MedifocusHealth

The second line of treatment for patients with benign paroxysmal positional vertigo is a series of positional maneuvers that is effective in up to 95% of patients undergoing the treatment. Some patients undergo this procedure two or three times if the initial treatment is not effective.

The goal of positional maneuvers is to promote the movement of particles (debris) through the semicircular canal into the utricle where they are eventually absorbed. Sometimes a vibrator is placed on the mastoid bone in order to help move the debris. Some maneuvers are based on the premise that the underlying cause of vertigo is canalolithiasis where when the head is moved, free-floating, small particles of debris strike the cupula and cause the sensation of vertigo. Other procedures are based on the premise that vertigo is caused by cupulolithiasis where the otoconia in the endolymphatic fluid adhere to the cupula and are not free-floating.

Repositioning procedures are usually carried out by a doctor, audiologist, or physical therapist. Relief typically comes quickly and the patient may be symptom-free within a week of the procedure but the response varies with the procedure and individual receiving treatment. Some people require a procedure to be repeated. Clinicians may use nystagmus and clinical features of benign paroxysmal positional vertigo in order to determine which repositioning procedure would be most effective.

Four of the positional maneuvers practiced to treat vertigo include:

• Canalith Repositioning Procedure
• Modifications of the Canalith Repositioning Procedure
• Brandt-Daroff Exercises
• Vestibular Retraining Exercises

Canalith Repositioning Procedure

The canalith repositioning procedure is most effective when symptoms of vertigo can be attributed to involvement of the posterior semicircular canal. There are two different versions of canalith repositioning procedure, the Epley Manuever and the Semont Maneuver. There are many variations and modifications of these procedures that professionals have developed over the years.

Epley Maneuver

The Epley maneuver is the most widely used canalith repositioning procedure and was developed by Dr. John Epley in 1992. It involves sequential movements into three positions:

• Sitting up
• Sitting up to lying down
• Lying down to rolling over
• Return to the sitting position

Each position is maintained for 1-4 minutes or at least until the symptoms of vertigo and nystagmus have disappeared for at least 30 seconds. The maneuvers include the following steps:

• The patient sits up with head turned 45 degrees to the affected side.
• The patient is tilted back to a horizontal position on a treatment table so that their head is hanging slightly off the edge of the table while the position of the head is still turned 45 degrees towards the affected side.
• The head is rotated slowly so that the unaffected ear is beneath the head.
• The patient is rotated towards the unaffected side and the head is rotated further so that the individual is looking down at the floor.
• The patient is then slowly returned to the sitting position and the head is rotated back to a central position.

For a few days following the Epley maneuver, it is recommended that the patient take the following precautions: