Vertigo
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
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
David F. Winter in 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.
Dizziness/Vertigo/Benign Paroxysmal Positional Vertigo (BPPV)
Charles Theisler in 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
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.
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.
Vestibular assessment and management in adults: current practice by South African audiologists
Published in Hearing, Balance and Communication, 2018
Tasneem Seedat, Katijah Khoza-Shangase, Ben Sebothoma
With regards to the types of treatment options available, majority of the participants in the current study indicated that VRT and canalith repositioning maneuvers (epley exercises) were the most common procedures performed. This is inconsistent with existing literature that suggests that the most common treatment procedure conducted is first canalith repositioning maneuvers and thereafter Brandt-Daroff exercises, followed by VRT [24]. VRT may be the most commonly used assessment used by South African audiologists as it involves the use of exercises to decrease vestibular related symptoms, without the need for specialized vestibular equipment [4]. Furthermore, VRT has several benefits for the patient, such as an improved quality of life as well as increased postural balance [29]. Additionally, the epley maneuver was the second most common treatment used possibly because it is a noninvasive procedure which can be conducted without specialized equipment [30]. Furthermore, it is used to treat BPPV, which is a common type of vestibular disorder, as previously mentioned [30].
Related Knowledge Centers
- Benign Paroxysmal Positional Vertigo
- Dizziness
- Nystagmus
- Otolith
- Semicircular Canals
- Utricle
- Vestibular System
- Vertigo
- Ampullary Cupula
- Dix–Hallpike Test