Wow, someone more skeptical than me!
I’m not sure I’d go that far, but I believe the medications may be doing one or two things:
- Making you feel better (but not necessarily resolving the problem). However this is working, it’s a good thing. My quality of life was definitely improved with Amitriptyline by a couple orders of magnitude. I could eliminate or increase the dizziness by increasing or backing off dosage and this was repeatable. It wasn’t placebo, no way … if I went too high with the meds dosage I would feel worse … not sure ‘placebo effect’ explains all that.
- Helping your brain to adapt by reducing the frequency of or eliminating migraines. I strongly believe that MAV is about chronic mal-adpation … and migraines get in the way of this. Control the migraines and you help the brain adapt.
- Effects we don’t know about … I wonder if the drugs that reduce blood pressure are reducing inner ear pressure …
For sure a lot of recovery is probably in large part about how the body re-regulates itself but I don’t think i’d use the word ‘scam’.
I believe doctors are genuinely trying to help but seem to be using clinical statistics to do this rather than science from reliable, known first principles. Whilst I believe the science is relatively underdeveloped and they have a long way to go to explain all the vestibular ailments, this is ok as they have real evidence of people’s symptoms improving and people getting their sanity and lives back.
But it’s surely not all good - I believe several of the ailments are related and different extents of a similar thing, but the doctors instead choose to classify them into buckets. When you present with things from two buckets they say something like “You are suffering from blah with a bit of blah” and offer absolutely no sensible explanation why!
A really bad example, of a brazen lack of using basic common sense to explain things is illustrated by BPPV and the Epley manoeuvre - now this is imho very dubious - they claim that by doing the Epley manoeuvre they re-position crystals back to where they should be. Absolutely ridiculous! For the crystals (otoliths) to send signals to the brain they would need to be attached to hairs and those hairs to tension-sensing neurons … if these crystals become loose and migrate into a canal they must have become detached, yet doctors claim by turning the head sharply without any instrumentation they can magically re-connect these tiny crystals to even tinier hairs! ARE YOU HAVING A LAUGH?! This kind of ridiculous explanation puts the whole discipline into disrepute and quite frankly they should be ashamed of telling us such nonsense. A far more likely explanation is that by increasing pressure in the inner ear by using both increased CSF pressure (they tilt you back) and centrifugal force (they twist your head) they cause an acute leak which reduces inner-ear pressure and this is what causes the relief! (but it’s risky because if you keep doing this you’d get Hydrops … oh and guess what? Hydrops is a known complication of BPPV treatment!! Badabing!). Of course there are other possible explanations - getting a clot of something or waste material in your motion sense area … repositioning that clot or garbage away from the senses may also help. But its surely nothing to do with ‘re-attachment’?! Can you imagine such a bull-in-the-china-shop action having such an incredibly precise effect?! Nope! It’s like hitting some balls of wool with a hammer and expecting this action to knit you a jumper!!!