreover, I started a third shift job over a month ago. My sleep schedule got out of wack. Futhermore, I had a really bad episode of vertigo and lightheadness over three weeks ago. A MD checked some vitals and nothing seemed out of place. Well, its been almost a month and Mr. Vertigo :mad: (a mild version) is still hanging out with me (and I do have a good sleep schedule now).

Well, I made an appointment with an osteopathic ENT this upcoming week. I'm thinking about just going in and straight out asking for some OMT because nothing else seems to work. Would anybody be able to vouch for the effectiveness of OMT for vertigo?
To preface, these boards arent meant to give medical advice- you should find a good osteopath or a neurologist (or both in one) to diagnose this condition for you. Dizziness and vertigo can be caused by several conditions, and without diagnosing the cause there is little hope of recovery. I do not know what tests were run, so i cannot give any recommendations or advice in your particular case.

However, two of the more common and benign causes of recurrent vertigo are:

1)temporal bone dysfunction due to a)cervicogenic dizziness, or b)primary skull trauma

2)an otolith

Both kinds of temporal bone dysfunction can be addressed by a DO that knows what they're doing with their hands. These are both due strain on the fascial structures surroinding the temporal bone in the skull -specifically the vestibulochoclear nerve (CN VIII) which can cause dizziness and sometimes ringing of the ears (tinnitis). facial nerve palsy/bells palsy due is also common due to entrapment of the neighboring facial nerve (CN VII). [When dizziness + ringing of the ears are both present in this condition, it is usually classified as meniere's syndrome]

Cervicogenic dizziness is usually due to SCM muscle spasm in the neck, this muscle pulls on the fascia around the temporal bone directly. In the history you will find a whiplash-like injury to the neck or torticollis within days to months before the onset of symptoms. The treatment can be physical therapy (which will typically take weeks) or OMM- with OMM often leading to immediate and complete recovery with one treatment. OMM will consist of muscle and fascial stretches (muscle energy, myofascial release, neurofascial release, counterstrain etc.), but any sort of physical/emotional relaxation therapy and the ability to sleep may ease your symptoms.

Temporal bone dysfunction can also be due to direct skull trauma (usually to the side of the head)- several days up to a few months before the onset of symptoms. The source of symptoms is the same as cervicogenic dizziness, with impingement of CN VIII due to local fascial irritation at the skull or membranous strain in the skull. This is a case where cranial osteopathy (despite its controversy) is really your first line of treatment, and clinical improvement if not total remission should be seen in one treatment if the diagnosis is correct and the practicioner knows what they're doing.


an otolith (small stone) in the vestibular system of the inner ear can sometimes be misplaced- which will also cause chronic dizziness, with exacerbations and remissions. The [Epley] maneuver attempts to move the stone back to its original position, and its common practice among both allopathic and osteopathic ENT's and Neurologists (though there are some that dont know it, depending on their training). This treatment is not unique to osteopathy. Some FP doctors and OMT specialists will know how to do this as well, however.

all that said, there are MANY other NON-benign causes of chronic dizziness. Medications need to be evaluated for ototoxicity. Patients with chronic dizziness that dont immediately resolve with OMT or positional therapy should be evaluated for CNS tumors, vertebrobasilar ischemia and vasculitis and other causes.

[Basilar migraines may cause dizziness as well, though these may or may not be entirely benign. they can mimic stroke symptoms and at times can have dramatic consequences while driving or operating machinery, and can potentially be damaging in and of themselves (increased stroke risk)]

hope that helps,
Michael
 

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I should also comment that you need to be clear as to whether this is dizziness, vertigo or light headedness- very different things. The scenarios i mentioned above were for vertigo, however light headedness can be accompanied by a "dizzy" feeling and is often confused with vertigo. Light headedness is very commonly caused by blood pressure medications, which is made worse by standing up suddenly (orthostatic hypotension). Low blood sugars secondary to predromal diabetes or diabetes medications may also cause intermittent light headedness (not associated with position).

Careful reajustment of medication doses and behavioral change are effective in addressing these problems.

Anemias can also sometimes present this way. A thorough workup is needed for these kinds of diagnoses, and a lot more history than you probably want to give us on a medical student forum.

good luck
 
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JohnUC33

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Thanks for all your information. I really hope this ENT knows enough to help me out. I'm just glad that he is not hindered with only using medications.
Thanks again :thumbup:
 

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Or it could be Meniere's disease, and treatment for that involves sodium reduction and diuretics...

The ENT I work with sends alot of his chronic vertigo patients (like the benign positional vertigo/otolith) to get what is called 'canal repositioning' and is done by a trained ENT or PT specialist in dizziness. It usually takes several sessions to do this and may be what the OMM is indirectly doing.
 

bones

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babyruth said:
Or it could be Meniere's disease, and treatment for that involves sodium reduction and diuretics...

The ENT I work with sends alot of his chronic vertigo patients (like the benign positional vertigo/otolith) to get what is called 'canal repositioning' and is done by a trained ENT or PT specialist in dizziness. It usually takes several sessions to do this and may be what the OMM is indirectly doing.
here's a blurb from uptodate.com:

INTRODUCTION — Meniere's disease is a condition that is thought to arise from an abnormal homeostasis of inner ear fluids. It is named for Prospere Meniere, a 19th century French physician who first recognized that the semicircular canals were balance organs and that they could be a source of balance disturbance. Meniere described the clinical characteristics of the condition (episodic vertigo preceded by tinnitus and hearing loss) that bears his name in 1861 [1].

The classic pathologic lesion of Meniere's disease is termed endolymphatic hydrops; it can only be definitively diagnosed by histopathologic analysis of the temporal bone. The association of Meniere's disease with endolymphatic hydrops was made by Lindsay in 1968 [2], and has been confirmed by many authors since that time. Endolymphatic hydrops causes a distortion and distention of the membranous, endolymph-containing portions of the labyrinthine system, compressing the perilymphatic spaces.

There are many potential causes of endolymphatic hydrops (show table 1). The disorder is usually idiopathic, in which case it is referred to as Meniere's disease, but may also occur secondary to these other inner ear disorders, in which case it is called Meniere's syndrome.

Because a definitive diagnosis can only be made postmortem, patients are presumed to have endolymphatic hydrops based upon a specific set of clinical symptoms that include episodic vertigo (a true spinning sensation that has an onset and an offset), tinnitus, aural fullness, and fluctuating sensory hearing loss. Often nausea is seen in conjunction with these other symptoms.
------------------------------------------------------------

The osteopathic theory is that trauma or chronic pull the temporal bone via SCM (or any of the other 20 things on their list of causes for local temporal bone edema) can cause local tissue inflammation, blocking the lymphatic flow as stated above. i.e. meniere's syndrome.

this is scenario #1. You can give diuretics or reduce sodium and attempt to reduce edema in the whole body, and implicitly, the temporal bone region as well (and of course subjecting the patient to a variety of diuretic side effects for its duration of use). Betahistine hydrochloride has also been shown to be effective in this regard in double blind studies. You will also need anti-emetics until the lymph drains, since the patient will have nausea for a while. This is the classic allopathic approach. When you stop the meds the problem usually comes back because you havent addressed the cause.

Since OMM works so effectively and permanently on the vast majority of cases that present as classic Meniere's there is little reason to resort to chronic medication use on this condition (of course, if you dont have the skills, you will have to refer to someone who does or use medications to treat their symptoms).
 

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There has been a lot of talk on here about (DIX-) HALLPIKE manuvers as a way to treat vertigo, I think that is not the case. "Hallpike" manuver is a way to DIAGNOSE positional vertigo, and the EPLEY (described by Brandt and Darofand others) manuevers/exercises are the series of head positions to TREAT it. This is a important distinction and the two are not similar I believe. If you have contradictory info please cite a source.

Source: Adams and Victor pp 264-265, 5th ed.

As an aside: Another item in the differential dx. given the relationship to sleep cycles would be basilar migraine, other symptoms in the basilar territory may occur and it is more common in females, and should have some level of HA assoc. with it.

To the OP, see a OMM specialist, you have nothing to lose and might benefit. (benefit/risk ratio could be very high).
 
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JohnUC33

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Thanks everyone. At least I won't be completely ignorant when I go see the ENT D.O. I just hope he just doesn't try to treat the symptoms by giving me a pill that I'll be on forever. I'll be sure to post whatever treatment he provides and whether it works or not.
 

bones

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macman said:
There has been a lot of talk on here about (DIX-) HALLPIKE manuvers as a way to treat vertigo, I think that is not the case. "Hallpike" manuver is a way to DIAGNOSE positional vertigo, and the EPLEY (described by Brandt and Darofand others) manuevers/exercises are the series of head positions to TREAT it. This is a important distinction and the two are not similar I believe. If you have contradictory info please cite a source.

Source: Adams and Victor pp 264-265, 5th ed.

As an aside: Another item in the differential dx. given the relationship to sleep cycles would be basilar migraine, other symptoms in the basilar territory may occur and it is more common in females, and should have some level of HA assoc. with it.

To the OP, see a OMM specialist, you have nothing to lose and might benefit. (benefit/risk ratio could be very high).
thanks Macman- my mistake. The dix-hallpike maneuver IS actually very similar to the first step of treatment in the Epley maneuver however- you lean and tilt the patient back for dix-hallpike, and then reposition to 3 or 4 additional positions to work the stone back using Epley (i had heard the mention of the name in reference to the diagnostic position, and assumed it applied to the whole procedure).

here's a good article on the traditional medical approach to Benign positional vertigo.
http://www.tchain.com/otoneurology/disorders/bppv/bppv.html


Yes, basilar migraines with associated dizziness are in the differential as well, though not as common in my experience as cervicogenic dizziness/temporal bone insult (close to half) or BPPV with classic features of nystagmus with dix-hallpike.

I will edit my above post for correctness. thx.
 

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I would suggest you see a neurologist and an ENT for formal vestibular testing and then a vestibular therapist for treatment if this is indeed the correct treatment required (vestibular therapists are usually OTs or PTs that specialize in inner ear issues such as this). Some of my patients have had excellent results.
 

babyruth

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Meniere's is one of those diseases that is a diagnosis of exclusion, so it is more likely that something else is going on... The ENT that I am working with looks long and hard before putting someone on diuretics and uses it as a last resort.

But the low salt diet would be a good idea in any case since it will not hurt you.

(A lady we saw the other day had possibility of Meniere's dz and she was already obese and HTN anyways. We are going to see her back after trying some other treatments but the diuretics and low salt diet would benefit her other comorbid conditions as well.)

To the OP, has anyone yet looked in your ears? Do you have chronic allergies or ear infections? These questions go on and on, and I am sure the ENT will make sure and do this, but sometimes it is the simple answer that is correct (Occham's razor).
 

babyruth

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I guess I would also have to ask if you what lightheadedness means to you? Because vertigo and lightheadedness are interpreted differently and differentials for both of these need to be considered. We have been focusing on the vertigo aspect but I guess the lightheaded component needs to be addressed as well...
 
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JohnUC33

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From my understanding, vertigo is the feeling you get that your still in motion although you are not. Lightheadness is the feeling where you like you are about to faint and have to lie down. If I'm wrong, someone please let me know? Well, my vertigo has only gotten worse since I've first written this post; therefore, I will be glad to see the ENT tomorrow. I would not wish this condition on anybody because all I can really do is lie down to relieve the symptoms (yea, my head is spinning just typing this). Oh, I'll be sure to post how it goes tomorrow
 

bones

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babyruth said:
(A lady we saw the other day had possibility of Meniere's dz and she was already obese and HTN anyways. We are going to see her back after trying some other treatments but the diuretics and low salt diet would benefit her other comorbid conditions as well.)
This is the kind of patient where diuretics WOULD be a good option in conjunction with OMT (since it would also help BP)... that is assuming significant temboral bone findings and that you've ruled out serious pathology with the appropriate tests and BPV with Dix-hallpike. If Dix-hallpike is positive the OMT and diuretics would both be useless (other than to treat BP).

Of course your best chance of long-term success would be if you could get her exercising regularly... and a low salt diet is good for most people, especially those with symptoms of edema.

we had a patient with medication-resistant HTN who was supposedly on a low-salt diet who we later found out was eating soy sauce on EVERY meal including breakfast... he was using it as a dipping sauce AND a dressing. :rolleyes: apparently he didnt read labels...


good luck :(
 
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JohnUC33

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Well, I finally saw the specialist. His diagnosis was BPPV and borderline Meniere's. He put me on a low sodium, no caffeine diet. Prescribed Meclizine and head exercises to do. Thanks for all your help and info because I actually understood some of the stuff he was saying. I hope it works.