Epley maneuver - Canalith re-postioning maneuver
This maneuver can be used to treat patients with benign paroxysmal positional vertigo (BPPV) - the maneuver is based on the theory that benign paroxysmal positional vertigo (canalolithiasis) is due the sudden movement of free-floating particles (otoconia) that accumulate in the posterior semi-circular canal of the ear. Sudden head movements (looking up, rolling over in bed, leaning forward) cause the debris to move about en masse in the posterior semi-circular canal and vertigo lasting a few seconds. Treatment of BPPV can be undertaken at home by performing the Epley maneuver as follows:- - Seat the patient upright on the bed with his head extending over the edge of the bed. Tilt the patient's head gently 45 degrees towards the affected side, gently lower the head of the bed so that the patient is lying in the horizontal position with his head over the edge of the bed - his head should then be about 45 degrees below the horizontal level. Wait about 30 - 60 seconds for the patient's vertigo to subside, and then keep the patient in that position for ~ 3 minutes. Turn the patient's head gently to the midline -- wait 30 seconds. Turn the patient's head another 45 degrees to the opposite (unaffected) side -- wait 30 seconds. Let the patient slowly roll his torso towards that opposite side so that he is lying on that opposite shoulder, which should enable him to rotate his head another 45 degrees in that opposite direction so that his face is directed towards the floor -- wait 30 seconds for any induced vertigo to resolve and keep the patient in that position for ~ 3 minutes. Slowly bring the patient back up to the vertical position while he is still lying in that position, then gently turn his head back towards the midline. When he is sitting upright, tilt the chin down about 30 degrees and keep the patient in that position for a few minutes. The manuever may have to be repeated a few times and the patient should be told to sleep upright and minimize head movements during the next 24 - 48 hours; the patient should still expect to have a sense of dysequilibrium for a few days - a clue to an unsuccessful canolith repositioning maneuver is nystagmus that changes direction during the maneuver (any nystagmus occurring during the maneuver should be in the same direction as the original nystagmus, which occurred when the patient was first placed flat with the affected ear undermost).
First, your doctor will have you briskly lie on your back with your head turned to the symptomatic side at a 45 degree angle. This picture illustrates a treatment of the right side. Your head will be kept in this position for 3 minutes. You will probably be dizzy for the first 10 seconds.
Next your will turn your head to the other side, and keep it in that position for 30 to 60 seconds. You may be dizzy again.
Finally, your doctor will have you roll in the same direction onto your side, carrying your head along so that it is pointed about 45 degrees, nose down. This position is also maintained for 3 minutes, and another burst of dizziness may occur.
Finally, you are returned to sitting. It is common to be very dizzy at this point for about 15 seconds, and your assistant will be available to steady you. Remain with the head tilted a bit down (as shown) for a few minutes. Then, the entire maneuver is repeated for two more repetitions.
The recurrence rate for Benign Paroxysmal Positional Vertigo (BPPV) after these maneuvers is about 30 percent, and in some instances a second treatment may be necessary.
From my own personal experience I found that my ear was susceptable to vertigo after having a wax build up removed. After that, I would easily get vertigo if I got water in my ear from baths or swimming.
Graphics are used with permission of Timothy C.
Hain, M.D., at: http://www.dizziness-and-balance.com
|Start sitting on a bed and turn your head 45° to the leftt. Place a pillow behind you so that on lying back it will be under your shoulders.||Lie back quickly with shoulders on the pillow and head reclined onto the bed. Wait for 30 seconds.||Turn your head 90° to the right (without raising it) and wait again for 30 seconds.||Turn your body and head another 90° to the right and wait for another 30 seconds.||Sit up on the right side.|
|This maneuver should be carried out three times a day. Repeat this daily until you are free from positional vertigo for 24 hours.|