Positional vertigo forums. Benign Paroxysmal Positional Vertigo: Symptoms, Treatments, and Patient Experiences
What are the common symptoms of BPPV. How is the Epley maneuver performed for treating BPPV. What are patients’ experiences with BPPV treatments and recovery. How long does BPPV typically last. Can BPPV recur after initial treatment.
Understanding Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo, commonly known as BPPV, is a condition that affects the inner ear, causing brief episodes of dizziness when a person’s head position changes. This condition occurs when tiny calcium crystals in the inner ear become dislodged and move into the semicircular canals, disrupting the normal fluid movement that these canals use to sense head motion.
BPPV is characterized by sudden, intense periods of vertigo that are typically triggered by specific changes in head position. These episodes can be quite distressing for patients, often accompanied by nausea and a sense of spatial disorientation.
Common Symptoms of BPPV
- Sudden onset of spinning sensation
- Dizziness when changing head position
- Nausea or vomiting
- Loss of balance or unsteadiness
- Rapid, uncontrolled eye movements (nystagmus)
Patients often report experiencing these symptoms when lying down, turning over in bed, looking up, or bending over. The severity and duration of symptoms can vary from person to person.
The Epley Maneuver: A Common Treatment for BPPV
The Epley maneuver is a series of head movements designed to treat BPPV by repositioning the displaced calcium crystals in the inner ear. This procedure is often performed by healthcare professionals but can also be taught to patients for self-administration at home.
During the Epley maneuver, the patient’s head is manipulated through a specific sequence of positions, each held for about 30 seconds. The goal is to move the crystals from the semicircular canals back into the utricle, where they can be reabsorbed by the body.
Steps of the Epley Maneuver
- Sit upright on an examination table with your head turned 45 degrees toward the affected ear.
- Quickly lie back with your head hanging slightly off the edge of the table, maintaining the 45-degree turn.
- Hold this position for 30 seconds or until dizziness subsides.
- Turn your head 90 degrees to the opposite side without raising it.
- Hold for another 30 seconds.
- Roll your body to the side in the direction you’re facing, turning your head another 90 degrees so it’s facing downward.
- Hold this position for 30 seconds, then slowly return to a sitting position.
While the Epley maneuver is generally effective, some patients may experience increased vertigo and nausea during and immediately after the procedure. These side effects usually subside within a few hours to a day.
Patient Experiences with BPPV Treatments
Patient experiences with BPPV treatments, particularly the Epley maneuver, can vary significantly. Some individuals report immediate relief after a single treatment, while others may require multiple sessions or experience prolonged symptoms.
One patient, identified as 22Tink in an online forum, described their experience: “My reaction to the maneuver was pretty nasty with terrible vertigo and nausea/dry heaves. I’ve been dizzy fairly constantly ever since.” This account highlights the potential for short-term exacerbation of symptoms following treatment.
Another forum user, mommasita, shared a different experience: “It lasted months. My doctor also tried, no success. I had many tests, MRI, all of it. So strange, I went on a cruise, floated on my back, got water in ears, and thought I was going to drown, I couldn’t tell up from down. BUT, the next day it was all gone.” This anecdote suggests that in some cases, BPPV may resolve spontaneously or through unconventional means.
Recovery Timeline and Recurrence of BPPV
The recovery period for BPPV can vary widely among patients. While some individuals experience immediate relief following treatment, others may have lingering symptoms for days or even weeks. In most cases, significant improvement is seen within a few days to a few weeks after treatment.
BPPV can recur in some patients, even after successful treatment. The recurrence rate is estimated to be around 15-20% within one year of the initial episode. Patients who have experienced BPPV once are advised to be cautious about rapid head movements and to maintain good overall health to reduce the risk of recurrence.
Factors Affecting Recovery and Recurrence
- Age (older individuals may have a longer recovery period)
- Overall health and fitness level
- Adherence to post-treatment instructions
- Presence of other inner ear or balance disorders
- Lifestyle factors (e.g., stress, sleep patterns)
Alternative Treatments and Self-Help Strategies for BPPV
While the Epley maneuver is the most common treatment for BPPV, there are other approaches that patients and healthcare providers may consider. These alternatives can be particularly useful for individuals who do not respond well to the Epley maneuver or who experience frequent recurrences.
Other Repositioning Maneuvers
- Semont maneuver
- Half-somersault or Foster maneuver
- Brandt-Daroff exercises
These maneuvers work on similar principles as the Epley maneuver but involve different sequences of head and body movements. Some patients may find one maneuver more effective or comfortable than others.
Vestibular Rehabilitation Therapy
Vestibular rehabilitation is a form of physical therapy that aims to retrain the brain to process balance information more effectively. This can be particularly beneficial for patients with chronic or recurrent BPPV symptoms.
Self-Help Strategies
Patients can also implement certain lifestyle changes and precautions to manage BPPV symptoms and reduce the risk of recurrence:
- Sleeping with the head slightly elevated
- Avoiding sudden head movements, especially when lying down or getting up
- Using two or more pillows when sleeping
- Getting out of bed slowly and sitting on the edge for a few moments before standing
- Avoiding bending over to pick up objects; instead, squatting with the head straight
The Psychological Impact of BPPV
The experience of BPPV can have significant psychological effects on patients. The sudden onset of vertigo and the fear of recurring episodes can lead to anxiety and changes in daily activities. Some patients may develop a fear of certain movements or positions, leading to a more sedentary lifestyle, which can further impact their overall health and well-being.
Common Psychological Challenges
- Anxiety about future episodes
- Depression due to lifestyle limitations
- Fear of falling or injuring oneself
- Frustration with ongoing symptoms or treatment ineffectiveness
- Social isolation to avoid triggering episodes in public
Healthcare providers should be aware of these psychological aspects and provide appropriate support or referrals for mental health services when necessary. Patients may benefit from cognitive-behavioral therapy or support groups to develop coping strategies and maintain a positive outlook during their recovery.
Advances in BPPV Diagnosis and Treatment
Research into BPPV continues to evolve, with new diagnostic tools and treatment approaches being developed. These advancements aim to improve the accuracy of diagnosis and the effectiveness of treatments, particularly for cases that do not respond to traditional methods.
Innovative Diagnostic Techniques
- Video-oculography: This technique uses specialized goggles to record and analyze eye movements during positional tests, allowing for more precise diagnosis.
- 3D modeling of the inner ear: Advanced imaging techniques can create detailed models of a patient’s inner ear structure, potentially identifying anatomical factors contributing to BPPV.
Emerging Treatment Approaches
- Vibration therapy: Some researchers are exploring the use of targeted vibration to assist in dislodging and repositioning the calcium crystals in the inner ear.
- Virtual reality-assisted rehabilitation: VR technology is being used to create immersive environments for vestibular rehabilitation exercises, potentially improving patient engagement and outcomes.
- Pharmacological interventions: While not a primary treatment for BPPV, researchers are investigating medications that may help prevent crystal formation or aid in their dissolution.
As research progresses, these new approaches may offer hope for patients with difficult-to-treat or recurrent BPPV. However, it’s important to note that many of these techniques are still in the experimental stages and may not be widely available in clinical practice.
Living with BPPV: Long-Term Management and Quality of Life
For many patients, BPPV becomes a chronic condition that requires ongoing management. While acute episodes can often be treated effectively, the possibility of recurrence means that patients must learn to adapt their lifestyle and develop strategies for long-term coping.
Long-Term Management Strategies
- Regular follow-up appointments with healthcare providers
- Maintaining a “vertigo diary” to track triggers and symptom patterns
- Incorporating balance and coordination exercises into daily routines
- Staying informed about new treatments and management techniques
- Joining support groups or online communities for BPPV patients
By taking a proactive approach to managing their condition, many BPPV patients are able to maintain a good quality of life and minimize the impact of the disorder on their daily activities. It’s important for patients to work closely with their healthcare team to develop a personalized management plan that addresses their specific needs and concerns.
Understanding BPPV and its treatment options is crucial for patients and their caregivers. While the condition can be distressing, most cases can be effectively managed with proper diagnosis and treatment. As research continues to advance, new techniques and therapies may offer even better outcomes for those affected by this common vestibular disorder.
Benign Paroxysmal Positional Vertigo (BPPV)-anyone ever dealt with this? | The DIS Disney Discussion Forums
22Tink
BC, Canada
#1
I’ve been having dizzy spells for the past few days and was diagnosed with BPPV. My doctor performed the Epley Maneuver yesterday. My reaction to the maneuver was pretty nasty with terrible vertigo and nausea/dry heaves. I’ve been dizzy fairly constantly ever since. I’m just curious if there’s anyone else that has had this and what your recovery experience was like? Man it’s been a rough few days!!
mommasita
DIS VETERAN
#2
Sorry you are going through this , but yes.
About 2 years ago right out of nowhere, but after A LOT of stress. It lasted months. My doctor also tried, no success. I had many tests, MRI, all of it. So strange, I went on a cruise, floated on my back, got water in ears, and thought I was going to drown, I couldn’t tell up from down. BUT, the next day it was all gone,
Dan Murphy
We are family.
#3
I have not, Tink. But sure wishing you well and a quick recovery. My best.
And, mommasita, good to hear you recovered from your episode with it.
Christine
DIS Veteran
#4
I’ve had mild forms of it.
When I tried to “self-perform” the Epley maneuver I almost vomited and it took me hours to recover.
My mother had it a few years ago. She didn’t feel quite right for weeks and she’s never really been the same since. She has to be careful when bending forward and down and also when she gets her hair done (shampoo bowl can be a problem).
mnrose
Queen of all she surveys
#5
Yes. The Epley procedure worked for me. It’s happened once since the original time, and I did it myself (google it…lots of things that show you how to do it).
If you continue to have this, I’d insist on a more complete workup.
Farro
Argh.
#6
Yes. For two months, finally got Epley, instantly fixed.
22Tink
BC, Canada
#7
Thanks for your input everyone.
I’m glad to hear the Epley worked for some of you. My doctor did say it sometimes takes more than one attempt so I’m hopeful it may still work yet.
22Tink
BC, Canada
#8
Christine said:
I’ve had mild forms of it. When I tried to “self-perform” the Epley maneuver I almost vomited and it took me hours to recover.
Click to expand…
That was my reaction yesterday. I could hardly function afterwards for hours.
She wants to try again tomorrow but I’m scared to go through that again.
22Tink
BC, Canada
#9
mommasita said:
Sorry you are going through this , but yes. About 2 years ago right out of nowhere, but after A LOT of stress. It lasted months. My doctor also tried, no success. I had many tests, MRI, all of it. So strange, I went on a cruise, floated on my back, got water in ears, and thought I was going to drown, I couldn’t tell up from down.
BUT, the next day it was all gone,
Click to expand…
BUT, the next day it was all gone,That’s interesting! Makes me want to try the water thing. My dr said it has something to do with displaced crystals in the ear canal so maybe the water in the ears helped fix that?
Luv Bunnies
DIS Veteran
#10
I was diagnosed with it several years ago. I still get it on occasion when I lie down, usually on my right side. Changing positions usually helps the dizziness subside.
FigmentSpark
DIS Veteran
#11
Yep.
It wasn’t fun. I think I had to have the maneuver done 3 times. Each time, I was told to keep upright for 24 hours, so slept sitting up. But eventually, you’ll get better. But it’s draining to not have full use of your body and to feel like your eyeballs are moving like a bobblehead on the car dashboard. I hope your family is understanding and supportive.
Also, I had it several years ago. Every once in awhile, I go through a mini bout. I can do things like normal, even driving is fine, but it just drains my energy.
I heard someone say that vertigo can be brought on by a virus, but I don’t know anything about that. I do know that my mom got it a month after I did, just after our visit, so that is suspicious. Why would two people get such a rare thing within a month of visiting each other? And we had just come back from a cottage (rental) when I got it, so maybe I did pick something up there?
leebee
DIS Veteran
#12
I can sometimes tell when an attack is going to happen.
I take a decent decongestant and that can help sometimes. I also take Bonine for the dizziness. When it’s really bad, it doesn’t help, but when I feel a slight touch of vertigo starting, both these things can stave it off… sometimes. I have to be careful when bending, looking down, looking up, laying down, and turning over as all these can trigger the vertigo. It complicates things like having my hair washed, lying down at the doctor/dentist/chiropractor, etc. The Epley didn’t work for me at all; I was incapacitated for about a week the one time I had it done. I went from a minor attack (so they thought this was a good time to try it) to being bedridden. I couldn’t sense where my feet/legs and hands/arms were in relation to my torso, I was so disoriented. It was awful.
Christine
DIS Veteran
#13
FigmentSpark said:
Yep.
Also, I had it several years ago. Every once in awhile, I go through a mini bout. I can do things like normal, even driving is fine, but it just drains my energy.
I heard someone say that vertigo can be brought on by a virus, but I don’t know anything about that. I do know that my mom got it a month after I did, just after our visit, so that is suspicious. Why would two people get such a rare thing within a month of visiting each other? And we had just come back from a cottage (rental) when I got it, so maybe I did pick something up there?
Click to expand…
It wasn’t fun. I think I had to have the maneuver done 3 times. Each time, I was told to keep upright for 24 hours, so slept sitting up. But eventually, you’ll get better. But it’s draining to not have full use of your body and to feel like your eyeballs are moving like a bobblehead on the car dashboard. I hope your family is understanding and supportive.So there are several types of vertigo.
One is BPPV which is caused by the osteoliths in your inner ear becoming lose (generally age related). Then there is labryinthitis, which usually comes on after a bad cold or viral illnes/sinus infection. That one cannot be corrected with the Epley maneuver.
22Tink
BC, Canada
#14
Luv Bunnies said:
I was diagnosed with it several years ago. I still get it on occasion when I lie down, usually on my right side.
Click to expand…
Changing positions usually helps the dizziness subside.My right side is worse too. That’s the ear she tried to treat with the Epley.
22Tink
BC, Canada
#15
FigmentSpark said:
Yep. It wasn’t fun. I think I had to have the maneuver done 3 times. Each time, I was told to keep upright for 24 hours, so slept sitting up. But eventually, you’ll get better. But it’s draining to not have full use of your body and to feel like your eyeballs are moving like a bobblehead on the car dashboard.
Also, I had it several years ago. Every once in awhile, I go through a mini bout. I can do things like normal, even driving is fine, but it just drains my energy.
I heard someone say that vertigo can be brought on by a virus, but I don’t know anything about that. I do know that my mom got it a month after I did, just after our visit, so that is suspicious. Why would two people get such a rare thing within a month of visiting each other? And we had just come back from a cottage (rental) when I got it, so maybe I did pick something up there?
Click to expand…
I hope your family is understanding and supportive.Yes I slept upright last night and maybe will tonight too. You’re so right on how draining it is! And I feel like a sloth, everything in slow motion so I don’t make the dizziness worse.
22Tink
BC, Canada
#16
leebee said:
I can sometimes tell when an attack is going to happen.
Click to expand…
I take a decent decongestant and that can help sometimes. I also take Bonine for the dizziness. When it’s really bad, it doesn’t help, but when I feel a slight touch of vertigo starting, both these things can stave it off… sometimes. I have to be careful when bending, looking down, looking up, laying down, and turning over as all these can trigger the vertigo. It complicates things like having my hair washed, lying down at the doctor/dentist/chiropractor, etc. The Epley didn’t work for me at all; I was incapacitated for about a week the one time I had it done. I went from a minor attack (so they thought this was a good time to try it) to being bedridden. I couldn’t sense where my feet/legs and hands/arms were in relation to my torso, I was so disoriented. It was awful.I’ve been taking Bonine but it doesn’t seem to be helping. I didn’t start taking it till yesterday though so maybe I waited too long. The Epley was rough! I’m not looking forward to trying it again tomorrow.
DLgal
DIS Veteran
#17
22Tink said:
I’ve been having dizzy spells for the past few days and was diagnosed with BPPV. My doctor performed the Epley Maneuver yesterday. My reaction to the maneuver was pretty nasty with terrible vertigo and nausea/dry heaves. I’ve been dizzy fairly constantly ever since. I’m just curious if there’s anyone else that has had this and what your recovery experience was like? Man it’s been a rough few days!!
Click to expand.
..That reaction pretty much proves that you needed the maneuver.
Did you stay upright for 24 hours afterwards? If not, you probably need to do it again. When I had it done, I slept in a recliner that night, because if you lay flat, you undo it and knock the crystals out of place again.
DLgal
DIS Veteran
#18
Do you have allergies? Try taking an antihistamine. I had a 3 week bout of dizziness last year that ended up being allergy related. Switching to Allegra from Zyrtec made it go away.
22Tink
BC, Canada
#19
DLgal said:
That reaction pretty much proves that you needed the maneuver.
Did you stay upright for 24 hours afterwards? If not, you probably need to do it again. When I had it done, I slept in a recliner that night, because if you lay flat, you undo it and knock the crystals out of place again.
Click to expand…
That’s exactly what my dr said. I did try stay upright but may have slipped down a bit in the night while asleep. I’m going sleep in the recliner tomorrow night after she retreats. Hopefully that helps.
morrik5
DIS Veteran
#20
I had it on our last trip to Hawaii in 2009 – not fun in a strange room, stubbing your toe etc.
I actually had it 6 months and the specialist told me the exercise to do to get the crystals back where they should be. It wasn’t an immediate cure but I did get over it. Good luck – I know it’s not fun.
Does anyone here suffer from BPPV/Benign Paroxysmal Positional Vertigo?
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If so, how do you deal with it? I was just diagnosed with it over the weekend and when it hits, it’s incapacitating. I can’t imagine having an episode in the middle of a ride….
Here is a wiki: http://en.wikipedia.org/wiki/Benign_paroxysmal_positional_vertigo
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sounds pretty awful. I had an episode of vertigo once.
I have no idea what brought it on…but thank goodness I was sitting down when it did. Whew…I had to hold on to the table just to stay sitting. I couldn’t imagine it being a constant concern.
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Yeah it sucks… It feels like Russian Roulette… I never know when it’s going to hit… The worst part is that my episodes last for over 24 hours!
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ouch. mine only lasted about a minute. any meds you can take to help?
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the doc prescribed meclizine and valium… I’m hoping to see a vestibular therapist to see if there are any exercises I can do to keep it in check… I’ve researched it quite a bit and it seems there are maneuvers like the Epley that I can do to minimize the impact when it does hit…
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It hit me, my wife made me go to see the doc and he gave me a printout with the Epley procedures. Mine went away in the first 48 hours and has not really returned.
He said that the particle that is in the fluid in your ear often dissolves over time.
Good Luck
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As a physical therapist that has worked in vestibular rehab, I can tell you that seeing a therapist will USUALLY take care of the problem, very quickly. Essentially, the PT will put you through certain positions to encourage the “ear rocks” to return to where they belong. After the procedure, there are some position restrictions to minimize the chances of the “rocks” moving again.
Of course, some people don’t respond that quickly and easily, and at times what is thought to be BPPV turns out to be something different. The key is to see a PT who is versed in vestibular rehab to help you sort out what is going on.
Also, have you seen an ENT (Ears, nose, throat doctor)? They are the docs who specialize in disorders such as this.
Presuming you see a PT for treatment, be forwarned the treatment will ellicit your dizziness again. The therapist has to provoke the symptoms to know where the problem is and how to treat it.
One other comment: be very cautious with the meds. Meclizine suppresses the vestibular system, which may make you feel better but actually puts you at risk for falling. The valium may make you more comfortable, but again the side effects for daily life can be incapacitating.
Good luck with this.. I always enjoyed seeing patients with BPPV because of how quickly and easily it was fixed.
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Thanks Chill,
I don’t like taking meds so I only took the valium and mezicline to get over the episode (we were on vacation in Maui at the time). I haven’t seen an ENT yet but that will be the next step more than likely if my visit to the Vestibular PT doesn’t help. I’m doing OK now but I still can’t move my head very fast and there are times when I feel like I’m on a rocking boat (not the best feeling when you’re riding). It’s great to hear that it’s a problem that is relatively easily resolved… I hope…
chillmolly said:
As a physical therapist that has worked in vestibular rehab, I can tell you that seeing a therapist will USUALLY take care of the problem, very quickly.
Of course, some people don’t respond that quickly and easily, and at times what is thought to be BPPV turns out to be something different. The key is to see a PT who is versed in vestibular rehab to help you sort out what is going on.
Also, have you seen an ENT (Ears, nose, throat doctor)? They are the docs who specialize in disorders such as this.
Presuming you see a PT for treatment, be forwarned the treatment will ellicit your dizziness again. The therapist has to provoke the symptoms to know where the problem is and how to treat it.
One other comment: be very cautious with the meds. Meclizine suppresses the vestibular system, which may make you feel better but actually puts you at risk for falling. The valium may make you more comfortable, but again the side effects for daily life can be incapacitating.
Good luck with this.. I always enjoyed seeing patients with BPPV because of how quickly and easily it was fixed.
Click to expand…
Essentially, the PT will put you through certain positions to encourage the “ear rocks” to return to where they belong. After the procedure, there are some position restrictions to minimize the chances of the “rocks” moving again.
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I got it the 2d time I was in Bosnia. I really think it had something to do with the ultr-cold aircon in the “CHU’s”. That and I had just gotten out of a cast from a broken arm, said arm still being sore.
Somehow I managed to wander over to “Blue Factory”–where the medical unit was. They did some etsts and said I had some sort of imbalance caused by particles in the fluid in the canal between the ars–or some such-can’t remember exact details. They seemed to think it wasn’t too abnormal.
The episode of dizzies and imbalance, especially from getting up from an inclined position lasted seveal days to a week.
This happened somewhere between 1997-1998. Thankfully I haven’t had another bout.
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flipnidaho said:
Thanks Chill,
I don’t like taking meds so I only took the valium and mezicline to get over the episode (we were on vacation in Maui at the time).Click to expand…
I haven’t seen an ENT yet but that will be the next step more than likely if my visit to the Vestibular PT doesn’t help. I’m doing OK now but I still can’t move my head very fast and there are times when I feel like I’m on a rocking boat (not the best feeling when you’re riding). It’s great to hear that it’s a problem that is relatively easily resolved… I hope…Try to figure out what postions set you off, and what side the problem seems to be coming from. That will help your therapist/doctor. Also think about intensity ( 0 being nothing to 10 being vomiting) and how long that severity lasts.
:thumbsup:
M
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chillmolly said:
Try to figure out what postions set you off, and what side the problem seems to be coming from. That will help your therapist/doctor. Also think about intensity ( 0 being nothing to 10 being vomiting) and how long that severity lasts.
:thumbsup:
M
Click to expand.
..The doc I saw said it was my right ear based on what position my eyes flickered during a “follow my finger test” and the fact that when I laid on my left ear, the room stabilizes. The intensity scale I would say close to a 10 (incapacitating to the point where I can’t even get up from laying down on my left side without having to almost hurl)… The weird thing for me is that the episode lasts over 24 hours (maybe longer if I don’t take meds). The typical BPPV case I read about only lasts 30 seconds to a few minutes so I think mine condition is a little odd/atypical…
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Yep, went thru it just recently, and it only took a few days on meclizine for mine to go away. Apparently, most episodes last for a week or two, then kinda resolve on their own. Mine would whip my butt when I sat up in bed in the morning, laid down at night, or leaned my head back if sitting on the couch or something like that. Was pretty fierce for about a week as I initially resisted taking the drugs, but after just a few days of meds, it went away.
Interestingly enough, even during the worst of it, it NEVER had any effect on me when riding.
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scooter_dude said:
Yep, went thru it just recently, and it only took a few days on meclizine for mine to go away. Apparently, most episodes last for a week or two, then kinda resolve on their own. Mine would whip my butt when I sat up in bed in the morning, laid down at night, or leaned my head back if sitting on the couch or something like that. Was pretty fierce for about a week as I initially resisted taking the drugs, but after just a few days of meds, it went away. Interestingly enough, even during the worst of it, it NEVER had any effect on me when riding.
Click to expand…
Funny you say that… The past few days, the only time I don’t feel like I’m on a boat is when I’m riding…
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Yes and mine also develops into full blown Meniere’s. I have had disabling attacks at work, at the airport and even while sleeping.:max_bytes(150000):strip_icc()/causes-of-vertigo-1298945-color-V13-614e9f9446fe4596bd4180958509cc61.png)
Been dealing with it for more than 12 years. Its comes and goes, some periods of remission have lasted close to a year.
The good news is I have never had a really bad episode while riding, that includes mtb, road and motorcycles.
Be wary of any ENT that wants to treat by surgery or injection to destroy the ear nerves on the affected side. It was recommended to me by the first ENT I saw.
Meclizine is something I keep handy when my symptoms are present. I dont take it on a regular basis.
Absolutely check out the Epiley maneuver or find a physical therapist that can help with that.
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67fastback said:
Yes and mine also develops into full blown Meniere’s. I have had disabling attacks at work, at the airport and even while sleeping. Been dealing with it for more than 12 years. Its comes and goes, some periods of remission have lasted close to a year.
The good news is I have never had a really bad episode while riding, that includes mtb, road and motorcycles.
Be wary of any ENT that wants to treat by surgery or injection to destroy the ear nerves on the affected side. It was recommended to me by the first ENT I saw.
Meclizine is something I keep handy when my symptoms are present. I dont take it on a regular basis.
Absolutely check out the Epiley maneuver or find a physical therapist that can help with that.
Click to expand…
I did some research on Meniere when I was trying to self diagnose and it’s scary… The worse part is the randomness. I also now keep Meclizine and Valium handy wherever I go (except for riding- maybe I should start carrying a pill box in my pack also). I agree with the surgery… It’s the last possible option for me. The surgery looks pretty close to brain surgery, I’d rather take drugs and deal with it than have someone cut into my head…
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Check this article: http://www.scielo.cl/pdf/ijmorphol/v23n2/art09.pdf
Its a 2006 study by Luis Miguel Ramirez Aristeguieta, very interesting stuff and some outside the box thinking.
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Disclaimer: I know nothing about this sort of thing, only sharing the experience of a family member.
That said, my mother-in-law has had what, I think, is the very same sort of issue. She tried meds to no avail. My wife took her to the local healthy / hippie / homeopathic sort of store to see if a friend of ours there had any magic potion to recommend. She did not, but she told my mother-in-law to try acupuncture.
So, long story short, she tried it, and it seems to have worked. YMMV, of course.
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The first time I had vertigo I figured I was about to buy the farm! I had a cold which began to make me slightly dizzy a few times a day – figured it was sinuses. Finally a week later at work it hit me like a ton of bricks, I (stupidly) managed to drive myself home and proceeded to puke my guts out. Next day felt fine, went to doc and was diagnosed with labyrinthitis. I have had it twice since then, the last one being two weeks ago.
I have noticed these spells are less worse each time, but I’ve never “passed” the BPPV test the docs do – always a diagnosis of labyrinthitis.
I think the absolute worst part is thinking “ok here it comes, this is going to suck!” I try to keep myself calm and just lay in bed and watch movies if possible.
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Newly diagnosed…out of nowhere, room started spinning so scared. Husband took me to hospital I was admitted and all tests point to MPPV. I had the eflee treatment in hospital, not fun and was sent home told me to follow up with ENT who just performed it again. Awful. I am really scared trying to sleep with head propped up but the slightest wrong move with my head and it starts again. I’m on steroids but cant imagine I now have to live like this.
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I’ve lived with Menieres for all of my adult life (58 now)… Totally deaf in my left ear with a constant ringing. From my experience it’s a change in barometric pressure that will trigger my drop attacks.
Low does Diazapan daily and Meclazine as needed can control it when huge pressure gradiance can’t be avoided. Turmeric to prevent inflammation is also helpful.
No caffeine.
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differential diagnosis and approaches to therapy uMEDp
The article deals with diseases that manifest themselves as episodic vestibular syndrome in the form of vertigo attacks of varying duration. Modern clinical criteria for diagnosis and principles of effective treatment of benign paroxysmal positional vertigo, vestibular migraine, Meniere’s disease, dehiscence of the superior semicircular canal, vestibular paroxysmia, Mal de Debarquement syndrome, etc. are presented.
Diagnosis of vertigo remains a difficult task for both a general practitioner and a narrow specialist – a neurologist, otorhinolaryngologist, cardiologist and psychotherapist.
This is primarily due to the fact that dizziness is included in the symptom complex of completely different diseases – from a panic attack to acute cerebrovascular accident.
Until recently, the main approach to managing patients with complaints of dizziness was considered to be the determination of the nature of the symptom itself [1]. Thus, rotational or systemic vertigo was regarded as a manifestation of a lesion of the peripheral part of the vestibular system – the inner ear, non-rotational or non-systemic vertigo – as a lesion of the vestibular centers of the central nervous system (CNS). Loss of consciousness or a feeling of impending fainting indicated cardiogenic causes, and unsteadiness during movement indicated metabolic or psychiatric disorders. The use of this approach in wide clinical practice for decades has not affected the reduction in the percentage of errors in the diagnosis. The fact is that in most cases, patients experience several types of dizziness at once [2].
For example, acute vestibular vertigo may be replaced by prolonged non-systemic vertigo with vestibular migraine or prolonged unsteadiness when walking on the background of vestibular neuronitis. In addition, patients with arrhythmia often describe episodes of cardiac arrhythmia as rotational vertigo, and elderly patients with benign paroxysmal positional vertigo (BPPV) complain of instability, rather than positional attacks of rotational vertigo due to adaptive behavior that excludes a quick change in body and head position [ 3]. In this regard, the experts of the Barany Society proposed a new algorithm for diagnosing dizziness, including determining the type of vestibular syndrome based on patient complaints and anamnesis of the disease, specifying triggers, concomitant neurological and otological symptoms, followed by the identification of characteristic positive tests during otoneurological examination [4 ].
Acute, episodic and chronic vestibular syndromes are distinguished by the nature of the course.
Acute vestibular syndrome is characterized by a sudden onset and long-term (days, weeks, months) persistence of symptoms of varying severity. Episodic vestibular syndrome manifests itself in the form of attacks of dizziness of varying duration, between which there are light asymptomatic intervals. In chronic vestibular syndrome, dizziness of a greater or lesser degree of severity is present daily, causing significant maladjustment.
Episodic vestibular syndrome includes the following diseases: BPPV, vestibular migraine, Meniere’s disease, transient ischemic attack, vestibular paroxysmia, dehiscence of the superior semicircular canal, Mal de Debarquement syndrome, and autoimmune lesions of the inner ear.
Benign paroxysmal positional vertigo
The prevalence of this disease is extremely high – 15–20% of all patients presenting complaints of dizziness at the appointment with a neurologist [5]. The pathogenesis of BPPV is associated with the ingress of otoliths – fragments of the otolithic membrane of the vestibule of the labyrinth into the semicircular canals, which leads to paroxysmal irritation of the ampullar receptor when they move in the canal under the influence of gravity when the position of the head changes.
Clinically, the disease manifests itself with short attacks of rotational vertigo from several tens of seconds to several minutes when the head position changes, more often when laying down and getting out of bed, turning from side to side, tilting and throwing the head back [6]. Actually attacks are seldom accompanied by vomiting, but the nausea is possible. Diagnosis of BPPV includes diagnostic positional tests: the Dix-Hallpike test to detect otolithiasis of the posterior and anterior semicircular canals and the McClure-Pagnini test (roll test) to confirm otolithiasis of the horizontal semicircular canal. A reliable diagnosis is established when a nystagmus characteristic of each channel is obtained in tests, accompanied by an attack of rotational dizziness [7].
The treatment of otolithiasis involves the use of repositioning maneuvers – turning the head in a certain sequence, during which the otoliths are shifted under the action of gravity in the lumen of the semicircular canal back to the vestibule.
The most effective Epley and Semont maneuvers have been proposed for the treatment of BPPV of the posterior semicircular canal [8]. Drug treatment of BPPV is prescribed only in case of pronounced autonomic reactions of the patient during repositioning maneuvers and involves the use of vestibular suppressants and antiemetics.
Vestibular migraine
The disease often remains underdiagnosed. However, according to epidemiological studies, its lifetime prevalence reaches 0.98% [9]. Vestibular migraine can develop at any age, more often in women, manifested by bouts of dizziness or unsteadiness lasting from several minutes to several days, accompanied by migraine headache or photo- and phonophobia. In most cases, during an otoneurological examination in the non-attack period, pathological symptoms cannot be detected, as a result of which the currently used diagnostic criteria are clinical, based on a characteristic anamnesis and the absence of signs of damage to the vestibular system during examination [10].
In accordance with the criteria of the Barani Society and the International Headache Society, a reliable diagnosis of vestibular migraine can be established:
- in the presence of five or more attacks of dizziness of severe and moderate intensity lasting from five minutes to 72 hours;
- a history of migraine with or without aura that meets the criteria for the International Classification of Headache;
- combination of vertigo attacks with migraine symptoms (migraine headache, photo- or phonophobia, visual aura) in half of the cases;
- the discrepancy between the symptoms of any other vestibular pathology based on the International Classification of Vestibular Disorders [11].
Therapy of vestibular migraine involves the prophylactic administration of the same drugs that are used to prevent migraine. However, the evidence base for their use in the vestibular course of this disease is extremely limited. In clinical practice, calcium channel blockers, beta-blockers, anticonvulsants and antidepressants are used.
In some cases, lifestyle modification (normalization of sleep, exercise), as well as the exclusion of dietary triggers (wine, beer, chocolate, aged cheeses, etc.) have a positive effect [12].
These studies have demonstrated the high efficiency of Arlevert: against the background of its use, the number of seizures is reduced by 60–80% [13].
Arlevert is a fixed combination of cinnarizine 20 mg and dimenhydrinate 40 mg. Cinnarizine blocks L-type calcium channels, which reduces the contractility of the smooth muscle elements of arterioles, directly inhibits the hair cells of vestibular receptors, and has moderate antihistamine activity. In addition, a good effect of cinnarizine has been shown in studies on the prevention of migraine, peripheral dizziness and vestibular migraine [14-16]. Dimenhydrinate is characterized by antihistamine activity and is usually used to prevent nausea and dizziness in motion sickness syndrome. The results of studies indicate the high efficiency of these drugs in a fixed combination in various vestibular disorders, including Meniere’s disease and vestibular neuronitis in the acute phase [17–19].
The synergistic effect of the drugs is due, on the one hand, to the effect of cinnarizine on the vestibular neuroepithelium by suppressing the entry of calcium ions into the cells and reducing peripheral vestibular impulses, on the other hand, to the antihistamine and anticholinergic effects of dimenhydrinate on the vomiting center of the CNS, preventing the development of nausea and other symptoms of motion sickness, which are often take place in the interictal period with vestibular migraine.
Arlevert has been present on the German pharmaceutical market since 1982 and is currently available in over 25 EU and other countries. Arlevert at a dose of one tablet three times a day for four weeks is well tolerated by patients and demonstrates high efficacy in vestibulopathies of various origins [20]. The drug is contraindicated in angle-closure glaucoma, convulsive syndrome, urinary retention in diseases of the urethra and prostate, pregnancy. Arlevert is recommended for use from the age of 18.
With caution, the drug is prescribed for Parkinson’s disease, hyperthyroidism, increased intraocular pressure. When using Arlevert at recommended doses, the risk of prolongation of the QT interval can be considered low. However, patients with heart disease or patients receiving other drugs that have the potential to prolong the QT interval should be given Arlevert with caution.
Meniere’s disease
Presumably, various factors are involved in the etiology of the disease, including genetic, autoimmune, vascular and metabolic disorders that contribute to the development of endolymphatic hydrops. An increase in endolymph pressure leads to a dysfunction of the organ of Corti of the inner ear, which is manifested by auditory symptoms in the form of noise and hearing loss in the affected ear, and also, possibly, to a rupture of the Reisner membrane at the height of the hydrops, endolymph enters the perilymphatic space and changes in the impulses of the vestibular receptors.
As a result, acute vestibular asymmetry and an attack of dizziness occur.
A reliable diagnosis of Meniere’s disease is established in the presence of more than two spontaneous attacks of rotational vertigo lasting from 20 minutes to 12 hours, fluctuations in auditory symptoms (noise, congestion and hearing loss), as well as the presence of sensorineural hearing loss in the low and medium frequencies before, during or after seizure, confirmed by the results of an audiometric study [21].
At the initial stage, the disease can be manifested exclusively by hearing impairment, which does not allow to differentiate it from acute or progressive sensorineural hearing loss. Only the occurrence of vertigo attacks several years after the onset of the first auditory symptoms allows a reliable diagnosis to be made.
The clinical course of the disease is purely individual, accompanied by little predictable periods of exacerbations, consisting of a series of frequently recurring attacks, and remissions that can last for years.
The dynamics of hearing changes against the background of vertigo attacks remains unclear: in some patients, there is a pronounced progression of hearing loss against the background of rare attacks, while others maintain low thresholds of hearing loss in the interictal period against the background of frequent severe attacks. However, over time, severe hearing loss develops, the thresholds of which exceed 50 dB after 20 years from the onset of the disease [22].
Additional diagnostic methods include magnetic resonance imaging (MRI) of the brain, extratympanic electrocochleography, videonystagmography, caloric and video pulse tests, but are used only for complex differential diagnosis, more often with vestibular migraine.
Treatment of Meniere’s disease is divided into relief of an acute attack and prophylactic therapy in the interictal period. During an attack, the patient must be provided with rest, a horizontal position, and also prescribe vestibular suppressants, antiemetics, possibly in combination with benzodiazepines.
With moderate severity of the attack, the drugs are used orally. When vomiting occurs, intramuscular and intravenous forms are used.
In order to prevent seizures, stepwise therapy is used, which begins with non-drug methods and pharmacotherapy and, in resistant cases, ends with the destruction of the labyrinth by surgery. In most cases, remission can be achieved with lifestyle modifications, including adherence to a hyposalt diet, stress reduction, normalization of the daily regimen, treatment of concomitant diseases, as well as with the appointment of betahistine, diuretics, calcium channel blockers.
The use of Arlevert in Meniere’s disease leads to a decrease in the number of episodes of dizziness. The drug is especially indicated for patients with association of the disease with migraine and persistence of symptoms of instability and mild dizziness in the interictal period [23]. With the ineffectiveness of conservative treatment, intratympanic injections of glucocorticosteroids (GCS) and operations on the endolymphatic sac are used with satisfactory hearing thresholds, as well as ablative methods (intratympanic administration of gentamicin, laser or surgical ablation of the labyrinth, neurectomy of the 8th pair of cranial nerves) with a resistant course of the disease and socially significant hearing loss.
In 10-20% of cases, Meniere’s disease in the later stages can occur in the form of Tumarkin’s otolithic crises – vestibular drop attacks, in which vestibular impulses from otolithic receptors change dramatically, activation of the vestibulospinal reflex, which is manifested by an unexpected fall of the patient without loss of consciousness. Tumarkin’s crises have a pronounced negative impact on the patient’s quality of life, lead to trauma and are not amenable to conservative treatment [24].
Transient ischemic attack
Due to the pronounced individuality of the vascularization of the vertebral and main arteries, episodes of ischemia in the vertebrobasilar basin, which supplies the vestibular centers of the trunk and cerebellum, as well as the inner ear and vestibular nerve, can occur with manifestation in the form of isolated dizziness without obvious focal symptoms. 10–20% of patients with a confirmed stroke of vertebrobasilar localization report dizziness attacks preceding the main episode, which resolved spontaneously [25].
There are no reliable criteria for this dangerous condition in the interictal period, but it should be suspected if there are a few attacks of dizziness in an anamnesis in an elderly patient with risk factors for stroke, especially in the absence of signs during an otoneurological examination that indicate other vestibulopathies (in particular, BPPV, Meniere’s disease). ). The special attention of a specialist in the case of a presumptive diagnosis of a transient ischemic attack should be focused on a thorough examination of the patient in order to identify risk factors and prescribe therapy for the primary prevention of stroke.
Vestibular paroxysm
The etiology of the disease initially assumed the presence of a vasoneural conflict of the 8th pair of cranial nerves with an artery or vein in the region of the brainstem, by analogy with trigeminal neuralgia and hemifacial spasm. However, subsequent studies in this area revealed the proximity of the vestibular nerve to the vessels in more than 40% of people from an arbitrary sample according to MRI, which did not allow the use of neuroimaging results to confirm the diagnosis.
In addition, a study on a high-field tomograph (7 Tesla) in patients with vestibular paroxysm did not show structural lesions of the vestibular nerve sheath. Therefore, the question of the pathogenesis of spontaneous stimulation of vestibular structures remains open [26].
Criteria for the diagnosis of vestibular paroxysmia include the presence of at least ten attacks of spontaneous rotational or non-rotational vertigo lasting less than a minute, their stereotypical course in each episode, and the presence of a positive effect in response to anticonvulsant therapy – carbamazepine or oxcarbazepine [27]. A probable diagnosis of the disease implies at least five stereotypical seizures lasting up to five minutes, occurring spontaneously or provoked by a certain position of the head. Optional symptoms include unilateral hearing loss and noise, as well as signs of unilateral vestibular asymmetry. But usually, an otoneurological examination does not reveal signs of peripheral or central vestibulopathy.
In addition to carbamazepine and oxcarbazepine, lamotrigine, baclofen, topiramate, and gabapentin are used, although the evidence base for their effectiveness is low.
According to research, treatment with anticonvulsants for three years can reduce the number and intensity of seizures. Microvascular decompression is used in rare cases with an unsatisfactory effect of conservative treatment and significant maladaptation of the patient [28].
Dehiscence of the superior semicircular canal
The etiology of the disease includes both anatomical predisposition (formation of a thin bone wall or the presence of initially slight dehiscence above the superior semicircular canal in the area of the middle cranial fossa) and exposure to external factors during life, such as mild head injuries, increased intracranial pressure. Patients with this disease complain of constant pulsating noise, autophony, hearing loss and dizziness in certain situations: with loud sounds, straining, blowing their nose.
Diagnosis criteria include the presence of at least one of the characteristic clinical symptoms: hyperacusis in the form of autophony, the ability to hear the sounds of one’s own body (heartbeat, steps, eye movement), dizziness with loud sounds or pressure changes in the middle ear), pulsating noise. At the same time, dehiscence should be confirmed not only by the results of high-resolution computed tomography of the temporal bones with multiplanar reformation in the canal plane, but also by another positive clinical test characteristic of the presence of the “third window” of the labyrinth: the appearance of nystagmus in the Valsalva test, negative bone conduction thresholds at low frequencies in tone threshold audiometry, a decrease in the thresholds of cervical vestibular evoked myogenic potentials, or an increase in the amplitude of ocular vestibular evoked myogenic potentials on the side of the lesion [29].
Conservative treatment for vestibular paroxysm is ineffective, so the doctor’s tactic is to explain to patients the benign etiology of symptoms.
As a result, according to statistics, no more than half of patients agree to surgical treatment, since some of them have mild or situational symptoms. In practice, both plasty and filling of the identified dehiscence are used, various surgical approaches, including the traditional transmastoid method, access through the middle cranial fossa [30].
Mal de Debarquement syndrome
This symptom complex occurs within 48 hours after passive movement, that is, moving in transport (car, ship, plane, train), sleeping on water mattresses, working on moving platforms and manifests itself in the form of non-rotational dizziness with a feeling of rocking, lasting most of the time and decreasing with the repetition of passive movement (driving in a car, train, etc.). As a rule, the trip preceding the illness should be quite long (at least an hour), and may be combined with additional triggers in the form of stress, lack of sleep, hormonal changes in premenopause or the premenstrual period.
There is a transient course of the syndrome, when the symptoms last less than four weeks, and a persistent form with a duration of more than four weeks. Dizziness worsens when lying down at rest and decreases with movement, especially driving, which distinguishes Mal de Debarquement syndrome from persistent postural-perceptual vertigo.
The pathogenesis of the disease is poorly understood: excessive activation of the vestibulo-ocular reflex against the background of neuronal integrator maladaptation, as well as overload of the entorhinal cortex during prolonged exposure to accelerations during movement are discussed [30].
There is no effective treatment: vestibular rehabilitation is ineffective, antidepressants (selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors) and benzodiazepines reduce symptoms but do not speed up recovery. The scientific literature discusses the use of drugs for migraine prevention, lifestyle improvement, as well as repetitive transcranial magnetic stimulation [31].
Autoimmune disorders of the inner ear
The study of the influence of autoimmune factors on the neuroepithelium of the labyrinth includes damage to the organ of Corti, accompanied by auditory disorders, and vestibular receptors, which happens much less frequently. In the presence of attacks of dizziness, a staged asymmetric progression of vestibular hypofunction is observed, which manifests itself during an otoneurological examination with nystagmus towards a more intact labyrinth and an asymmetric course of instrumental tests (video impulse test, caloric and rotational tests). There may be an improvement in the treatment of the underlying autoimmune disease, if any, or trial administration of corticosteroids, in rare cases, cytostatics. An example of such a disease is Cogan’s syndrome, which is manifested by interstitial keratitis, sensorineural hearing loss, vestibulopathy, as well as the development of vasculitis of any localization, including aortitis, aortic aneurysm, and heart valve damage [32].
Conclusion
The diagnostic approach to the treatment of patients with vertigo attacks includes a thorough questioning of the duration of the attacks, their accompanying symptoms and factors provoking them, as well as an otoneurological examination. If necessary, instrumental methods are used (audiometry, computed tomography, MRI, vestibular evoked myogenic potentials, etc.).
Only a correct diagnosis can provide adequate patient management tactics – using non-drug methods, pharmacotherapy or surgical treatment.
Therapeutic positional maneuver for dizziness in Kaluga
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Therapeutic positional maneuver for vertigo
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Dizziness is the second most common reason, after headache, for which patients seek medical attention. Most often, these patients turn to a neurologist, general practitioner, therapist. In the age group over 50, about 30% experience dizziness.
It belongs to the group of subjective sensations, which is why it is so difficult to describe it. Like any feeling, it is strictly individual and always has a bright emotional coloring.
Dizziness can be a symptom of many diseases, most of which are related to neurological and otoneurological pathology.
In this article, we will talk about such a condition as Benign Paroxysmal Positional Vertigo (BPPV).
The prevalence of this pathology: every 3rd person over 70 years of age had an attack of positional vertigo at least once. Women get sick 2 times more often than men. In 80% of cases, the posterior semicircular canal is affected and in 90% of cases of positional vertigo occur for no apparent reason. Other causes include: traumatic brain injury, Meniere’s disease, labyrinthitis, vestibular neuronitis, middle ear surgery, SARS, otitis media, intoxication.
Pathogenesis:
Clinical manifestations of benign paroxysmal positional vertigo are preceded by changes in the vestibular apparatus itself:
- Movement of otolith fragments from the vestibule to the semicircular canal
- Formation of canalolithiasis (otolith particles enter the lumen of the semicircular canal) or cupulolithiasis (otolith particles settle on the cupula) with irritation of the ampullar receptor
- Destruction of the otolithic membrane with the formation of a clot, its movement to the threshold of the labyrinth.
Favorable conditions for the formation of a clot occur during sleep, when the head is motionless. When turning in bed, this clot enters the semicircular canal, which causes irritation of the receptors and, as a result, the occurrence of dizziness, autonomic reactions (nausea, vomiting, palpitations, a sense of fear). Over time, the clot particles dissolve in the endolymph. The dizziness subsides. However, relapses of dizziness are possible due to the fact that particles can stick to the walls of the canal and suddenly slide off it, stick together when the head is stationary and again cause an attack of dizziness.
Clinic:
- BPPV is characterized by a sudden development of an attack of dizziness with a sensation of rotation of objects around the patient. It is aggravated by changing the position of the head (turning in bed, tipping or tilting the head forward) and the body (from a lying position to a sitting position and vice versa).
- Time of occurrence of attacks: at night, at the time of turning in bed or after sleep.
- The duration of the attack is up to 1 minute.
- Nystagmus – horizontal or horizontal-rotary. It indicates irritation of the receptors of the posterior semicircular canal.
- Vegetative reactions: nausea, vomiting, anxiety, oscillopsia.
- Attacks can recur for several months, followed by remission up to several years.
Diagnosis:
The main method for diagnosing BPPV is the Dix-Holpike test.
Treatment:
In the treatment of this pathology, the main place is occupied by therapeutic positional maneuvers and vestibular gymnastics.
- Semont maneuver.
Performed with the help of a doctor. The initial position of the patient is sitting on the couch, legs are hanging down. While sitting, the patient turns his head in a horizontal plane by 45° to the healthy side. Fixing the head with his hands, the doctor lays the patient on his side on the side of the affected ear and lingers in it for about 90 seconds.
Then the doctor, continuing to fix the patient’s head in the initial position, quickly places the patient to the opposite side through the “sitting” position – forehead down. The patient also stays in this position for 90 seconds. Further, without changing the position of the patient’s head, he is seated on the couch. If necessary, you can repeat the maneuver. - Epley maneuver (with pathology of the posterior semicircular canal).
The starting position of the patient is sitting along the couch. Previously, the patient’s head is turned in the direction of the pathology and 45 degrees up. Next, the patient is placed on his back, head tilted back by 45°. The next turn of the fixed head is in the opposite direction in the same position on the couch. Then the patient is laid on his side, the position of the head also continues to be fixed. Next, the patient sits down, head tilted forward. The stay of the patient in each position is determined individually, on average 90 seconds.
As a rule, 2-3 maneuvers are performed during one session. - Lempert’s maneuver (with pathology of the horizontal semicircular canal).
The starting position, as well as when performing the Epley maneuver, is along the bed. The patient’s head remains fixed by the doctor during the entire procedure. The patient’s head is rotated 45° in the horizontal plane towards the pathology. Then the patient is laid on his back, consistently turning his head in a healthy direction. After that, the patient turns on a healthy side – a healthy ear down. Further, in the same direction, the patient turns on his stomach; the head is placed with the nose down. Following this, the patient is laid on the side of the affected side; head – with a sore ear downwards. The last stage – the patient is seated on the couch through a healthy side. The maneuver can be repeated.
Then the doctor, continuing to fix the patient’s head in the initial position, quickly places the patient to the opposite side through the “sitting” position – forehead down. The patient also stays in this position for 90 seconds. Further, without changing the position of the patient’s head, he is seated on the couch. If necessary, you can repeat the maneuver.
As a rule, 2-3 maneuvers are performed during one session. The starting position, as well as when performing the Epley maneuver, is along the bed. The patient’s head remains fixed by the doctor during the entire procedure.
The patient’s head is rotated 45° in the horizontal plane towards the pathology. Then the patient is laid on his back, consistently turning his head in a healthy direction. After that, the patient turns on a healthy side – a healthy ear down. Further, in the same direction, the patient turns on his stomach; the head is placed with the nose down. Following this, the patient is laid on the side of the affected side; head – with a sore ear downwards. The last stage – the patient is seated on the couch through a healthy side. The maneuver can be repeated.
After the positional maneuver, the patient is recommended to perform gymnastics at home according to the Brandt-Daroff method for several days, after which he returns to the doctor’s office to assess the condition and correct therapy.
According to this technique, the patient is recommended to perform exercises three times a day, 5 times in both directions. Exercises are performed in bed, immediately after waking up.
The patient sits in the center of the bed with the legs hanging down. Then he is laid on one side, while the head is turned up by 45 °, and is in this position for 30 seconds (or until the dizziness stops). After that, the patient returns to the starting position sitting. The patient remains in the starting position for 30 seconds. Then everything repeats, but in the opposite direction. If dizziness occurs at least once in any of the positions, then the gymnastics should be repeated in the afternoon and evening.
Drug therapy for BPPV includes the use of the following groups of drugs:
- Antiemetics
- Antihistamines
- Vestibulolytic preparations
- Nootropics
In the end, I would like to say that if dizziness occurs, it is necessary to consult a doctor for differential diagnosis of the disease, the correct prescription of medications and therapeutic measures. All this is the guarantee of your health!
If you do not live in Kaluga, you can sign up for an online consultation via WhatsApp: +7 (961) 123-69-68.
For a course of treatment, a rehabilitation course for patients from other cities, we provide inexpensive accommodation in apartments. For surgical operations, we offer accommodation in a 24-hour hospital.
Do you have questions? Ask us on our social networks.
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Review of neurologist N. I. Nikolaeva
11/27/2017
Review of neurologist N. I. Nikolaeva
11/27/2017
Review of neurologist N. I. Nikolaeva
11/27/2017
Review of neurologist N. I. Nikolaeva
11/27/2017
Chulyak Anna
Very good doctor, thank you very much for the treatment, they helped a lot, the condition improved
02.06.0002 Hello Anna! Thank you for taking the time to review! We wish you good health and a great summer mood!
Sincerely, the administration of the “Clinic of PAIN”
Full review
Denis
I visited Darya Andreevna for the second time, she carefully asked about how the treatment was going.
Made some changes. The condition is getting better. Thank you very much
08/29/2022
Reply to Review
Good morning, Denis! Thank you for your feedback! We are very happy that you feel better. We wish you a speedy recovery!
Sincerely, Administration of PAIN Clinic
Completely review
Tamara Leonidovna
Miracle doctor! Attentive, accurate, everything is on the case, does not prescribe anything superfluous. Helped me a lot with my headaches. Thank you very much
07/23/2022
Reply to Review
Good morning! Thank you for your feedback, Tamara Leonidovna! Daria Andreevna will be very pleased to read your words! We wish you health and life without pain! Sincerely, the administration of the PAIN Clinic
Completely review
Tamara Dmitrievna
Wonderful doctor! Attentive, empathetic, she picked up the treatment and did the blockade on the same day right away. I can live without pain again. God bless you and your professional growth!
06/29/2022
Reply to Review
Good morning, Tamara Dmitrievna! Thank you very much for your feedback! We wish you good health! Sincerely, the administration of the Pain Clinic
Completely review
Ekaterina
Thank you very much for the treatment.
Very kind doctor!
03/29/2022
Reply to Review
Good afternoon! Thank you for your attention to the work of Natalia Igorevna. We will pass on your words to her. Be healthy! Sincerely, the administration of the Pain Clinic
Completely review
Yashin
The treatment is wonderful. The doctor showed sensitivity, understanding. I got relief on the first day.
30.05.2020
Reply to Review
Thank you for your feedback! Nice to know that we were able to help you! Be healthy! Sincerely, Administration of Pain Clinic
Full review
Gorodnov Andrey Vladimirovich
Appealed to the Pain Clinic with a diagnosis of “herniated discs, spondylarthrosis 2 tbsp.” Prior to that, she had been treated with injections and pills for 2 years. Wherever I went, they offered surgery everywhere. Until I got to the neurosurgeon Gorodnov A.V., who took up the treatment without surgery. After 10 days of rehabilitation, I felt like a complete person.
Thanks a lot!
26.02.2020
Complete review
Yudaeva
Ustyuzhanin Ivan Vladimirovich – a super doctor, I advise everyone.
2/25/2020
Reply to Review
Good evening, thank you for your review.
Full review
Komissarova Irina Anatolyevna
Many thanks for the professional treatment. They got rid of the pain in my arm in one week, although I treated my arm for several months in other clinics! Thank you, I will recommend to everyone. Klautov N.V. just magical hands. From the very first session, I left with no pain. I wish you further development. All the best!
05.02.2020
Full review
Ustyuzhanin I.V.
Very good, competent, attentive doctor. I was treated by many doctors, no one helped me, and this doctor helped me a lot. Thank him very much!
Sodayeva’s patient.
12/30/2019
Full review
Valentina Alekseevna
Many thanks to Dr. V.A. Loskutova and Shatov A.
A. for the mind, for saving people’s lives. These doctors are lifeguards. PAIN clinic, I wish you more such specialists!
06/25/2019
Full review
Nikolaeva N.I.
Addressed with a headache to Nikolaeva N.I. Very attentive and sympathetic doctor, examined meticulously. Has appointed or nominated treatment. After the complex, the treatment helped, now I feel good.
Thank you so much!
20.04.2018
Full review
Ustyuzhanin Ivan Vladimirovich
I am very grateful to the doctors Ivan Vladimirovich Ustyuzhanin and Andrey Vladimirovich Gorodnov for their professionalism, sensitive and attentive attitude towards patients. Thank you so much for helping the sick. I wish you good luck, success and all the best. Thanks to the entire staff of the Kaluga Pain Clinic. Let people leave you only with joy and a smile on their faces. Thank you!
09/08/2017
Fully reviewed
I thank the entire personal team for the treatment, help and attention provided to me.