Vertigo in layman term means dizzy spells or feeling of an imbalance that makes you feel lopsided, you might feel as if the entire world around you is spinning but in actual it is an inner ear problem that causes these dizzy spells. You may often find yourself swaying or feel tilted and even feel a pull in one direction; all of these are symptoms of vertigo. Some causes of vertigo are as below: BPPV means benign paroxysmal positional vertigo. It occurs when there is a deposit of calcium particles in the canals of the inner ear.
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Vertigo in layman term means dizzy spells or feeling of an imbalance that makes you feel lopsided, you might feel as if the entire world around you is spinning but in actual it is an inner ear problem that causes these dizzy spells.
You may often find yourself swaying or feel tilted and even feel a pull in one direction; all of these are symptoms of vertigo. Some causes of vertigo are as below: BPPV means benign paroxysmal positional vertigo. It occurs when there is a deposit of calcium particles in the canals of the inner ear. Mostly associated with age BPPV mostly bothers senior citizens. A viral infection called Vestibular neuritis also causes vertigo. This causes inflammation in the nerves surrounding the inner ear.
Sometimes Vertigo is also associated with injuries of the head and the neck, migraine, sinusitis, tumor or stroke in the brain and even medications that can cause damage to the ear. To understand the treatment and how beneficial this can prove for persons suffering from Vertigo, let us understand what is Epley Maneuver?
What is Epley Maneuver? In medical terminology, Epley Maneuver is a repositioning procedure that is used to treat BPPV or vertigo in the ear canals, either in the posterior or interior parts. The procedure enables free-floating particles to be placed back in the utricle of the ear canal from the affected area by using gravitational techniques.
These particles are relocated from the affected part of the semicircular canal so that they may not cause any further stimulation of the cupula, hence vertigo can be corrected. Procedure of Epley Maneuver It was a procedure developed by Dr. John Epley and Dominic W. Hughes in The procedure of Epley Maneuver is as below: Step 1 The doctor is likely to make you sit in an upright position wherein your legs are extended in front.
Now the patients head is tilted at an angle of 45 degrees towards the side. Now without the doctor having to change your head position, you will be quickly guided to a position wherein your shoulders are on the table while your head is hanging on the fringe of the examination table.
This position is held for 30 seconds to a minute till the time vertigo has come to a closing stage. This step also helps the doctor to understand the primary stage of nystagmus or a condition that causes rapid and an uncontrolled eye movement.
Step 2 In step 2, the doctor turns your neck to enable you to look at 45 degrees on the opposite side this means that if you were made to look on the left in the first step then now you are looking in the right-hand direction , this is done without lifting your head. This position too is held for 30 seconds to a minute so as to understand the secondary stage of nystagmus or until vertigo has stopped completely. Step 3 In step 3, the doctor will now help you to turn to one particular side so that vertigo will be facing upward.
This position too is maintained for 30 seconds to a minute until vertigo comes to an end completely. Step 4 This is the last step wherein the doctor helps you to sit back with your legs hanging on the examination table on the similar side as in step 3. This manipulation or maneuver is a 10 to 15 minutes session that is all that is needed to treat vertigo. Usually done in assistance of a therapist or a clinician, the head is moved in different positions to control the movement of calcium debris or particles, therefore, helping a patient to overcome the vertigo ailment.
This maneuver is done with the assistance of a doctor or physical therapist. Patients might feel some kind of dizziness during the procedure but once treated, this is likely to help in the longer run.
Post the treatment, Patient is provided with a soft collar to be worn throughout the day so as to avoid displacement of Otoconia. The patient is also asked to avoid too much bending, rotating the head in different directions or even lying backward.
The patient is additionally advised to sleep in a position where the head is rested at 45 degrees angle. This is to be followed for two nights and can be done by using a recliner chair or arranging the pillows in a said manner on the couch. Sometimes 2 to 3 sessions of the above procedure are required to attain a successful outcome.
This procedure helps in restoring the balance in the vestibular system. Once the free-floating particles that get displaced from the otolithic membrane of the canal, they cause a misbalance and hence Vertigo appears. Hope the procedure was easy for you to comprehend.
Do not try this at home if you have been diagnosed with Vertigo. It is always a good practice to show your self to the doctor who can then treat you in accordance with the procedure of Epley Maneuver. Epley Maneuver Diagram.
Dix Hallpike maneuver
BPPV should be suspected in patients with: true rotatory vertigo lucid hallucination of room spinning reproducible symptoms on certain kinds of movements eg on turning over in bed, or on turning the head in one direction short duration of symptoms ie up to 30 seconds history of head trauma or previous viral vestibular neuronitis It can be easier to learn these procedures visually. You will need an examination couch or firm bed with no headboard You will need assistance if the patient has reduced mobility Explain the procedure and take verbal consent; ensure there are no contraindications such as spinal pathology. Reassure the patient that the test may reproduce their vertigo, but that it will pass quickly. Keeping the head at 45 degrees, quickly lie the patient flat in one motion, lowering the head 30 degrees below the horizontal. The ear you are testing is the one turned towards the floor Ask the patient to keep their eyes open, but not fixated on a particular point. Observe for torsional, geotropic towards the floor nystagmus for 60 seconds. There is a latent period, so persevere even if there is no nystagmus for the first 30 seconds Horizontal or other nystagmus, particularly if there is no latent period, may be indicative of central neurological conditions and may require investigation If the test was positive, proceed directly to perform the Epley manoeuvre once the nystagmus has fully settled.
Dix-Hallpike & Epley
Dix-Hallpike Test for Vertigo Vertigo is a common problem, especially among older adults. It is defined as a feeling of dizziness accompanied by a sensation of spinning or tilting that cannot be controlled. Vertigo usually occurs when you suddenly turn your head or when you change position such as when you roll over in bed or tilt your head back. An easy test to determine if your condition is due to BPPV is to do a Dix Hallpike maneuver, which involves testing if vertigo occurs when you turn your head a certain way. Your doctor will also observe if your eyes produce involuntary movements nystagmus during the test.
Dix-Hallpike Test for Vertigo
Procedure[ edit ] When performing the Dix—Hallpike test, patients are lowered quickly to a supine position lying horizontally with the face and torso facing up with the neck extended 30 degrees below horizontal by the clinician performing the maneuver. As such, the side-lying position can be used if the Dix—Hallpike cannot be performed easily. In BPPV, the nystagmus typically occurs in A or B only, and is torsional--the fast phase beating towards the lower ear. Its onset is usually delayed a few seconds, and it lasts seconds. As the patient is returned to the upright position, transient nystagmus may occur in the opposite direction.