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Dizziness/Vertigo/Benign Paroxysmal Positional Vertigo (BPPV)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Epley Maneuver: One of the first treatments is the Epley maneuver which involves a series of positions that are performed before bedtime each night until the symptoms of vertigo resolve for at least 24 hours.4
Vertigo
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Christopher C. Glisson, Jorge C. Kattah
The treatment goal in episodic triggered vertigo (BPPV) is to move the displaced otolith particles out of the affected canal and back to the utricle (both in the canalo- and cupulolithiasis BPPV variants).20 Accordingly, it is of great importance to identify the symptomatic canal. We count with evidence-based data available in favor of repositioning maneuvers (Head and Neck Surgery Academy, and the Academy of Neurology Guidelines).21 The Epley maneuver,20 described in the last decade of the 20th century, is now supported as a class I evidence-based treatment of posterior canal BPPV. In older patients, however, BPPV recurrence is frequent and may relate to difficulty in performing the maneuver due to cervical spine comorbidities or related to morphologic alteration in the otolith themselves. In experimental calcium and vitamin D–deficient diet mice, the otolith particles are grossly abnormal and are potentially less likely to improve with the repositioning maneuvers and more prone to recurrence. The h-BPPV canalolithiasis variant responds to the Lempert maneuver (barbecue rotation)10,12,13,22 or the Gufoni maneuver.23 Horizontal cupulolithiasis responds best to the modified Gufoni maneuver.24
How to “Do” Concierge Medicine
Published in David F. Winter, Service Extraordinaire, 2017
Patients are aware that modern medicine is capable of many great things—conquering illnesses that were previously untreatable, for example—but they often worry that their feelings may be left in the lurch. I recently saw an anxious young man who had been to an ear, nose, and throat specialist; a neurologist; and a vascular specialist. He was having dizzy spells and was convinced he was going to become disabled. He confided that his mother remains paralyzed on one side from the results of a stroke. On examination, he displayed a classic fluttering of eyes called nystagmus when I laid his head back and to the left. This was accompanied by marked dizziness, and he became frightened. As I performed the Epley maneuver, his symptoms abated. “What did you do?” he asked, incredulously. I brought out an anatomic model of the ear and spent time explaining how a crystal in the semicircular canal of the ear can produce his symptoms and how we were able to move the crystal out of the area to make the symptoms go away. He listened attentively and then calmly said, “Thank you. Now I understand.” I suspect that others had tried to explain what was going on with him, but he needed a more thorough, unhurried explanation.
Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D
Published in Acta Oto-Laryngologica, 2020
Xianglong Tang, Jie Tang, Li Gong, Rongdan Ke, Songhua Tan, Anzhou Tang
Variation could be found in angles between the semicircular canal and the standard plane of skull, which means there might exist semicircular canals variation in the skull of BPPV patient.The variation of angles between PSC and sagittal plane could have an adverse effect on Epley maneuver, especially when the angle is less than 45°. This variation had possibility of happening in patients with benign paroxysmal positional vertigo, and might cause Epley maneuver to be invalid. By changing the rotation angle in Epley maneuver after evaluating for individual case, the adverse effect of the angle variation can be compensated.
Caloric tests in clinical practice in benign paroxysmal positional vertigo
Published in Acta Oto-Laryngologica, 2019
Jingtao Bi, Bo Liu, Yi Zhang, Jinping Duan, Qian Zhou
All enrolled patients received DH maneuver and a roll-test at the initial diagnosis, followed by caloric test one week later. For those patients who were diagnosed with BPPV also received CRPs at the initial diagnosis. Patients with PC-BPPV were treated according to Epley Maneuver, those with HC-BPPV-canalithiasis and cupulolithiasis, Barbecue Maneuver and Gufoni Maneuver, and those with AC-BPPV, Yacovino Maneuver, respectively. Patients with MC-BPPV, on the other hand, would be sequentially treated of their semicircular canals by CRP, with the responsible SC which induced the most severe dizziness and nystagmus as the top priority. Once the responsible SC was reset successfully, CRP for other involved SCs would be conducted one by one at the intervals of 3d. The examination, diagnosis and treatment were all conducted by the same group of doctors, two of whom are chief physicians and three are examination technicians. Blinding was not employed in the study and all the patients know their own diagnosis results.
Atypical variants of posterior canal benign paroxysmal positional vertigo after canalith repositioning: a case report
Published in Hearing, Balance and Communication, 2019
A 47-year-old male patient presented to our outpatient vestibular clinic with a three-day history of positional vertigo and nausea. The patient was seen 10 months prior for treatment of obvious right posterior semicircular canal canalithiasis BPPV and was treated successfully in clinic with the modified Epley maneuver. The patient contacted the clinic to report a sudden onset of ‘spinning’ vertigo while looking up in the shower, with symptoms returning when rolling to the right side in bed. There was no spontaneous vertigo, headache, hearing loss or imbalance; the patient did, however, describe a nearly constant feeling of ‘woozy’ dizziness and fatigue in the hours after onset. On the day of symptom onset, the patient completed one repetition of the previously taught self-repositioning maneuver, the right modified Epley maneuver. The patient was advised to repeat the self-repositioning maneuver the next day and to remain upright for at least 20 min afterward. The patient completed the repositioning maneuver the next morning, however, failed to remain upright and immediately moved into supine provoking an increase in vertigo and nausea. The patient then experienced residual feelings of vague dizziness and nausea and proceeded to contact the clinic for further instruction, prompting a visit with his vestibular physical therapist the next morning.