July 29, 2025 • 34 mins
Navigating the complex world of inner ear disorders, Dr. Ayla Wolf and Sophia Bouwens discuss the mechanics and causes of Benign Paroxysmal Positional Vertigo (BPPV) and what contributes to re-occurring BPPV.
• Difference between true vertigo and general dizziness
• How the semicircular canals and otolithic organs in our inner ear detect all head movements
• Infrared goggles essential for accurate BPPV diagnosis
• Vitamin D, calcium, magnesium and B vitamin deficiencies linked to recurring BPPV
• Thyroid disorders, hormonal fluctuations, and certain antibiotics can trigger vestibular problems
• COVID infections associated with increased vestibular symptoms
• Chinese medicine perspective on "dampness" and its relationship to dizziness
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Ayla Wolf (00:01):
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolf and I will behosting today's episode, where
we help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go toresource for actionable
information, whether you'redealing with a recent concussion
(00:22):
, struggling with postconcussion syndrome or just
feeling stuck in your healingprocess.
In each episode, we dive deepinto the symptoms, testing,
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
(00:44):
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
All right, sophia, how are youdoing today?
All right, sophia, how are youdoing today?
Sophia Bowens (01:04):
I'm doing really well, Ayla.
How are you today?
Dr. Ayla Wolf (01:08):
I am good.
It's super hot and humid out,so I'm happy to be recording
this podcast in a niceair-conditioned room.
Sophia Bowens (01:27):
You know, what's interesting is this time of the
year in Chinese medicine is sucha rising energy heat and we're
in this transition into likedampness.
Dr. Ayla Wolf (01:31):
And it's interesting because in my
experience at the neurosciencecenter and even in my own life
I've been noticing a lot ofpeople are getting more dizzy
for our listeners who don't knowwhat dampness means, maybe you
could explain what that termmeans in Chinese medicine and
then how that might translate toan increase in dizziness.
Sophia Bowens (01:53):
Oh yes, so that's a great lead.
So dampness in Chinese medicineis like the stickiness you know
when it's humid or hot andheavy and like kind of damp
outside or there's kind of thislike griminess sensation of it's
not everything's not superclear.
It's both like a feeling andalso a physiological condition,
(02:15):
right, so it can lead to morephlegm, it can lead to more
digestive disruption, it canlead to more like sticky skin
conditions and it can also leadto this feeling of like
fogginess or brain fog.
And this condition of just notclear thinking can disrupt our
(02:36):
ability to sense the worldaround us and lead to the sense
of like imbalance or dizziness.
Dr. Ayla Wolf (02:42):
And people are also eating way more ice cream,
which is super phlegm and dampforming.
Yes, exactly so.
One of the ways that I look atdampness, this concept of
dampness from a Chinese medicineperspective, is a stagnation
within the lymphatic system andthat can also create a sense of
(03:07):
heaviness and swelling and edema.
But within the inner ear we alsohave endolymph, so we have a
very special kind of lymph inthe inner ear and the viscosity
of that is different from otherlymph in the body.
And so when we think aboutdampness causing dizziness, it
(03:33):
can also mean that the endolymphitself is actually congested
and that the body isn'tproducing enough new, clear,
healthy endolymph.
Almost like the blood canbecome thick, the endo lymph can
become thick, and so that canalso cause things like dizziness
or vertigo or disequilibriumand all these type of inner ear
disorders.
Sophia Bowens (03:54):
Fascinating.
Do you think hydration wouldaffect that?
Dr. Ayla Wolf (03:58):
I think that the electrolyte balance is important
, or just the amount ofelectrolytes, but also balance
is important, or just the amountof electrolytes.
But also, if you think aboutthis idea that the endolymph is
unique and it's in one part ofthe body, our body is supposed
to have the wisdom to be able tohave the right concentration of
different electrolytes indifferent parts of the body.
(04:19):
And so, obviously, when peoplehave underlying health issues,
or even again, like a headtrauma that affects the ear or
the structures around the ear,that's where you can actually
get some of this congestion thathappens in that particular part
of the body, which makes peoplemore susceptible to things like
(04:40):
dizziness.
Sophia Bowens (04:42):
Well, let's dive in.
So today we're going to talkabout BPPV.
Dr. Ayla Wolf (04:46):
BPPV is Benign Paroxysmal Positional Vertigo,
which is such a mouthful thatpeople tend to abbreviate it as
BPPV.
Sophia Bowens (05:00):
There's a lot of interesting terminology in this
discussion.
As we go, the words not onlythe name is complex, but the
words that describe themechanisms and these weird
organs that are in between ourears and have so much effect on
our sense of balance in space inthe world.
They have the strangest nameswe're not used to hearing.
(05:20):
So it's fitting that the titleof the condition is kind of
complex, but we're going to alsowork to be making it really
really straightforward andunderstand some of these more
complex words that we use todescribe this condition.
Dr. Ayla Wolf (05:36):
For sure, and I feel like people that come into
my office fall into two camps.
The first camp is when I sayBPPV, they give me a blank look
and they've never heard thatterm or that abbreviation before
ever.
And then the other camp ispeople who have kind of
associated all vertigo as BPPVand then I have to explain that
(06:01):
while BPPV is often the mostcommon kind of cause of vertigo,
not all vertigo is BPPV.
So those are kind of the twocamps of people that I feel like
I see and I figured I'd justlike throw that out there that
you know it's important torecognize that this is one
(06:22):
source or one cause of vertigo,but it's not the only.
It's not the only cause.
Sophia Bowens (06:28):
No, and that's really important because
oftentimes describing thissensation is really important
for the correct diagnosis oreven for people to go down the
trail of looking for the correctdiagnosis.
So there's a lot of peopleconfused, dizziness and vertigo.
Can you describe or define whateach of those are and how they
(06:50):
might feel or be describeddifferently by patients?
Dr. Ayla Wolf (07:09):
true vertigo is a sense of rotation or spinning,
and so people will either feellike the world is spinning
around them or they feel likethey are spinning, and so that
is what we would consider to bea true vertigo sensation,
whereas dizziness is more of avague sensation of being
disconnected from yourenvironment.
Some people will describe it asbeing like oftentimes, when
(07:33):
you're dizzy, you are also offbalance.
So people can be like well, Ifeel off balance.
Or maybe people will say I feela little lightheaded
lightheaded, but often it's likethis sense of disorientation
where you're just all of asudden not feeling normal in
your own body because of thedizziness.
Sophia Bowens (07:55):
And one marked thing I noticed and I don't
think you can correct me if I'mwrong, because you know so much
more about this topic than I do.
I have had vertigo twice andthe second time I had this like
extreme feeling of being likepulled to the ground.
It felt like I was in like atilt of world and just like
(08:18):
being propelled over and Icouldn't.
It was kind of awful, kind ofterrible and I was like oh my
gosh, that that is definitelyvertigo of some kind.
I got tested and got this.
You know everything was treatedwell and that thank goodness I
knew I had the tools to havethat done quickly.
(08:39):
But I think that this, likestrong pulling sensation or
forceful sensation, happenssometimes.
Does it always happen invertigo?
Dr. Ayla Wolf (09:01):
It's not always just like oh, I feel like the
world is spinning to the rightor the world is spinning to the
left.
Some people will say, you know?
They'll say I feel like I'mlike doing a backflip, where I'm
like going back into the left,or I feel like I'm falling
forward into the right, and sopeople can have all of these
diagonal directionalities totheir sense of vertigo, which
(09:24):
might also feel like you're likebeing pulled to the floor.
But then, when there is vertigo, there can also be an otolithic
component where, if there'sjust hyperactivity happening
within the otolithic organs,that can also cause a sense of
feeling like you're being pulledto the ground.
Sophia Bowens (09:46):
Okay.
Dr. Ayla Wolf (09:47):
And so sometimes, when we talk about vertigo,
this is where, like youmentioned, there's all this
neuroanatomy that we have to getinto, but the thing that causes
the spinning is dysfunctionwithin the semicircular canals.
So those are part of thevestibular system in the inner
(10:08):
ear, and then another part ofthe vestibular system are the
otolithic organs, and so I thinkit's important to recognize
like these are special organsthat we have in the inner ear
and they have lots of sensoryreceptors that are picking up
every single time our bodies aremoving forwards, backwards,
(10:30):
side to side or up and down.
So you can imagine that if oneof these sensors, the one that's
telling your brain that we'removing down, if that's firing
too much, you're literally goingto feel like you're being
pulled to the floor.
Sophia Bowens (10:46):
Yep, and that was awful.
That's what was happening to me.
So there's these.
It was.
There's these otolithic organs,but there's also these
semicircular canals, and can youdescribe for listeners what
those are, what those look likeor how they translate
information to us?
Dr. Ayla Wolf (11:08):
Yeah, so if we are going to talk about this in
terms of shapes, we could saythat in the inner ear we have
this thing called the vestibule,and we can picture the
vestibule as a, as a box, andthen inside that box we have the
otolithic organs, are twootoliths, and then inside that
box we have the otolithic organs, our two otoliths, and then on
the outside of the box we've gothalf circles which represent
(11:32):
the three semicircular canals.
And so on the right ear we havethree semicircular canals and
on the left ear we have threesemicircular canals, so we've
got six in total.
We have three semicircularcanals, so we've got six in
(12:06):
total.
Bowl with a marble in it.
Every time you tipped the bowl,the marble would roll right.
And so all of thesesemicircular canals the three on
the right and the three on theleft they're all working
together to tell the brainexactly how the head is tipping
and tilting and turning everytime you move your head.
(12:28):
And so it's like if that bowlwas just one big giant sensor.
It would be telling the brainexactly where the marble is.
Sophia Bowens (12:35):
Yeah, I like that .
And these canals.
They work together to provideinformation to the brain kind of
where and how our head isturning.
Is that right?
Dr. Ayla Wolf (12:45):
Yeah, and so the problem is, when there's too
much activity happening in acanal, it tells the brain that
the head is turning in like more, more than it actually is.
Or if somebody is perfectlystill and that canal is firing,
then it's telling the brain thatthere's that movement is
(13:06):
happening when it's nothappening.
Sophia Bowens (13:08):
And that can lead to symptoms like vertigo.
Dr. Ayla Wolf (13:11):
Exactly.
Sophia Bowens (13:13):
Okay, so this is complex and there's all these
mismatched features of things,but I think that gets really
interesting and important whenwe're looking at really how do
we treat this, how do wediagnose it, how do we assess it
, how do we figure out what'sgoing on so we can help correct
it.
What would you say is some ofthe hallmarks of BPPV, versus
(13:37):
just regular dizziness?
Dr. Ayla Wolf (13:41):
I think it's important to point out that when
people have BPPV, they can havea pretty long list of symptoms,
and so some people like themost common symptom like people
will have vertigo.
Other people might actuallyjust feel dizzy.
Other people could havedisequilibrium.
Some people can have headachesand nausea and neck tension.
(14:04):
So there's a whole long list ofpossible symptoms that people
could experience.
But I think that there's acouple of differentiating
features that are helpful interms of identifying BPPV, and
one of them is that when youhave a canal lithiasis and this
(14:26):
is again another fancy term it'sa type of BPPV, saying that
there are calcium crystals thathave fallen into the canal that
are causing the excessiveactivity that is now tricking
your brain into thinking thatthere's movement happening, and
so typically, a classicpresentation of BPPV is that
(14:49):
somebody tips their head into aspecific position and all of a
sudden they get vertigo, butthen as soon as they get out of
that position, it calms backdown.
So it's not constantly there allthe time, and the thing that my
patients often will tell me iswhen I lay back to go to bed at
(15:10):
night, I'll have an episode ofvertigo, or when I sit up in the
morning I'll have an episode ofvertigo.
Or when I tilt my head back inthe shower to shampoo my hair.
All of a sudden I get vertigohair.
All of a sudden I get vertigo,and so people can often identify
the position that their headgoes into.
(15:31):
That then triggers the symptom.
Sophia Bowens (15:33):
And does that help you figure out how to treat
it?
Or does that give youinformation which position it is
or how the angle that they haveto turn to?
Does that make a difference?
Dr. Ayla Wolf (15:44):
So that's often the symptom that clues me in to
say that sounds like BPPV.
Right, but the absolute bestway to really diagnose BPPV is
to have the patient put infraredgoggles on so that the
clinician can actually see theireyes, so that the clinician can
(16:07):
actually see their eyes, andthen the patient is going to be
tilted into certain positionsthat bias one of the
semicircular canals.
And if nystagmus is observed inthe eyes, that then what's
nystagmus?
So nystagmus is a very specifictype of eye movement where the
eyes are slowly drifting onedirection and then they're
(16:28):
rapidly correcting back in theopposite direction.
The thing that we have toappreciate is the fact that our
vestibular system, thesesemicircular canals they are
hardwired into the nuclei thatthen control the six eye muscles
, and so when a canal isoverfiring, it's going to cause
(16:51):
the eyes to move in a veryspecific direction.
So, for example, if the leftposterior canal is overfiring,
the eyes are going to be pusheddown into the right and then
they're going to correct back upinto the left, and there's also
going to be a torsional aspectto this as well, meaning the
(17:14):
eyes are going to roll and soyou're going to see a nystagmus
that is in a very specificdirection and there might also
be a torsional component to it.
And there might also be atorsional component to it,
(17:41):
whereas if you have a highfiring left horizontal canal,
the eyes are going to be pushedto the right and then have a
fast correction these infraredgoggles on.
And there was a study that Ithought was really important,
because the study said that ifyou are only relying on just
tilting somebody's head indifferent positions to see if it
triggers dizziness or vertigo,and you're not using infrared
(18:04):
goggles and you're not actuallyseeing nystagmus, that you're
going to get your diagnosiswrong 50% of the time.
Sophia Bowens (18:10):
Basically, Wow, that's not good.
So you don't just go based on,like what they're feeling.
You have to.
This eye movement component isreally important for this
diagnosis to be accurate.
Is that what I'm hearing yousay?
Dr. Ayla Wolf (18:25):
Yep, that's exactly it.
So being able to observe thenystagmus is really key if we
want to have an accuratediagnosis.
And then to add even morecomplexity, sometimes, these
calcium crystals that we thinkare in some cases causing the
BPPV, there's again, there'svery smart people who still
(18:49):
aren't quite sure if thiscalcium crystal theory is like
the end-all, be-all of allcauses of BPPV.
But to make matters morecomplex, these calcium crystals,
they can adhere to the wall ofthe canal, and so if they've
adhered to the wall of the canal, you might not see the
nystagmus during your testing.
(19:09):
And so one of the things thatcan help is to just take a
tuning fork and place it on themastoid, which causes a really
gentle vibration, but it canshake those crystals loose off
of the canal wall.
And so then, if there reallytruly are free floating crystals
in the canal that's causing thevertigo, well, now you've kind
(19:32):
of loosened them up so that, a,you can get an accurate
diagnosis and then, b, the headrepositioning maneuvers are
probably going to be moreeffective, because you've
actually gotten the crystals toshake loose and then they can
more freely fall back into thevestibule where they belong.
Sophia Bowens (19:51):
So complex.
So I know that we've alreadydove into this topic so much,
but I want to just backtrack fora second because I want to be
clear on how someone mightdescribe dizziness or a feeling
of imbalance in a way that mighttune you in to think it might
be BPPV versus other types ofdizziness.
Dr. Ayla Wolf (20:10):
You don't want to diagnose BPPV based on
somebody's symptoms.
However, when someone describesvertigo that comes on suddenly
and usually calms back downwithin about 30 seconds to a
minute and seems to beresponsive to an adjustment of
position, that's always my kindof cue to say this sounds like
(20:35):
BPPV.
Sophia Bowens (20:37):
Versus another type of dizziness, because there
are other drivers of dizzinessor vertigo.
Bppv is just the most common,is that right?
Dr. Ayla Wolf (20:46):
Yeah, I mean there's a million causes of
dizziness.
That's a whole notherconversation.
When people say they're dizzy,that could mean anything.
Sophia Bowens (20:56):
That definitely needs a lot more diagnostic
workup and it's not kind ofconstant all the time.
It's definitely positional andthere are these eye movement
components that are present tohelp us understand what is kind
(21:16):
of going on and how we mightassess or treat it.
And then you talked about thislike crystal component of these
crystals are floating around inthese canals that are providing
feedback into our system, butsome schools of thought and some
really intelligent peoplechallenge this crystal theory.
That's really interesting to mebecause for as long as I've
(21:38):
learned about BPPV or thisvestibular component, it's
always this like dynamic betweenthese little cilia here on the
inside of these canals and thesecrystals floating around.
Can you talk more about thisidea that maybe that's not the
endovial, maybe there'sdifferent types or maybe there's
other things driving this?
Dr. Ayla Wolf (21:57):
I think a lot of it is observation, because once
you start seeing lots and lotsof patients that have vertigo,
you start to feel like noteverybody falls into a textbook.
Cat, you know, category of BPPV, and that's the thing is is
like we, you know, we all go toschool we learn these textbook
(22:19):
presentations and then we getout into the real world and all
these people come in and theyare they don't fit the textbook
right, they're not textbook.
Sophia Bowens (22:28):
Right A little bit of this a little bit of that
, no.
Dr. Ayla Wolf (22:33):
Yeah.
And so I think that when you'vegot a lot of practitioners who
see people that always thatmaybe don't fit into these
textbook descriptions of BPPV,they start to think like, well,
what else is going on?
And it also seems like if you,if you go on the internet,
(22:53):
there's a new vestibularrepositioning technique that
shows up every year.
And so now we have all thesedifferent repositioning
maneuvers and it's like, okay,well, are they actually dealing
with calcium crystals, or arethese repositioning maneuvers
somehow maybe recalibrating thevestibular system in a way that
(23:17):
is actually helping the patientto not be so dizzy or have
vertigo?
And so I think that when veryintelligent people are saying
I'm not sure this calciumcrystal theory is the end-all,
be-all of explaining everysingle case of BPPV, I think
this is where they're comingfrom.
Sophia Bowens (23:36):
And I wonder too if this challenge comes from a
reoccurrence of BPPV, Like ifit's just these crystals that
get dislodged, a what causesthem to be dislodged and what
about when those crystals getput back into place.
And it continues to be an issuefor some patients and not for
others.
Dr. Ayla Wolf (23:54):
When people do get BPPV.
Some people end up in the campwhere they then start to get it.
I don't necessarily it doesn'talways have to be frequently,
but some patients will say, ohmy gosh, I get it every three
months.
Some people will say I get itonce a year.
Some people will say I get itonce a year.
Some people will say I had ityears ago and now I have it
again.
So can reoccur at verydifferent frequencies for
(24:16):
different people.
But there I think has been moreinterest in trying to
understand why does this keepcoming back?
And so we can break it up intokind of a couple different
categories.
So what they have found is thatsome people have nutrient
deficiencies that can contributeto it.
So simple things like a vitaminD deficiency seems to cause
(24:41):
reoccurring BPPV.
So for some people it's assimple as hey, you need to get
your vitamin D status back up toa healthy level.
Sophia Bowens (24:53):
Vitamin D is considered like a yang tonic or
a yang vitamin in Chinesemedicine and yang helps
transform phlegm or thisdampness.
It comes from the sunshine,which helps dry dampness.
So if we're thinking of thisthrough the Chinese medicine
lens, for me that's kind ofwhere my head goes, like oh yeah
, this young thing that reallyhelps clear dampness and dry up
(25:15):
and clear phlegm.
I love Chinese medicine and howit ties into these wisdoms.
Sometimes when you see the dots, you can't help but connect
them.
So vitamin D deficiency can bea contributing factor to
reoccurring BPPT a contributingfactor to reoccurring BPPT.
Dr. Ayla Wolf (25:33):
Yeah, and I think that's hilarious that you were
able to bring this full circlefrom when we started talking
about dampness to then talkingabout vitamin D and sunlight
drying dampness.
So there you go.
Sophia Bowens (25:42):
Are there other things that I mean not just
vitamin D, though, right,there's like a lot more.
Dr. Ayla Wolf (25:48):
Yeah, so I mean as far as the nutrients, calcium
and magnesium deficiencies canbe problematic as well as B
vitamin deficiencies.
So there's research to showthat B vitamin deficiencies can
contribute to reoccurring BPPV.
So those are kind of the bigones as far as nutrients go.
And then when people havethyroid dysfunction or
(26:11):
parathyroid disorders that canaffect calcium metabolism, and
so whenever you're throwing offcalcium metabolism, obviously
those are the people that thenalso might be dealing with
osteoporosis or osteopenia, andso those particular individuals
can have reoccurring BPPV.
Sophia Bowens (26:30):
They're more prone to it.
And what stands out to me aboutall those things those
nutrients calcium, magnesium, bvitamins is they're really
important for nerve function andmaintaining that cellular
balance.
This system is really sensitiveto those even small disruptions
in the cellular functioning.
Dr. Ayla Wolf (26:53):
Yeah, absolutely.
And then I don't know if yousaw this, but during COVID,
especially when the Omicronvariant was going around, lots
of my patients were coming inwith vestibular disorders and
with reoccurring BPPV, and soinfections and anything
affecting the inner ear candefinitely cause that.
(27:14):
And I think one of the mostfrustrating thing for those
patients is that they were allsaying the exact same thing,
which was I went to my ENT, theylooked in my ears, they told me
I was fine and they sent mehome and they're like but I am
still dizzy and I have vertigoand I can't walk straight and I
(27:34):
have all these vestibularsymptoms, and so in that case I
think again, when you're talkingabout the inner ear, it is very
sensitive to infections, it'svery sensitive to inflammation
and, as we mentioned before,that idea that if the endolymph
is getting congested and it'sthrowing off the viscosity of
the endolymph, all of that cancause vestibular symptoms it's
(27:58):
amazing that we don't all have alot more vestibular symptoms.
Yeah and a lot of this stuff.
With the reoccurring bppv, itrequires again more like
investigative lab work to try tofigure out does somebody have a
nutrient deficiency?
Do they maybe have a thyroiddisorder?
Because autoimmune thyroidissues Hashimoto's is very
(28:21):
common and autoimmune disordersare on the rise and especially
as people age it actuallybecomes more common.
And so again, I think, inelderly individuals a lot of
times doctors aren't, they'renot searching for an autoimmune
disorder, they're not lookingfor you know, they're not
immediately thinking let's testthe thyroid for Hashimoto's with
(28:44):
this person who's in their 60s,for example.
Sophia Bowens (28:47):
Do you see this being sensitive to blood sugar
regulation or people withdiabetes?
Dr. Ayla Wolf (28:52):
Absolutely so.
That can be another source ofwhy people might have
reoccurring BPPV, because whenpeople have diabetes and
unmanaged high blood sugar, thatactually causes nerve damage
and in some cases that causesnerve damage to the inner ear,
and so that can be a problem.
And then there's alsoantibiotics that are actually
(29:14):
ototoxic, so they're toxic tothe inner ear and can cause
inner ear damage, and so it'simportant to recognize, I think,
for people, if they've alreadydealt with BPPV, to be very
careful about antibiotic use andwhich ones they need to avoid.
Sophia Bowens (29:33):
That's super fascinating that even things
like antibiotics, which could beused to treat things like ear
infections or strep or otherinfections, can have this risk
of being ototoxic.
Do you know which antibioticsin particular present this
highest risk for thisototoxicity?
Dr. Ayla Wolf (29:54):
Yeah, they say definitely when people have
intravenous antibiotics incertain classes that I think
that becomes like one of thehigher risk factors.
So the aminoglycosides are oneexample, Streptomycin is one of
those, and then vancomycin has ahigher risk.
And the macrolides thatcategory of antibiotics which
(30:19):
include azithromycin anderythromycin, all are known.
I think that's important forpeople that do have kind of a
background in vestibulardisorders.
If they're ever given anantibiotic, I think it would be
important that they talk totheir doctor and read the
potential side effects to makesure that they might not be
(30:39):
taking something that's ototoxicif they already have different
vestibular issues going on.
So that's an important thing tokeep in mind.
Sophia Bowens (30:48):
All these things we haven't really thought about
but can make such a differencefor this really sensitive
apparatus.
Dr. Ayla Wolf (30:54):
Yeah, even different issues with hormones.
So I have a friend who I workout with at the gym and she was
having BPPV and basicallyfinally figured out that it was
hormonal and so it was happeningat a very specific time in her
cycle every month and once shedealt with her hormonal and so
it was happening like at a veryspecific time in her cycle every
month and once she dealt withher hormonal imbalances, then
(31:15):
the vertigo went away.
Sophia Bowens (31:16):
So for women who are menstruating, it could be
like that this comes on acertain time of the month when
that gets higher.
What about do you see thishappening more or less in like
menopausal, paramenopausal?
Dr. Ayla Wolf (31:27):
women.
For sure, like with menopause,those hormone changes can affect
the difference between estrogenplaying a role in our bone
density and our calciummetabolism.
So as estrogen levels fall,then all of a sudden that gets
thrown out of balance.
So that can also be a trigger.
Sophia Bowens (31:47):
Fascinating so much.
Well, this is an interestingtopic and I think we scratched
the surface of it.
I think a follow up episode weshould do is like the
complexities of, like the visualsystem, how it plays into this
vestibular system, and maybe howthings like proprioception or
joint position can play intothis too.
In your book you do such a nicejob of breaking down all these
(32:08):
things in relation to BPD.
Dr. Ayla Wolf (32:10):
Oh, well, thank you so much, and we'll
definitely have to do anotherdeep dive into the world of
vestibular symptoms here soon.
And for you listening, we'dlove to hear what specific
topics you want to hear moreabout, and you can do that by
clicking the send us a text linkthat's at the top of the show
notes.
I also want to mention thereare now video clips from
(32:30):
previous episodes on the LifeAfter Impact YouTube channel,
which you can find by searchingfor at Life After Impact Medical
disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
(32:51):
professional health careservices, including the giving
of medical advice.
No doctor patient relationshipis formed.
The use of this information andmaterials included is at the
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
(33:11):
consumers of this informationshould seek the advice of a
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
Welcome to Life After Impact the concussion
recovery podcast.
I'm Dr Ayla Wolf and I will behosting today's episode, where
we help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go toresource for actionable
information, whether you'redealing with a recent concussion
(00:22):
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feeling stuck in your healingprocess.
In each episode, we dive deepinto the symptoms, testing,
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forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
(00:44):
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
All right, sophia, how are youdoing today?
All right, sophia, how are youdoing today?
Sophia Bowens (01:04):
I'm doing really well, Ayla.
How are you today?
Dr. Ayla Wolf (01:08):
I am good.
It's super hot and humid out,so I'm happy to be recording
this podcast in a niceair-conditioned room.
Sophia Bowens (01:27):
You know, what's interesting is this time of the
year in Chinese medicine is sucha rising energy heat and we're
in this transition into likedampness.
Dr. Ayla Wolf (01:31):
And it's interesting because in my
experience at the neurosciencecenter and even in my own life
I've been noticing a lot ofpeople are getting more dizzy
for our listeners who don't knowwhat dampness means, maybe you
could explain what that termmeans in Chinese medicine and
then how that might translate toan increase in dizziness.
Sophia Bowens (01:53):
Oh yes, so that's a great lead.
So dampness in Chinese medicineis like the stickiness you know
when it's humid or hot andheavy and like kind of damp
outside or there's kind of thislike griminess sensation of it's
not everything's not superclear.
It's both like a feeling andalso a physiological condition,
(02:15):
right, so it can lead to morephlegm, it can lead to more
digestive disruption, it canlead to more like sticky skin
conditions and it can also leadto this feeling of like
fogginess or brain fog.
And this condition of just notclear thinking can disrupt our
(02:36):
ability to sense the worldaround us and lead to the sense
of like imbalance or dizziness.
Dr. Ayla Wolf (02:42):
And people are also eating way more ice cream,
which is super phlegm and dampforming.
Yes, exactly so.
One of the ways that I look atdampness, this concept of
dampness from a Chinese medicineperspective, is a stagnation
within the lymphatic system andthat can also create a sense of
(03:07):
heaviness and swelling and edema.
But within the inner ear we alsohave endolymph, so we have a
very special kind of lymph inthe inner ear and the viscosity
of that is different from otherlymph in the body.
And so when we think aboutdampness causing dizziness, it
(03:33):
can also mean that the endolymphitself is actually congested
and that the body isn'tproducing enough new, clear,
healthy endolymph.
Almost like the blood canbecome thick, the endo lymph can
become thick, and so that canalso cause things like dizziness
or vertigo or disequilibriumand all these type of inner ear
disorders.
Sophia Bowens (03:54):
Fascinating.
Do you think hydration wouldaffect that?
Dr. Ayla Wolf (03:58):
I think that the electrolyte balance is important
, or just the amount ofelectrolytes, but also balance
is important, or just the amountof electrolytes.
But also, if you think aboutthis idea that the endolymph is
unique and it's in one part ofthe body, our body is supposed
to have the wisdom to be able tohave the right concentration of
different electrolytes indifferent parts of the body.
(04:19):
And so, obviously, when peoplehave underlying health issues,
or even again, like a headtrauma that affects the ear or
the structures around the ear,that's where you can actually
get some of this congestion thathappens in that particular part
of the body, which makes peoplemore susceptible to things like
(04:40):
dizziness.
Sophia Bowens (04:42):
Well, let's dive in.
So today we're going to talkabout BPPV.
Dr. Ayla Wolf (04:46):
BPPV is Benign Paroxysmal Positional Vertigo,
which is such a mouthful thatpeople tend to abbreviate it as
BPPV.
Sophia Bowens (05:00):
There's a lot of interesting terminology in this
discussion.
As we go, the words not onlythe name is complex, but the
words that describe themechanisms and these weird
organs that are in between ourears and have so much effect on
our sense of balance in space inthe world.
They have the strangest nameswe're not used to hearing.
(05:20):
So it's fitting that the titleof the condition is kind of
complex, but we're going to alsowork to be making it really
really straightforward andunderstand some of these more
complex words that we use todescribe this condition.
Dr. Ayla Wolf (05:36):
For sure, and I feel like people that come into
my office fall into two camps.
The first camp is when I sayBPPV, they give me a blank look
and they've never heard thatterm or that abbreviation before
ever.
And then the other camp ispeople who have kind of
associated all vertigo as BPPVand then I have to explain that
(06:01):
while BPPV is often the mostcommon kind of cause of vertigo,
not all vertigo is BPPV.
So those are kind of the twocamps of people that I feel like
I see and I figured I'd justlike throw that out there that
you know it's important torecognize that this is one
(06:22):
source or one cause of vertigo,but it's not the only.
It's not the only cause.
Sophia Bowens (06:28):
No, and that's really important because
oftentimes describing thissensation is really important
for the correct diagnosis oreven for people to go down the
trail of looking for the correctdiagnosis.
So there's a lot of peopleconfused, dizziness and vertigo.
Can you describe or define whateach of those are and how they
(06:50):
might feel or be describeddifferently by patients?
Dr. Ayla Wolf (07:09):
true vertigo is a sense of rotation or spinning,
and so people will either feellike the world is spinning
around them or they feel likethey are spinning, and so that
is what we would consider to bea true vertigo sensation,
whereas dizziness is more of avague sensation of being
disconnected from yourenvironment.
Some people will describe it asbeing like oftentimes, when
(07:33):
you're dizzy, you are also offbalance.
So people can be like well, Ifeel off balance.
Or maybe people will say I feela little lightheaded
lightheaded, but often it's likethis sense of disorientation
where you're just all of asudden not feeling normal in
your own body because of thedizziness.
Sophia Bowens (07:55):
And one marked thing I noticed and I don't
think you can correct me if I'mwrong, because you know so much
more about this topic than I do.
I have had vertigo twice andthe second time I had this like
extreme feeling of being likepulled to the ground.
It felt like I was in like atilt of world and just like
(08:18):
being propelled over and Icouldn't.
It was kind of awful, kind ofterrible and I was like oh my
gosh, that that is definitelyvertigo of some kind.
I got tested and got this.
You know everything was treatedwell and that thank goodness I
knew I had the tools to havethat done quickly.
(08:39):
But I think that this, likestrong pulling sensation or
forceful sensation, happenssometimes.
Does it always happen invertigo?
Dr. Ayla Wolf (09:01):
It's not always just like oh, I feel like the
world is spinning to the rightor the world is spinning to the
left.
Some people will say, you know?
They'll say I feel like I'mlike doing a backflip, where I'm
like going back into the left,or I feel like I'm falling
forward into the right, and sopeople can have all of these
diagonal directionalities totheir sense of vertigo, which
(09:24):
might also feel like you're likebeing pulled to the floor.
But then, when there is vertigo, there can also be an otolithic
component where, if there'sjust hyperactivity happening
within the otolithic organs,that can also cause a sense of
feeling like you're being pulledto the ground.
Sophia Bowens (09:46):
Okay.
Dr. Ayla Wolf (09:47):
And so sometimes, when we talk about vertigo,
this is where, like youmentioned, there's all this
neuroanatomy that we have to getinto, but the thing that causes
the spinning is dysfunctionwithin the semicircular canals.
So those are part of thevestibular system in the inner
(10:08):
ear, and then another part ofthe vestibular system are the
otolithic organs, and so I thinkit's important to recognize
like these are special organsthat we have in the inner ear
and they have lots of sensoryreceptors that are picking up
every single time our bodies aremoving forwards, backwards,
(10:30):
side to side or up and down.
So you can imagine that if oneof these sensors, the one that's
telling your brain that we'removing down, if that's firing
too much, you're literally goingto feel like you're being
pulled to the floor.
Sophia Bowens (10:46):
Yep, and that was awful.
That's what was happening to me.
So there's these.
It was.
There's these otolithic organs,but there's also these
semicircular canals, and can youdescribe for listeners what
those are, what those look likeor how they translate
information to us?
Dr. Ayla Wolf (11:08):
Yeah, so if we are going to talk about this in
terms of shapes, we could saythat in the inner ear we have
this thing called the vestibule,and we can picture the
vestibule as a, as a box, andthen inside that box we have the
otolithic organs, are twootoliths, and then inside that
box we have the otolithic organs, our two otoliths, and then on
the outside of the box we've gothalf circles which represent
(11:32):
the three semicircular canals.
And so on the right ear we havethree semicircular canals and
on the left ear we have threesemicircular canals, so we've
got six in total.
We have three semicircularcanals, so we've got six in
(12:06):
total.
Bowl with a marble in it.
Every time you tipped the bowl,the marble would roll right.
And so all of thesesemicircular canals the three on
the right and the three on theleft they're all working
together to tell the brainexactly how the head is tipping
and tilting and turning everytime you move your head.
(12:28):
And so it's like if that bowlwas just one big giant sensor.
It would be telling the brainexactly where the marble is.
Sophia Bowens (12:35):
Yeah, I like that .
And these canals.
They work together to provideinformation to the brain kind of
where and how our head isturning.
Is that right?
Dr. Ayla Wolf (12:45):
Yeah, and so the problem is, when there's too
much activity happening in acanal, it tells the brain that
the head is turning in like more, more than it actually is.
Or if somebody is perfectlystill and that canal is firing,
then it's telling the brain thatthere's that movement is
(13:06):
happening when it's nothappening.
Sophia Bowens (13:08):
And that can lead to symptoms like vertigo.
Dr. Ayla Wolf (13:11):
Exactly.
Sophia Bowens (13:13):
Okay, so this is complex and there's all these
mismatched features of things,but I think that gets really
interesting and important whenwe're looking at really how do
we treat this, how do wediagnose it, how do we assess it
, how do we figure out what'sgoing on so we can help correct
it.
What would you say is some ofthe hallmarks of BPPV, versus
(13:37):
just regular dizziness?
Dr. Ayla Wolf (13:41):
I think it's important to point out that when
people have BPPV, they can havea pretty long list of symptoms,
and so some people like themost common symptom like people
will have vertigo.
Other people might actuallyjust feel dizzy.
Other people could havedisequilibrium.
Some people can have headachesand nausea and neck tension.
(14:04):
So there's a whole long list ofpossible symptoms that people
could experience.
But I think that there's acouple of differentiating
features that are helpful interms of identifying BPPV, and
one of them is that when youhave a canal lithiasis and this
(14:26):
is again another fancy term it'sa type of BPPV, saying that
there are calcium crystals thathave fallen into the canal that
are causing the excessiveactivity that is now tricking
your brain into thinking thatthere's movement happening, and
so typically, a classicpresentation of BPPV is that
(14:49):
somebody tips their head into aspecific position and all of a
sudden they get vertigo, butthen as soon as they get out of
that position, it calms backdown.
So it's not constantly there allthe time, and the thing that my
patients often will tell me iswhen I lay back to go to bed at
(15:10):
night, I'll have an episode ofvertigo, or when I sit up in the
morning I'll have an episode ofvertigo.
Or when I tilt my head back inthe shower to shampoo my hair.
All of a sudden I get vertigohair.
All of a sudden I get vertigo,and so people can often identify
the position that their headgoes into.
(15:31):
That then triggers the symptom.
Sophia Bowens (15:33):
And does that help you figure out how to treat
it?
Or does that give youinformation which position it is
or how the angle that they haveto turn to?
Does that make a difference?
Dr. Ayla Wolf (15:44):
So that's often the symptom that clues me in to
say that sounds like BPPV.
Right, but the absolute bestway to really diagnose BPPV is
to have the patient put infraredgoggles on so that the
clinician can actually see theireyes, so that the clinician can
(16:07):
actually see their eyes, andthen the patient is going to be
tilted into certain positionsthat bias one of the
semicircular canals.
And if nystagmus is observed inthe eyes, that then what's
nystagmus?
So nystagmus is a very specifictype of eye movement where the
eyes are slowly drifting onedirection and then they're
(16:28):
rapidly correcting back in theopposite direction.
The thing that we have toappreciate is the fact that our
vestibular system, thesesemicircular canals they are
hardwired into the nuclei thatthen control the six eye muscles
, and so when a canal isoverfiring, it's going to cause
(16:51):
the eyes to move in a veryspecific direction.
So, for example, if the leftposterior canal is overfiring,
the eyes are going to be pusheddown into the right and then
they're going to correct back upinto the left, and there's also
going to be a torsional aspectto this as well, meaning the
(17:14):
eyes are going to roll and soyou're going to see a nystagmus
that is in a very specificdirection and there might also
be a torsional component to it.
And there might also be atorsional component to it,
(17:41):
whereas if you have a highfiring left horizontal canal,
the eyes are going to be pushedto the right and then have a
fast correction these infraredgoggles on.
And there was a study that Ithought was really important,
because the study said that ifyou are only relying on just
tilting somebody's head indifferent positions to see if it
triggers dizziness or vertigo,and you're not using infrared
(18:04):
goggles and you're not actuallyseeing nystagmus, that you're
going to get your diagnosiswrong 50% of the time.
Sophia Bowens (18:10):
Basically, Wow, that's not good.
So you don't just go based on,like what they're feeling.
You have to.
This eye movement component isreally important for this
diagnosis to be accurate.
Is that what I'm hearing yousay?
Dr. Ayla Wolf (18:25):
Yep, that's exactly it.
So being able to observe thenystagmus is really key if we
want to have an accuratediagnosis.
And then to add even morecomplexity, sometimes, these
calcium crystals that we thinkare in some cases causing the
BPPV, there's again, there'svery smart people who still
(18:49):
aren't quite sure if thiscalcium crystal theory is like
the end-all, be-all of allcauses of BPPV.
But to make matters morecomplex, these calcium crystals,
they can adhere to the wall ofthe canal, and so if they've
adhered to the wall of the canal, you might not see the
nystagmus during your testing.
(19:09):
And so one of the things thatcan help is to just take a
tuning fork and place it on themastoid, which causes a really
gentle vibration, but it canshake those crystals loose off
of the canal wall.
And so then, if there reallytruly are free floating crystals
in the canal that's causing thevertigo, well, now you've kind
(19:32):
of loosened them up so that, a,you can get an accurate
diagnosis and then, b, the headrepositioning maneuvers are
probably going to be moreeffective, because you've
actually gotten the crystals toshake loose and then they can
more freely fall back into thevestibule where they belong.
Sophia Bowens (19:51):
So complex.
So I know that we've alreadydove into this topic so much,
but I want to just backtrack fora second because I want to be
clear on how someone mightdescribe dizziness or a feeling
of imbalance in a way that mighttune you in to think it might
be BPPV versus other types ofdizziness.
Dr. Ayla Wolf (20:10):
You don't want to diagnose BPPV based on
somebody's symptoms.
However, when someone describesvertigo that comes on suddenly
and usually calms back downwithin about 30 seconds to a
minute and seems to beresponsive to an adjustment of
position, that's always my kindof cue to say this sounds like
(20:35):
BPPV.
Sophia Bowens (20:37):
Versus another type of dizziness, because there
are other drivers of dizzinessor vertigo.
Bppv is just the most common,is that right?
Dr. Ayla Wolf (20:46):
Yeah, I mean there's a million causes of
dizziness.
That's a whole notherconversation.
When people say they're dizzy,that could mean anything.
Sophia Bowens (20:56):
That definitely needs a lot more diagnostic
workup and it's not kind ofconstant all the time.
It's definitely positional andthere are these eye movement
components that are present tohelp us understand what is kind
(21:16):
of going on and how we mightassess or treat it.
And then you talked about thislike crystal component of these
crystals are floating around inthese canals that are providing
feedback into our system, butsome schools of thought and some
really intelligent peoplechallenge this crystal theory.
That's really interesting to mebecause for as long as I've
(21:38):
learned about BPPV or thisvestibular component, it's
always this like dynamic betweenthese little cilia here on the
inside of these canals and thesecrystals floating around.
Can you talk more about thisidea that maybe that's not the
endovial, maybe there'sdifferent types or maybe there's
other things driving this?
Dr. Ayla Wolf (21:57):
I think a lot of it is observation, because once
you start seeing lots and lotsof patients that have vertigo,
you start to feel like noteverybody falls into a textbook.
Cat, you know, category of BPPV, and that's the thing is is
like we, you know, we all go toschool we learn these textbook
(22:19):
presentations and then we getout into the real world and all
these people come in and theyare they don't fit the textbook
right, they're not textbook.
Sophia Bowens (22:28):
Right A little bit of this a little bit of that
, no.
Dr. Ayla Wolf (22:33):
Yeah.
And so I think that when you'vegot a lot of practitioners who
see people that always thatmaybe don't fit into these
textbook descriptions of BPPV,they start to think like, well,
what else is going on?
And it also seems like if you,if you go on the internet,
(22:53):
there's a new vestibularrepositioning technique that
shows up every year.
And so now we have all thesedifferent repositioning
maneuvers and it's like, okay,well, are they actually dealing
with calcium crystals, or arethese repositioning maneuvers
somehow maybe recalibrating thevestibular system in a way that
(23:17):
is actually helping the patientto not be so dizzy or have
vertigo?
And so I think that when veryintelligent people are saying
I'm not sure this calciumcrystal theory is the end-all,
be-all of explaining everysingle case of BPPV, I think
this is where they're comingfrom.
Sophia Bowens (23:36):
And I wonder too if this challenge comes from a
reoccurrence of BPPV, Like ifit's just these crystals that
get dislodged, a what causesthem to be dislodged and what
about when those crystals getput back into place.
And it continues to be an issuefor some patients and not for
others.
Dr. Ayla Wolf (23:54):
When people do get BPPV.
Some people end up in the campwhere they then start to get it.
I don't necessarily it doesn'talways have to be frequently,
but some patients will say, ohmy gosh, I get it every three
months.
Some people will say I get itonce a year.
Some people will say I get itonce a year.
Some people will say I had ityears ago and now I have it
again.
So can reoccur at verydifferent frequencies for
(24:16):
different people.
But there I think has been moreinterest in trying to
understand why does this keepcoming back?
And so we can break it up intokind of a couple different
categories.
So what they have found is thatsome people have nutrient
deficiencies that can contributeto it.
So simple things like a vitaminD deficiency seems to cause
(24:41):
reoccurring BPPV.
So for some people it's assimple as hey, you need to get
your vitamin D status back up toa healthy level.
Sophia Bowens (24:53):
Vitamin D is considered like a yang tonic or
a yang vitamin in Chinesemedicine and yang helps
transform phlegm or thisdampness.
It comes from the sunshine,which helps dry dampness.
So if we're thinking of thisthrough the Chinese medicine
lens, for me that's kind ofwhere my head goes, like oh yeah
, this young thing that reallyhelps clear dampness and dry up
(25:15):
and clear phlegm.
I love Chinese medicine and howit ties into these wisdoms.
Sometimes when you see the dots, you can't help but connect
them.
So vitamin D deficiency can bea contributing factor to
reoccurring BPPT a contributingfactor to reoccurring BPPT.
Dr. Ayla Wolf (25:33):
Yeah, and I think that's hilarious that you were
able to bring this full circlefrom when we started talking
about dampness to then talkingabout vitamin D and sunlight
drying dampness.
So there you go.
Sophia Bowens (25:42):
Are there other things that I mean not just
vitamin D, though, right,there's like a lot more.
Dr. Ayla Wolf (25:48):
Yeah, so I mean as far as the nutrients, calcium
and magnesium deficiencies canbe problematic as well as B
vitamin deficiencies.
So there's research to showthat B vitamin deficiencies can
contribute to reoccurring BPPV.
So those are kind of the bigones as far as nutrients go.
And then when people havethyroid dysfunction or
(26:11):
parathyroid disorders that canaffect calcium metabolism, and
so whenever you're throwing offcalcium metabolism, obviously
those are the people that thenalso might be dealing with
osteoporosis or osteopenia, andso those particular individuals
can have reoccurring BPPV.
Sophia Bowens (26:30):
They're more prone to it.
And what stands out to me aboutall those things those
nutrients calcium, magnesium, bvitamins is they're really
important for nerve function andmaintaining that cellular
balance.
This system is really sensitiveto those even small disruptions
in the cellular functioning.
Dr. Ayla Wolf (26:53):
Yeah, absolutely.
And then I don't know if yousaw this, but during COVID,
especially when the Omicronvariant was going around, lots
of my patients were coming inwith vestibular disorders and
with reoccurring BPPV, and soinfections and anything
affecting the inner ear candefinitely cause that.
(27:14):
And I think one of the mostfrustrating thing for those
patients is that they were allsaying the exact same thing,
which was I went to my ENT, theylooked in my ears, they told me
I was fine and they sent mehome and they're like but I am
still dizzy and I have vertigoand I can't walk straight and I
(27:34):
have all these vestibularsymptoms, and so in that case I
think again, when you're talkingabout the inner ear, it is very
sensitive to infections, it'svery sensitive to inflammation
and, as we mentioned before,that idea that if the endolymph
is getting congested and it'sthrowing off the viscosity of
the endolymph, all of that cancause vestibular symptoms it's
(27:58):
amazing that we don't all have alot more vestibular symptoms.
Yeah and a lot of this stuff.
With the reoccurring bppv, itrequires again more like
investigative lab work to try tofigure out does somebody have a
nutrient deficiency?
Do they maybe have a thyroiddisorder?
Because autoimmune thyroidissues Hashimoto's is very
(28:21):
common and autoimmune disordersare on the rise and especially
as people age it actuallybecomes more common.
And so again, I think, inelderly individuals a lot of
times doctors aren't, they'renot searching for an autoimmune
disorder, they're not lookingfor you know, they're not
immediately thinking let's testthe thyroid for Hashimoto's with
(28:44):
this person who's in their 60s,for example.
Sophia Bowens (28:47):
Do you see this being sensitive to blood sugar
regulation or people withdiabetes?
Dr. Ayla Wolf (28:52):
Absolutely so.
That can be another source ofwhy people might have
reoccurring BPPV, because whenpeople have diabetes and
unmanaged high blood sugar, thatactually causes nerve damage
and in some cases that causesnerve damage to the inner ear,
and so that can be a problem.
And then there's alsoantibiotics that are actually
(29:14):
ototoxic, so they're toxic tothe inner ear and can cause
inner ear damage, and so it'simportant to recognize, I think,
for people, if they've alreadydealt with BPPV, to be very
careful about antibiotic use andwhich ones they need to avoid.
Sophia Bowens (29:33):
That's super fascinating that even things
like antibiotics, which could beused to treat things like ear
infections or strep or otherinfections, can have this risk
of being ototoxic.
Do you know which antibioticsin particular present this
highest risk for thisototoxicity?
Dr. Ayla Wolf (29:54):
Yeah, they say definitely when people have
intravenous antibiotics incertain classes that I think
that becomes like one of thehigher risk factors.
So the aminoglycosides are oneexample, Streptomycin is one of
those, and then vancomycin has ahigher risk.
And the macrolides thatcategory of antibiotics which
(30:19):
include azithromycin anderythromycin, all are known.
I think that's important forpeople that do have kind of a
background in vestibulardisorders.
If they're ever given anantibiotic, I think it would be
important that they talk totheir doctor and read the
potential side effects to makesure that they might not be
(30:39):
taking something that's ototoxicif they already have different
vestibular issues going on.
So that's an important thing tokeep in mind.
Sophia Bowens (30:48):
All these things we haven't really thought about
but can make such a differencefor this really sensitive
apparatus.
Dr. Ayla Wolf (30:54):
Yeah, even different issues with hormones.
So I have a friend who I workout with at the gym and she was
having BPPV and basicallyfinally figured out that it was
hormonal and so it was happeningat a very specific time in her
cycle every month and once shedealt with her hormonal and so
it was happening like at a veryspecific time in her cycle every
month and once she dealt withher hormonal imbalances, then
(31:15):
the vertigo went away.
Sophia Bowens (31:16):
So for women who are menstruating, it could be
like that this comes on acertain time of the month when
that gets higher.
What about do you see thishappening more or less in like
menopausal, paramenopausal?
Dr. Ayla Wolf (31:27):
women.
For sure, like with menopause,those hormone changes can affect
the difference between estrogenplaying a role in our bone
density and our calciummetabolism.
So as estrogen levels fall,then all of a sudden that gets
thrown out of balance.
So that can also be a trigger.
Sophia Bowens (31:47):
Fascinating so much.
Well, this is an interestingtopic and I think we scratched
the surface of it.
I think a follow up episode weshould do is like the
complexities of, like the visualsystem, how it plays into this
vestibular system, and maybe howthings like proprioception or
joint position can play intothis too.
In your book you do such a nicejob of breaking down all these
(32:08):
things in relation to BPD.
Dr. Ayla Wolf (32:10):
Oh, well, thank you so much, and we'll
definitely have to do anotherdeep dive into the world of
vestibular symptoms here soon.
And for you listening, we'dlove to hear what specific
topics you want to hear moreabout, and you can do that by
clicking the send us a text linkthat's at the top of the show
notes.
I also want to mention thereare now video clips from
(32:30):
previous episodes on the LifeAfter Impact YouTube channel,
which you can find by searchingfor at Life After Impact Medical
disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
(32:51):
professional health careservices, including the giving
of medical advice.
No doctor patient relationshipis formed.
The use of this information andmaterials included is at the
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
(33:11):
consumers of this informationshould seek the advice of a
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
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