ear, nose, and throat disorders
Benign Paroxysmal Positional Vertigo
Treatment of Benign Paroxysmal Positional Vertigo
Provocative maneuvers to fatigue symptoms Canalith repositioning maneuvers BPPV usually subsides spontaneously in several weeks or months but may continue for months or years. Because brief episodes can recur over a long period of time, medications (such as those used in Treatment ) are not recommended. Often, the adverse effects of medications worsen dysequilibrium. Because BPPV is fatigable, one therapeutic approach is to have the patient perform provocative maneuvers early in the day in a safe environment. Symptoms are then minimal for the rest of the day. Canalith repositioning maneuvers (most commonly the Epley maneuver: A simple treatment for a common cause of vertigo or, less commonly, the Semont, maneuver or Brandt-Daroff exercises) involve moving the head through a series of specific positions intended to return the errant canalith to the utricle. After the Epley or Semont maneuver is done, the patient should try to avoid neck flexion or extension for 1 to 2 days. These maneuvers can be repeated as necessary. The Brandt-Daroff exercises are done 5 times in a row, 3 times/day, for about 2 weeks or until there is no vertigo with the exercise. All of these maneuvers can be done by the patient at home. The maneuver is done by following the clockwise order of the red arrows below. For theSemont maneuver,the patient is seated upright in the middle of an examination table. The patient’s head is rotated toward the unaffected ear; this rotation is maintained throughout the maneuver. Next, the torso is lowered laterally onto the examination table so that the patient is lying on the side of the affected ear with the nose pointed up. After 3 minutes in this position, the patient is quickly moved through the upright position without straightening the head and is lowered laterally to the other side now with the nose pointed down. After 3 minutes in this position, the patient is slowly returned to the upright position, and the head is rotated back to normal. TheBrandt-Daroff exercisecan be taught to the patient. The patient sits upright, then lies on one side with the nose pointed up at a 45-degree angle. The patient remains in this position for about 30 seconds or until the vertigo subsides and then moves back to the seated position. The same motion is repeated on the opposite side. This cycle is repeated 5 times in a row, 3 times/day, for about 2 weeks, or until there is no more vertigo with the exercise. 