by Dr. Iain Corness
Going round in circles
Ever turned over in bed and the room began to spin? It might
have been Benign Paroxysmal Positional Vertigo (BPPV). This is a very
distressing condition, and much more common than you imagine. If you have it,
after you move in a particular way, you feel that the room spins around you and
you cannot stop it. It is like being so drunk that when you lie down on the bed
the spinning rotation is so bad you grip the edges of the bed to stop falling
off? That is what BPPV is like - but without the hangover the next morning!
The symptoms of BPPV include the dizziness (vertigo), lightheadedness,
imbalance, and nausea. Activities that bring on symptoms will vary, but are
almost always produced by a rapid change of position of the head. Getting out of
bed or turning over in bed are common ‘problem’ motions. Because people with
BPPV often feel dizzy and unsteady when they tip their heads back to look up,
BPPV is sometimes called ‘top shelf vertigo.’ Women with BPPV may find that
having a shampoo can bring on the symptoms. It also tends to be recurrent. So
until you read further, don’t look up or get your hair washed!
To understand BPPV, you have to understand the workings of your inner ear. You
have three semi-circular canals aligned in different directions, which act like
spirit levels (the builders type, not the three fingers on the glass barman
type) which have cells with fine hairs bathed with fluid as your head moves in
different directions. The movement of the fine hairs sends electrical impulses
to the brain to tell it (and you) which way is “up”.
However, with BPPV, the natural movement inside the semi-circular canals is
disrupted, so the fine hairs send the wrong signals to the brain, and being
unable to work out which way is really “up” the sufferer falls over, totally
unable to save themselves from hitting the floor. Debilitating and embarrassing!
Ask anyone who has had BPPV.
The commonest cause of interruption to the normal ebb and flow in the
semi-circular canals is produced by something we have called “ear rocks”. These
are made up of crystals of calcium carbonate, and we medicos call these ear
rocks “otoconia”. Imagine these rocks to be like sugar crystals in the bottom of
your coffee cup. These now swish around every time you move your cup, and
likewise your “ear rocks” swish around every time you move your head.
However, it is not all that simple (it never is, is it?) as the commonest cause
of BPPV in people under 50 is head injury. In older people, the most common
cause is degeneration in the semi-circular canals of the inner ear. BPPV becomes
much more common with advancing age, but in 50 percent of all cases, BPPV is
called ‘idiopathic’, which is a fancy word we use when we don’t know!
Viruses can be accused too, such as those causing vestibular neuritis, minor
strokes such as those involving anterior inferior cerebellar artery (AICA)
syndrome, and Meniere’s disease are significant but unusual causes. Occasionally
BPPV follows surgery, where the cause is felt to be from a prolonged period of
lying on the back with the chin raised (for the anaesthetic tubes to slip down
your throat), or ear trauma when the surgery is to the inner ear. The simple
situation is that we can make the diagnosis, but it can be harder for us to
exactly pinpoint the cause. To make it even harder, an intermittent pattern is
common. Your BPPV may be present for a few weeks, then stop, but then come back
Is there any treatment? Yes there is, if ear rocks are the cause. Treatment
usually consists of a series of maneuvers you are put through which are designed
to move the ‘ear rocks’ around till they no longer cause problems. These are
demonstrated by the Ear, Nose and Throat (ENT) specialists and usually result in
around a 90 percent cure rate. The most common is called the Epley maneuver or
the particle repositioning or canalith repositioning procedure, but have your
ENT specialist show you how to do this.
The humble cup of coffee has come in
for another beating. This is nothing new as the controversy has raged since
the Middle Ages as to the medicinal, or otherwise, effects of coffee. A 1661
tract entitled “A character of coffee and coffee-houses”, listed some of the
“Tis extolled for drying up the Crudities of the Stomack, and for expelling
Fumes out of the Head. Excellent Berry! which can cleanse the English-man’s
Stomak of Flegm, and expel Giddinesse out of his Head.”
However, just like today, there was another side to the coffee bean. An
anonymous “Women’s Petition Against Coffee” in 1674 declared: “...the
Excessive Use of that Newfangled, Abominable, Heathenish Liquor called
Coffee has Eunucht our Husbands, and Crippled our more kind Gallants, that
they are become as Impotent, as Age.” In the Middle Ages coffee cleared your
head but had disastrous effects on the male dangly bits. Thank goodness we
have the Blue Diamonds these days to counteract the effects of the coffee
Unfortunately, there appears to be a rather large army of ‘researchers’ who
are studying anything we enjoy these days, from coffee to genetically
modified mouse droppings, and with a great splash come out in print with
their latest findings and the latest thing that is going to kill you.
Every week in the lay press we are bombarded with horror stories of what
dangers we all face. These horror stories come from reports done by
legitimate researchers, by the way, picked up by the media and away it goes
On the surface, it all seems very probable. Take the two cups of caffeine
and be ready to miscarry item. Dr De-Kun Li of Kaiser Permanente Division of
Research, whose study involved 1063 pregnant women who never changed their
caffeine consumption during pregnancy. What they found was women who
consumed the equivalent of two or more cups of regular coffee or five 340 ml
cans of caffeinated soft drink - were twice as likely to miscarry as
pregnant women who avoided caffeine.
However, this study of 1063 pregnant women is also a very small percentage
of women world-wide who drink coffee while they are pregnant.
However, two days after the shock-horror miscarriage item hit the world
media, there was another report. Researchers now claim the much-demonized
substance may fight cancer.
After studying more than 80,000 women, US and Australian experts found foods
containing caffeine - such as coffee, tea, cola and chocolate - may reduce
the risk of ovarian cancer, the sixth-most common cause of cancer deaths
among Australian women.
According to Assistant Professor Shelley Tworoger of Harvard University in
Boston and her colleagues - including medical epidemiologist Associate
Professor Dorota Gertig of the University of Melbourne and Victorian
Cytology Service - caffeine was beneficial, but decaffeinated coffee showed
no health benefit at all.
For reasons they cannot yet explain, the group also found the beneficial
effect of caffeine was strongest for women who had never used oral
contraceptives or postmenopausal replacement hormone therapy.
The researchers analyzed data from the Nurses’ Health Study, an ongoing
assessment of the well-being of 212,701 female registered nurses that began
in 1976 when the nurses were aged 30-35.
Every two years, researchers at Boston’s Brigham and Women’s Hospital
checked up on the surviving women. After studying the nurses’ history,
Professor Tworoger and Professor Gertig’s group found only a very small
association between smoking and mucinous tumours, a rare form of ovarian
cancer. They also found no connection between alcohol consumption and
Oncologist Ian Olver, head of Cancer Council Australia said, “It’s well
worth looking into further,” and even coffee and chocolate couldn’t hurt and
might even help. “My standard advice is everything in moderation,” he said.
The whole research really hangs on Professor Olver’s statement, “It’s well
worth looking into further.” And research salaries and equipment costs
money, and where does it come from? Make the biggest claims with the
greatest amount of shock-horror and funding will be forthcoming. Mark my
words, the chocolate manufacturers will jump on this like blowflies on a
And if you really want something to ponder - cigarettes are far more
dangerous than your morning latte. Stop today!