Benign Paroxysmal Positional Vertigo and Epley Maneuver

Total Page：16

File Type：pdf, Size：1020Kb

Benign Paroxysmal Positional Vertigo and Epley Maneuver What is benign paroxysmal positional vertigo? Some parts of your ear help you with hearing. Some parts of your ear help you with balance. The part of your ear that controls balance is called the semi-circular canal. You have a semi-circular canal in the inner part of each ear. In some people, sand-like particles or crystals called canaliths in the inner ear become loose and move around. This causes dizziness which is also called vertigo. What is the Epley Maneuver? This is a series of steps you can do at home to help reposition the canaliths and help dizziness. Step 1: Sit up straight in the middle of your bed. Step 2: Turn your head 45 degrees toward the ear that is causing your symptoms and hold the position for 1 full minute: For problems with your right ear, turn your head to the right. For problems with your left ear, turn your head to the left. Step 3: Keep your head and neck at this 45 degree angle and gently lie down flat on your back. Hold this position for 1 minute even if you feel dizzy. Step 4: While still lying flat on your back slowly rotate your head towards your good ear as far as you can or about 90 degrees. Hold this position for 1 full minute even if you feel dizzy. Step 5: With your head still in this position, slowly roll the rest of your body toward your good side so that your body and head lie in the same direction. Bracing yourself with one hand, roll forward slightly so you can turn your face toward the floor. Hold this position for 1 minute. Step 6: Slowly return to a sitting position with your head up but flexed forward about 45 degrees. Hold this position for 1 minute. Important: Each series of steps should take about 5 minutes to do. You should do 3 complete series of steps before going to bed. Move slowly from one position to another. If you have a headache or feel weak, numb or have vision changes, stop the Epley Maneuver and get medical help. Other things you can try to help: Prop your head on pillows when sleeping. Avoid extending your head and neck backwards until you feel better. PD 8567 (03-2014) File: peyles .

Copy Link

Recommended publications

Effectiveness of the Epleys Maneuver for Treatment of Benign Paroxysmal
Effectiveness of the Epleys Maneuver for Treatment of Benign Paroxysmal Positional Vertigo Salah Uddin Ahmmed1, Md Zakir Hossain2,Mohammad Neser Uddin2, Sarder Mohammad Golam Rabbani2, Arba Md Shaon Mursalin Alman3. Abstract Background: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent vestibular disorder. It is characterized by recurrent spells of vertigo associated with certain head movements such as turning the head to right or left, getting out of bed, looking up and bending down. Objectives: The aim of this study was to compare the efficacy of treatment by the Epley maneuver with medicine and medicine (betahistine) only for benign paroxysmal positional vertigo. Materials and Methods: Fifty six patients with benign paroxysmal positional vertigo were randomly divided in two groups. One group was treated with Epley maneuver wth medicine as case and other group with only medicine (betahistine) as control. Results: At the end of first week who were treated with Epley maneuver with medicine, 24 (85.71%) patients recovered and 27 (96.42%) were recovered at second week and all the 28 (100%) were found recovered at end of third week. Whereas, who treated with betahistine only 7(25.00%) recovered at end of first week 22 (78.58%) recovered at second week, 25 (89.29%) recovered at third week and all the 28 (100%) were at end of fourth week. Who received only medical therapy needed one more extra visit than case patients Conclusion: Treatment of BPPV with the Epleys manouvre with medicine resulted in early better and improvement of symptoms than with medicine alone. Keywords: Benign paroxysmal positional vertigo, Epleys manouvre, betahistine.
[Show full text]
Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo
OTOXXX10.1177/0194599816689667Otolaryngology–Head and Neck SurgeryBhattacharyya et al 6896672017© The Author(s) 2010 Reprints and permission: sagepub.com/journalsPermissions.nav Clinical Practice Guideline Otolaryngology– Head and Neck Surgery Clinical Practice Guideline: Benign 2017, Vol. 156(3S) S1 –S47 © American Academy of Otolaryngology—Head and Neck Paroxysmal Positional Vertigo (Update) Surgery Foundation 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI:https://doi.org/10.1177/0194599816689667 10.1177/0194599816689667 http://otojournal.org Neil Bhattacharyya, MD1, Samuel P. Gubbels, MD2, Seth R. Schwartz, MD, MPH3, Jonathan A. Edlow, MD4, Hussam El-Kashlan, MD5, Terry Fife, MD6, Janene M. Holmberg, PT, DPT, NCS7, Kathryn Mahoney8, Deena B. Hollingsworth, MSN, FNP-BC9, Richard Roberts, PhD10, Michael D. Seidman, MD11, Robert W. Prasaad Steiner, MD, PhD12, Betty Tsai Do, MD13, Courtney C. J. Voelker, MD, PhD14, Richard W. Waguespack, MD15, and Maureen D. Corrigan16 Sponsorships or competing interests that may be relevant to content are associated with undiagnosed or untreated BPPV. Other out- disclosed at the end of this article. comes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary re- turn physician visits, and maximizing the health-related quality Abstract of life of individuals afflicted with BPPV. Action Statements. The update group made strong recommenda- Objective. This update of a 2008 guideline from the American tions that clinicians should (1) diagnose posterior semicircular Academy of Otolaryngology—Head and Neck Surgery Foun- canal BPPV when vertigo associated with torsional, upbeating dation provides evidence-based recommendations to benign nystagmus is provoked by the Dix-Hallpike maneuver, per- paroxysmal positional vertigo (BPPV), defined as a disorder of formed by bringing the patient from an upright to supine posi- the inner ear characterized by repeated episodes of position- tion with the head turned 45° to one side and neck extended al vertigo.
[Show full text]
A Practical Approach to Assessment and Treatment of Benign Paroxysmal Positional Vertigo Combining Research and Clinical Practice
A Practical Approach to Assessment and Treatment of Benign Paroxysmal Positional Vertigo Combining research and Clinical Practice Naseem Chatiwala, PT, DPT, MS, NCS Board certified Neuro Clinical Specialist Certified Vestibular Specialist Workshop Objectives • Analyze normal and abnormal anatomy and physiology of the vestibular system • Recognize signs and symptoms of BPPV and confidentially identify variants of BPPV • Explain physiologic rationale of test procedures and results of various test for BPPV • Utilize results of clinical examination to develop treatment plans • Be able to identify treatment procedure Overview • In the USA, 1.7 million people sustain a TBI each year • 30% and 65% of people with TBI suffer from some form of dizziness and/or have balance problems at some point during their recovery • 28% of individuals with head trauma have BPPV • A smaller study, of 69 patients with chronic BPPV, found a history of head or neck trauma in 81% of the cohort Pisani et al, 2015 Iglebekk W, 2017 Definitions • Vertigo • Disequilibrium • Presyncope • Floating or rocking sensation • Light headedness ?? DIZZY?? 4 Anatomy and Physiology • 3 Components – Peripheral sensory Apparatus • Motion sensors – Central processor • Vestibular nuclear complex and Cerebellum – Motor output • To ocular muscles and spinal cord Central Sensory Input Motor Output Processor 5 Peripheral Sensory Apparatus [ Motion Sensors] Three Semicircular Canals Lateral, Anterior (superior) and posterior Two Otolith Organs Utricle Saccule 6 • Lateral Canal: Angled at 30°
[Show full text]
Epley Manoeuvre for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo in People with Multiple Sclerosis: Protocol of a Randomised Controlled Trial
Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2020-046510 on 18 March 2021. Downloaded from Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial Cristina García- Muñoz ,1 María- Dolores Cortés- Vega ,1 Juan Carlos Hernández- Rodríguez ,2 Rocio Palomo- Carrión,3 Rocío Martín- Valero ,4 María Jesús Casuso- Holgado 1 To cite: García- Muñoz C, ABSTRACT Strengths and limitations of this study Cortés- Vega M- D, Hernández- Introduction Vestibular disorders in multiple sclerosis (MS) Rodríguez JC, et al. Epley could have central or peripheral origin. Although the central ► This randomised controlled trial will be the first to manoeuvre for posterior aetiology is the most expected in MS, peripheral damage is semicircular canal benign address knowledge gap on the effectiveness of the also significant in this disease. The most prevalent effect of paroxysmal positional vertigo in Epley manoeuvre in a multiple sclerosis population. vestibular peripheral damage is benign paroxysmal positional people with multiple sclerosis: ► Double- blind and concealed allocation will reduce vertigo (BPPV). Impairments of the posterior semicircular protocol of a randomised the possibility of bias. controlled trial. canals represent 60%–90% of cases of BPPV. The standard BMJ Open ► Videonystagmography goggles will enable the pri- gold treatment for this syndrome is the Epley manoeuvre (EM), 2021;11:e046510. doi:10.1136/ mary outcome of the research to be measured more bmjopen-2020-046510 the effectiveness of which has been poorly studied in patients objectively. with MS. Only one retrospective research study and a case ► Prepublication history and ► The Epley manoeuvre is an easy and quick vestib- study have reported encouraging results for EM with regard additional material for this ular treatment that results in significant changes in to resolution of posterior semicircular canal BPPV.
[Show full text]
BPPV: Understanding Eye Movements & Treatment Approaches Benign
10/20/2015 House Rules: • If your pager or cell phone goes off during this presentation, you must stand and sing a BPPV: Understanding Eye Barry Manilow song (Loudly!) Movements & Treatment Approaches David A. Zapala, Ph.D. & Janet Shelfer, Au.D. Ringing cell phones & Otolaryngology / Head and Neck Surgery / Audiology AQUIRING knowledge Mayo Clinic - Jacksonville don’t mix! Benign Paroxysmal Positional Dix-Hallpike or Nylen Maneuver Vertigo (BPPV) • Intense but transient vertigo provoked by moving into specific head positions – Most common cause of vertigo – Accompanied by a characteristic nystagmus – Thought to be caused by debris in the semicircular canals Furman and Cass “Benign Paroxysmal Positional Vertigo.” NJM 1999. Our aim is to help sharpen your Characteristic Response abilities to: – Torsional nystagmus (rolling eye movement) & vertiginous sensation • Onset latency (5-45 sec) – Recognize and understand common subtypes of • Crescendo then fatigues (typically within 30 sec) BPPV presentations and how to treat them • Symptoms extinguish (adapt) over repeated trials – Recognize when “Benign” is not benign – Appreciate current limits of our understanding of this condition – Can be treated by a simple in office procedure 1 10/20/2015 Development of Theories of BPPV • Adler (1897): First formal description Theories of BPPV • Barany (1921): Case report • Proposed degeneration of the utricle as cause of condition • BPPV formally defined by Dix and Hallpike (1952) • Described BPPV in 100 cases • Demonstrated utricular degeneration in one temporal bone Cupulolithiasis Theory Cupulolithiasis Theory • Schuknecht (1969, 1972): “Heavy Cupula” explanation – Debris (otoconia?) adheres to cupula of the posterior semicircular canal – Weight of otoconia causes cupula to deflect, making it gravity-sensitive.
[Show full text]
Benign Paroxysmal Positional Vertigo David Solomon, MD, Phd
Benign Paroxysmal Positional Vertigo David Solomon, MD, PhD Address Department of Neurology, University of Pennsylvania, 3 W. Gates Building, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA. Email: [email protected] Current Treatment Options in Neurology 2000, 2:417–427 Current Science Inc. ISSN 1092-8480 Copyright © 2000 by Current Science Inc. Opinion statement Benign paroxysmal positional vertigo can be diagnosed with great certainty, and treated effectively at the bedside using one of the canalith repositioning procedures described in this paper. This treatment has been shown effective in properly controlled trials, has a rational basis, and has minimal risk [1]. Introduction Benign paroxysmal positional vertigo (BPPV) is the most rior SCC [7]. Convincing evidence [8, Class I] in support common diagnosis made in many specialty clinics serv- of canalithiasis as a pathophysiologic explanation for ing patients with dizziness. This diagnosis is suggested by BPPV validates treatment with any procedure that can a history of brief (less than one minute) episodes of ver- effectively clear these dense particles from the posterior tigo that are provoked by rolling over in bed, lying down, semicircular canal. Canalithiasis can occur in any canal. sitting up from a supine position, bending over, or look- The posterior semicircular canal (PSC) was affected in the ing up. BPPV commonly is worse in the early morning majority of cases of BPPV (93% of cases) [9], with 85% (matutinal vertigo), and may be absent for weeks or being unilateral, and 8% affecting the PSC on both sides. months at a time before returning. Diagnosis rests on the The horizontal semicircular canal (HSC) was affected in observation of characteristic eye movements accompany- 5% of cases.
[Show full text]
Balance Disorders in Children Margaretha L
Neurol Clin 23 (2005) 807–829 Balance Disorders in Children Margaretha L. Casselbrant, MD, PhDa,b,*, Ellen M. Mandel, MDa,b aDepartment of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA bDepartment of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Balance disorders in children may be difficult to recognize. Children often are unable to describe their symptoms and they may just seem clumsy. The episodes may be of short duration, autonomic symptoms may be prominent, or symptoms may be thought of as a behavioral disorder. Dizziness may indicate a problem in the vestibular system or may indicate a problem in other sensory systems or an abnormality of other organ systems. Management of these disorders depends on an accurate diagnosis. Disorders associated with dizziness in children can be divided into three broad categories: (1) acute nonrecurring spontaneous vertigo; (2) recurrent vertigo; and (3) nonvertiginous dizziness, disequilibrium, and ataxia [1]. Vertigo is defined in clinical practice as a subjective sensation of movement, such as spinning, turning, or whirling, of patients or the surroundings. Dizziness is a nonspecific term used by patients to describe sensations of altered orientation to the environment that may or may not include vertigo [2]. Vertigo and dizziness are symptoms, not diagnoses. Balance is maintained through visual, proprioceptive, and vestibular signals. Damage to any of these systems or an abnormality in the central nervous system (CNS) that coordinates impulses from these three sensory systems can cause symptoms. In children and in adults, a careful history, physical Adapted from Furman JM, Casselbrant ML, Whitney SL.
[Show full text]
Otorhinolaryngology (Ent)
OTORHINOLARYNGOLOGY (ENT) FEE FEE MEDICAL PROCEDURE surgeon assistant € € SIMPLE MEDICAL PROCEDURE AT THE DOCTOR'S OFFICE Simple Otorhinolaryngeal Examination 50 Examination at home 60 24 hours patient monitoring in a common room: a) Weekdays 100 b) Saturdays, Sundays, Holidays (public and religious) 120 24 hours patient monitoring in the Intensive Care Unit: a) Weekdays 155 b) Saturdays, Sundays, Holidays (public and religious) 180 Laryngoscopy (with mirror) 50 Video Rigid Laryngoscopy 110 Video Flexible Laryngoscopy 120 Video - Stroboscopy 110 Video Nasal Endoscopy - Sinonasal - Nasopharyngeal 140 ( Panendoscopy ) Evaluation of Swallowing FEES 250 Evaluation of Swallowing with SENSORY TESTING FEEST 250 Cerumen Removal 50 Removal of Foreign Body from the Nose 90 Ear Foreign Body Removal 90 Removal of Foreign Body from the Throat 90 Removal of Foreign Body from Hypopharynx-Larynx 90 Eardrum Puncture in O.T. Otitis 120 Ventilation Tube Removal 90 Small Boil Opening or Cyst or Poros abscess 90 Rhinomanometry 90 Chemical Nasal Cautery 70 Front Stopper 90 Eustachian Tube Blowing 50 Intravenous Infusion of Cortisone 80 Sleeping TEST ( Polysomnography ) 300 Smelling TEST 100 Allergy TEST 100 Endoscopic Sialendoscopy 280 AUDIOLOGY Audiogram 70 Tympanography and Reflex Stirrups 45 Speech Audiogram 70 Free Field Audiogram ( Game Audiometry ) 70 Audiovisual Broadcasts 100 Acoustic ERPs 130 Electronystagmography 130 Videonystagmography 150 Rotation Chair Examination 80 Epley Maneuver 80 MOUTH -THROAT - HYPOPHARYNX - SALIVARY GLANDS OPERATIONS Removal
[Show full text]
Effectiveness of the Epley's Maneuver Performed In
Ballve Moreno et al. Trials 2014, 15:179 http://www.trialsjournal.com/content/15/1/179 TRIALS STUDY PROTOCOL Open Access Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial José Luis Ballve Moreno1*, Ricard Carrillo Muñoz2, Iván Villar Balboa2, Yolanda Rando Matos1, Olga Lucia Arias Agudelo1, Asha Vasudeva1, Olga Bigas Aguilera2, Jesús Almeda Ortega3, Alicia Capella Guillén1, Clara Johanna Buitrago Olaya1, Xavier Monteverde Curto1, Estrella Rodero Perez1, Carles Rubio Ripollès1, Pamela Catalina Sepulveda Palacios2, Noemí Moreno Farres1, Anabella María Hernández Sánchez4, Carlos Martin Cantera5 and Rafael Azagra Ledesma6 Abstract Background: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design: This study is a randomized clinical trial conducted in the primary care setting. The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver).
[Show full text]
Read More/Download
2016 Scientific Program – Charlottetown, PEI Sunday Sir John A. MacDonald Ballroom Coles Ballroom Henry Johnson Room June 12 07:30 – 07:40 President’s Opening Remarks – P. Spafford, Saskatoon, SK OVERALL LEARNING OBJECTIVES 07:40 – 07:45 Scientific Program Chair’s Opening Remarks – B. Rotenberg, This meeting provides learners in the specialty of Otolaryngology – Head and Neck Surgery (including general and London, ON subspecialty otolaryngologists as well as resident and medical student trainees) a significant opportunity to attend 07:45 – 07:50 Introduction of the Guest of Honour Dr. Patrick Gore-Hickman, sessions of interest and acquire further understanding and knowledge in areas of perceived / unperceived weakness in Saskatoon, SK – P. Spafford, Saskatoon, SK the specialty. All branches of the specialty, including head & neck oncology, laryngology, rhinology, otology, neurotology, 07:50 – 08:05 Guest of Honour Presentations – P. Gore-Hickman, Saskatoon, SK pediatric otolaryngology, facial plastic and reconstructive surgery, general otolaryngology, sleep disorders, and medical 08:05 – 08:10 Introduction of the Lifetime Achievement Award Recipient, Dr. education, are part of the program. Patrick Gullane, Toronto, ON – P. Spafford, Saskatoon, SK 08:10 – 08:25 Lifetime Achievement Award Recipient Presentation – P. Gullane, Building on the success of last year, we will run three concurrent sessions of workshops and podium presentations. New Toronto, ON this year is the addition of an extra day of general, subspecialty and resident sessions, as well as a series of debates. This 08:25 – 08:30 Introduction of Guest Speaker Dr. Mark Urken, New York, NY – P. provides delegates with a great variety of learning opportunities.
[Show full text]
Balance Disorders
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ∙ National Institutes of Health NIDCD Fact Sheet | Hearing and Balance Balance Disorders What is a balance disorder? Structures of the balance system inside the inner ear A balance disorder is a condition that makes you feel unsteady or dizzy. If you are standing, sitting, or lying down, you might feel as if you are moving, spinning, or floating. If you are walking, you might suddenly feel as if you are tipping over. Everyone has a dizzy spell now and then, but the term “dizziness” can mean different things to different people. For one person, dizziness might mean a fleeting feeling of faintness, while for another it could be an intense sensation of spinning (vertigo) that lasts a long time. Experts believe that more than four out of 10 Americans, sometime in their lives, will experience an episode of dizziness significant enough to send them to a doctor. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain. A balance disorder can profoundly impact daily activities and cause Credit: NIH Medical Arts psychological and emotional hardship. } Dizziness or vertigo (a spinning sensation) What are the symptoms of a balance disorder? } Falling or feeling as if you are going to fall } Lightheadedness, faintness, or a floating sensation If you have a balance disorder, you may stagger when you try to walk, or teeter or fall when you try to stand } Blurred vision up. You might experience other symptoms such as: } Confusion or disorientation. NIDCD...Improving the lives of people with communication disorders Other symptoms might include nausea and When you turn your head, fluid inside the vomiting, diarrhea, changes in heart rate and semicircular canal moves, causing the cupula to blood pressure, and fear, anxiety, or panic.
[Show full text]
Vestibular Autorotation Test (VAT)
Name of Blue Advantage Policy: Vestibular Autorotation Test (VAT) Policy #: 329 Latest Review Date: October 2010 Category: Medical Policy Grade: Active Policy but no longer scheduled for regular literature reviews and updates. Background: Blue Advantage medical policy does not conflict with Local Coverage Determinations (LCDs), Local Medical Review Policies (LMRPs) or National Coverage Determinations (NCDs) or with coverage provisions in Medicare manuals, instructions or operational policy letters. In order to be covered by Blue Advantage the service shall be reasonable and necessary under Title XVIII of the Social Security Act, Section 1862(a)(1)(A). The service is considered reasonable and necessary if it is determined that the service is: 1. Safe and effective; 2. Not experimental or investigational*; 3. Appropriate, including duration and frequency that is considered appropriate for the service, in terms of whether it is: • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member; • Furnished in a setting appropriate to the patient’s medical needs and condition; • Ordered and furnished by qualified personnel; • One that meets, but does not exceed, the patient’s medical need; and • At least as beneficial as an existing and available medically appropriate alternative. *Routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000 which meet the requirements of the Clinical Trials NCD are considered reasonable and necessary by Medicare. Providers should bill Original Medicare for covered services that are related to clinical trials that meet Medicare requirements (Refer to Medicare National Coverage Determinations Manual, Chapter 1, Section 310 and Medicare Claims Processing Manual Chapter 32, Sections 69.0-69.11).
[Show full text]