I’ve done some more research, and there is something called “Subjective BPPV” which means that the nystagmus is not present, but the person is having BPPV-like symptoms.
Many doctors in the past argue that just as many people who don’t have spinning or dizziness have loose otoliths in their semi-circular canal so why is it that only some experience intense vertigo or smaller dizzy fits?
Then, there is the argument of the Epley Maneuver not moving otoliths at all. The question begs, however, why does the Epley work on so many people:
- Habituation. The brain gets used to the signals.
- The otoliths move around and “shake things up.”
- or like you say, some fluid exists.
A study in patients with subjective BPPV has patients perform the dix-hallpike (not the Epley) on both ears 20 x per days for 4-5 seconds. Almost 95% of patients were symptom-free even at the 6 months follow up. They believe, in these people, the otoliths fall from the utricle macular and inside the utriculopetal and stay there and only move slightly when the person is in an upright position (like me, since my positional stuff never happens when I am laying down) and then when the person makes a sudden movement or turn of the head, these otoliths touch the nerve endings. But, its never enough to cause nystagmus.
This is interesting because originally, perhaps, I did have some otoliths moving into the canal and now when I lean back, I don’t spin because there simply isn’t enough to cause nystagmus or spinning.
And perhaps, even another theory is that when one is tired/stressed the body becomes hypersensitive. Therefore, the nerve endings in the inner ear become extremely hypersensitive to the otoliths and cause dizziness. Which would explain by 80% of people who get idiopathic BPPV were under a lot of stress before it occurred or suffer from pre-existing anxiety conditions. I could also see how dehydration can play a part in the otoliths not breaking down.
For me, they say I don’t have a perilymph fistula. I have no hearing loss and no true spinning vertigo and no other symptoms. They have done so many pressure tests on me.