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| Positional Vertigo Patient Instructions | |
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EPLEY MANEUVERS CANALITH REPOSITIONING for the treatment of BENIGN PAROXYSMAL POSITIONAL VERTIGO What is Benign Paroxysmal Positional Vertigo (BPPV)?BPPV is a type of dizziness caused by a problem with the balance system of the inner ear (the labyrinth). What causes BPPV? The labyrinth helps the body maintain balance. Tiny bits of the balance organ in the labyrinth can break off and float into the fluid that fills the part of the labyrinth called the semicircular canals. (See diagram.) These pieces (called canaliths) break off due to a jarring of the inner ear, due to the aging process, and for other reasons. A change in the position of the head can affect the movement of the canaliths and cause a spinning sensation. The spinning usually lasts less than 30 seconds, but is often very strong and can cause nausea and imbalance that may last for hours. How is BPPV diagnosed? The spinning of BPPV causes eye movements (called nystagmus) to happen at the same time. The eye movements can be observed either by looking at the eye or with special eye monitoring equipment while the spinning is taking place. How is BPPV treated? Do nothing and wait. The condition of BPPV might clear up without treatment after weeks, months, or years. Physical Therapy. Certain exercises may be helpful for some people. The exercises can, however, cause dizziness and nausea. Any improvement that may take place can take weeks or months. Surgery. A semicircular canal in the problem ear can be plugged or surgery may attempted to inactivate the balance nerve on the bad side. Surgical treatment is a last resort and should be used when all other methods have failed. Epley Maneuvers (EM). This procedure for canalith repositioning is a painless, low-risk treatment which usually has an immediate, positive effect. By a series of gentle changes in the position of the head, the canaliths are moved to an area in the labyrinth where the balance system won't be upset. How effective is EM? Use of this procedure has shown a 80% success rate in relieving the dizziness due to BPPV. Sometimes the floating canaliths return to the semicircular canals after months or years to again cause dizziness. If that happens, the repositioning procedure is redone. How is EM done? First the eye movements that occur with the spinning are observed and the semicircular canal where the canaliths are floating is identified. The head is positioned to cause the canaliths to move out of the canal and into the area of the labyrinth where balance will no be disturbed. Sometimes a small vibrator is placed behind the ear to help the floating material to move through the fluid more freely. The EM may take from 15 to 30 minutes and may need to be repeated in a few days to be sure that all of the canaliths have been moved to the proper place in the labyrinth. Are there risks or side effects with EM? This procedure is painless and does not require any treatment inside the ear. A few patients may have nausea while the canaliths are being repositioned. Medication given by mouth may be administered one hour prior to the procedure may minimize this side effect. It is possible that short-term dizziness may happen right after the EM, but usually there is quick relief from the spinning. What does the patient do during the EM? The Em will require the patient to lid down on an examining table, roll over, and move the head as requested by the doctor or his assistant. The patient remains in a relaxed state and allows the doctor or his assistant to gently position the body and the head as the canaliths are moved in the labyrinth. |
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