Melons and otoliths, what is the “benign paroxysmal positional vertigo” that affected the prime minister – WWN

Prime Minister Giorgia Meloni suffers from a problem related to her ear ligaments which forced her “in bed and in the dark”, with nausea and dizziness, for almost two days. The symptoms were initially attributed to after-effects of the flu. On Wednesday, an ENT specialist visited the Prime Minister and instead diagnosed “otolithic syndrome” (orBenign paroxysmal positional vertigo»), and performed a maneuver indicated in these cases. Meloni must wear a collar that prevents sudden movements of the neck.

«Pebbles» in the ear

The otoliths as the Higher Institute of Health explains on its website ISSaluteare small formations of calcium oxalate (“pebbles”) present on the cells that line the inner ear, located inside the eardrum. They constitute the delicate apparatus that allows you to maintain balance and orient yourself in movement and direction. In the inner ear there are structures hollowed out in the bone that contain a liquid (endolymph) and cells equipped with cilia, which are the sensors of balance. Above these cells rests a layer of otoliths which, with every movement of the head, stimulate the cilia: these in turn send information to the brain on the change in the position of the head. If the otoliths detach from the cell surface and move freely in the ear canals, the hair cells are mistakenly stimulatedsending altered movement information to the brain and causing the dizziness. This condition is called “benign positional vertigo” or “benign paroxysmal positional vertigo”.

Very intense malaise

Vertigo is defined as «positional” Why appears only when you assume a certain position: it often happens when you go from lying to standing and vice versa or with the rotation of your head on the pillow. Vertigo is then defined as «paroxysmal» because it manifests itself in short and intense attacks that last up to a minute; finally it is «benign» because it is not a condition linked to serious pathologies and, if treated appropriately, it heals. However, the feeling of malaise that causes vertigo is very violent and intense and is often associated with nausea, vomiting and involuntary eye movements.

The possible causes

The “otolith syndrome”, or detachment of the otoliths from their position, can occur due to trauma, surgery, infections or other factors. Vertigo due to detachment of the otoliths can instead be linked to head or ear traumaaging, ear infections, prolonged bed rest, surgical interventions, Ménière’s syndrome (a pathology of the inner ear), “saccular hydrops” (increased volume of the endolymph), accidents of various kinds (sports, automobiles), blockage of blood circulation in an artery in the inner ear.

Eye movements

To confirm the diagnosis the specialist can perform the so-called «Dix-Hallpike maneuver», in which he examines nystagmus (i.e. the abnormal involuntary movement of the eyes). The technique aims to move the otoliths to a part of the ear where they do not cause discomfort. To perform the maneuver, the patient sits down, tilts his head 45 degrees and then slowly lowers it until an angle of approximately 20 degrees is formed between his back and the table itself, always maintaining the same head inclination. By evaluating the times in which nystagmus appears, it is possible to establish whether it is «benign positional vertigo» or another condition.

The resolution maneuvers

The treatment of vertigo caused by the detachment of the otoliths includes some maneuvers that allow the “pebbles” to be repositioned in place. The best known and most used ones are the «Epley maneuver» and the «Semont maneuver». They are both effective and the choice to do one or the other depends on the doctor and the person’s mobility abilities. They consist of a very precise sequence of head movements and rapid movements from sitting to lying down. During the maneuvers, a violent vertigo occurs (called “liberating vertigo”), with the opposite direction to that which occurs during the crises, and involuntary movement of the eyes. If the maneuver is successful, the patient recovers and the vertigo disappears completely. Otherwise it is necessary to repeat the procedure several times. Treatment with drugs is usually not recommended and surgery is very rare.

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