benign positional vertigo treatment epley maneuver

BENIGN POSITIONAL VERTIGO TREATMENT EPLEY MANEUVER SERIES

Given his clinical presentation and his favourable response to the Epley maneuver, we discharged the patient home with no medication. This was consistent with a diagnosis of left posterior canal benign paroxysmal positional vertigo (BPPV), which can be best managed using the Epley maneuver (an author video showing this patient’s Dix–Hallpike test and a demonstration of the Epley maneuver is available at ).įifteen minutes after completion of the Epley maneuver, repeat Dix–Hallpike testing of the patient’s left ear found no vertigo or nystagmus. It became more vertical upward when his gaze was directed toward his upward right ear. The nystagmus was mostly rotatory, with the upper poles of his eyes beating toward his downward left ear. However, during testing of the left side and after a brief latency of 2 or 3 seconds, he had vertigo and nystagmus that lasted 15 seconds. The patient’s right-sided Dix–Hallpike test was normal, without vertigo or nystagmus. Because his vertigo was started by head movements and lasted less than a minute and he had no nystagmus, he was a good candidate for positional testing. In the sitting position, he did not have nystagmus while looking straight ahead (spontaneous nystagmus) or when asked to gaze left and then right (gaze-evoked nystagmus). On physical examination, we found no focal weakness, sensory deficit or dysmetria.

He did not have a headache, neck pain, decreased hearing, paresthesia in his face or limbs, visual field loss, dysarthria, dysphagia, diplopia or dysphonia. The intense vertigo resolved if he stayed still, but similar brief episodes recurred several times when he laid supine in the hospital.

He came to the emergency department an hour later. Although lasting only 10–15 seconds, he became sweaty afterwards without nausea or vomiting.

Wear a soft collar to keep your head still.Case 1: benign paroxysmal positional vertigoĪt 4:00 am, a 71-year-old man turned over in bed onto his left side and experienced a sudden onset of dizziness, described as if the bed was moving.Sleep with two or more pillows to tilt your head to a 45-degree angle.Moving or lying down too quickly, or tilting your head back and forth may dislodge the crystals and symptoms may reappear. Avoid movements that could dislodge the crystals in the ear.Your doctor will outline specific instructions after the Epley Maneuver. Repeat the process as many as three times until your dizziness subsides.Roll you on the affected side so the side where you are experiencing the worst vertigo - is facing upward and holds it in position for up to two minutes.Move your head in the other direction until it is 30 degrees away from the table and hold you in place for up to two minutes or until dizziness stops.Your doctor will hold your head in this position for up to two minutes or until your dizziness subsides.Your head will be positioned at a 30-degree angle and lifted slightly off the table. Position your head to face the affected side of your body.Forcefully push you back to the table so that your shoulder blades touch the table.Instruct you to extend your legs out in front of you, while you sit on an exam table.What to expect during the Epley maneuverĭuring the Epley maneuver, your doctor will perform the following steps: The Epley Maneuver is a generally safe procedure with few or no risks. Once you have seen the Epley maneuver performed by a doctor, you can perform it at home to relieve your symptoms. Generally, the Epley maneuver is not recommended for patients who have vertigo from other conditions, such as migraines, ear infections, anemia, or a cerebellar stroke. Your doctor may perform the Epley maneuver to help patients who are experiencing dizziness and nausea associated with BPPV. Most people experience long-term and short-term symptom relief from the therapy.

BENIGN POSITIONAL VERTIGO TREATMENT EPLEY MANEUVER SERIES

An Epley maneuver is a series of movements used to relieve symptoms of BPPV.ĭuring the Epley maneuver, your doctor will use movements to reposition crystals in your ear that may be causing dizziness and nausea.

Benign positional vertigo treatment epley maneuver