Autoimmune disorders and the inner ear

I am noticing that clients battling one or more autoimmune disorders who are struggling with dizziness may tend to share the following characteristics:

1. Drop attacks/Tumarkin's Syndrome/Otolith Crisis: I have recently had a few individuals with autoimmune disorders report feeling like they are being thrown or shoved to the ground. 
2. More unstable and unpredictable spells of dizziness than someone battling a vestibular problem because of a virus, aging or blood flow compromise.
3. When battling BPPV, repositioning maneuvers may not work as quickly.  BPPV may recur more frequently.  Post maneuver restrictions may be more necessary for these individuals than for individuals battling BPPV from other causes.

Dr. Timothy Hain shares a lot of valuable information about autoimmune disorders and the inner ear here: http://www.dizziness-and-balance.com/disorders/autoimmune/aied.html

What Is Secondary BPPV?

I believe secondary BPPV is BPPV caused by another vestibular dysfunction. For instance, neuritis may cause swelling around the nerve, which could push on arteries that supply blood to the otoliths. This could cause the system to become necrotic and now the person is more likely to get BPPV. Meniere's slowly destroys the otoliths and the rest of the inner ear causing one to be more likely to develop BPPV. A person who has TIAs may not only have poor circulation to their brain, but also to the inner ear...this could be an example of secondary BPPV. In this last case, BPPV would not really be so benign because it's cause is actually life threatening. 

What do frozen shoulder and some forms of BPPV have in common?

Just like frozen shoulder occurs in stages (freezing, frozen and thawing), I believe some forms of BPPV occur in stages.  Stages for some forms of BPPV seem to be dumping, dumped and recovery.  Based upon what I see in the clinic, timing of when clients receive repositioning treatments seems to impact the success of the maneuvers for some individuals.   I believe some forms of BPPV suddenly occur.  In other words, if 100,000 pieces of otoconia are going to fall out, they all fall out at once. These clients seem to reposition fairly easily.   I believe there are others who dump a few thousand out every day or week for a period of time.  If we try to reposition otoconia when the person is in the dumping phase, we will need to continue repositioning periodically until the client reaches the dumped or recovery phase.  I believe the dumping stage represents BPPV at an unstable level.

Many forms of vestibular dysfunction seem to occur in stages.  Depending upon whether or not vestibular rehab works will depend upon which stage the individual is in.

Meniere's Disease, Primary and Secondary BPPV

all battled by the same individual is a double whammy.  Not only does the individual have to deal with the undpredictable nature of the Meniere's Disease and the destruction that follows leading to secondary BPPV, but they also have to deal with primary BPPV in the opposite ear.  This individual has led me to wonder if they could also be battling primary and secondary BPPV in the same ear because of the way in which her spells sometimes return.