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BPPV and its therapy ‘Epley Maneuver’

Benign Paroxysmal Positional Vertigo (BPPV) is a type of benign vertigo that occurs when a specific body part is inverted. Rather than being a condition, vertigo is a symptom that reflects a false sensation of spinning. Whereas Epley Maneuver is an exercise that helps alleviate the symptoms of ‘Benign Paroxysmal Positional Vertigo (BPPV).’ 

The role of the ear in BPPV:

BPPV is named as an inner ear disorder that can cause vertigo sensation by changing the position of your head. Vertigo is a feeling that everything is spinning around you. The spinning sensations of BPPV can badly affect your ability to move and overall disrupt the quality of life. The vertigo sensation can be mild or severe that can last for a few minutes. 

Symptoms of BPPV:

Following symptoms are commonly observed in BPPV affected persons;

  • Headache
  • Dizziness
  • Loss of balance
  • Nausea
  • Vomiting
  • Double vision or loss of vision
  • Loss of hearing
  • Trouble in speaking
  • Weakness in arms and legs

Causes of BPPV:

The tiny crystals of calcium carbonate inside your ear can sometimes lose from their original spot/position and flow it to the other positions such as ear canals and give the feeling of head rotation. These tiny crystals are also called ‘ear rocks’ or ‘otoconia.’  The rotation of your head is measured by three loop-shaped structures (semicircular canals) in your brain that contain fluid and delicate, hair-like sensors. 

Once the tiny crystals clump in your ear, they will descend to the lowest part of the inner ear. After that, when you turn or change your position, these clumps will develop persistent fluid in your inner ear that you can hear even you are still or stand (no movement). 

The following movements can trigger BPPV episodes:

  • Getting up from bed or rolling over.
  • Looking down while bending the head forward.
  • Leaning back.

Most people suffer from BPPV in only one ear, although both ears can be affected rarely.

How we will know which side is affected by BPPV:

There are different steps to check the affected side of the ear from BPPV:

  • Lie down on the bed and let your head hang over the edge.
  • Tilt your head to the right side and quickly get back to the original position.
  • Take one minute to relax.

In case of dizziness, the right ear is the affected ear.

  • Sit up if you do not experience dizziness.
  • Take a moment to recover.
  • Turn your head to the left and rapidly lie down in the original position.
  • Hold this position for 1 minute.

In cases of dizziness, your left ear is the affected ear.

How is BPPV treated?

Mainly, doctors can treat the BPPV affected person by using one of the following procedures; 

  • Epley Maneuver: In this treatment, the head is placed at a specific angle to move out the crystals from the ear’s semicircular canals.
  • Semont Maneuver: It is a simple procedure to treat BPPV by relocating the canaliths to eliminate vertigo.

BPPV usually goes away on its own within a few weeks if you don’t want to get treatment or if treatment fails. In contrast, your brain will likely become accustomed to the confusing signals that it gets from your inner ear over time.

Regardless of the cause, specific simple exercises can train the brain about the procedure to deal with the confusing signals caused by vertigo. Here we will discuss the Epley Maneuver procedure in detail;

Epley Maneuver: An Epley Maneuver is a procedure that can be performed in a physician’s office. It is specially designed to move the otoconia (calcium deposits) to a different ear part where it will be less likely to produce symptoms. This treatment includes a particle repositioning procedure or the modified liberation maneuver.

Particle Repositioning Procedure: During the particle repositioning procedure, the head and body positions are changed through a series of physical movements. The otoconia are then shifted out of the semicircular canals and put back into their proper place in the utricle by performing the following actions. This is a relatively simple procedure that may take up to 15 minutes to complete. Comfortable clothing should be worn to ensure that the patient can move freely. Most cases of BPPV can be treated with the single-particle repositioning procedure. It may be necessary to perform more exercises or reposition yourself if the symptoms persist.

Procedure:

  1. Sit down on the table or bed.
  2. Lie your back on the bed or table with your head over the edge. Tilt the head slightly to ensure that the affected ear must be at 45 degrees angle away from the bed. Hold the position of a body for a few minutes until the symptoms go away.
  3. Then you are recommended to turn your head quickly in the opposite direction without raising it so that your “good” ear is parallel with the table or bed but slightly over the edge. Hold this position for about a minute or until the symptoms subside.
  4. Sit up straight by keeping your chin tucked in. Your healthcare provider will give you instructions on repositioning the particle once you get it.

How does the Home Epley Maneuver help?

If you have symptoms of BPPV, you may want to try the Epley maneuver at home. Some head movements may trigger BPPV-related vertigo, while the sensation could last several minutes. Some people experience the symptoms of BPPV more frequently than others. Epley maneuvers are inexpensive and safe at home. 

Often, BPPV occurs for no apparent reason. But sometimes, it can be caused by; 

  • Traumatic brain injury
  • Complications after ear surgery

Risks of Epley Maneuver:

You can safely perform the Epley maneuver at home. Still, it is not recommended for those people who have neck or back problems, an underlying vascular disease, or a retinal detachment. For them, it is strongly advised to discuss the case with your healthcare provider.

What are the chances of returning to BPPV?

After successful treatment, a new episode of BPPV can occur. Recurrence rates (unknown episodes) are 15-50% on average. Various movements can be performed when an outbreak of recurrent BPPV occurs, thus treating it at home. A physical therapist will help patients develop a plan for dealing with recurrences either on their own or with the assistance of a physical therapist.

Following are the steps that must be followed if you are suffering from positional vertigo in general;

  • Wait a minute after you have moved into the good-ear-down position.
  • Slide to the foot of the bed in a face-down pose and slowly change your position.
  • If you are standing or kneeling on the floor, keep your head down until you reach the end of the bed.
  • Lift your head slowly in an upright position.

As an alternative to sitting towards the foot of the bed, you can also stretch your legs slightly and leave your head to the comfortable rest position. If you already have neck problems, you shouldn’t overextend your neck. It may be necessary to receive assistance if your symptoms are severe.

BPPV symptoms can remain to persist without treatment. Therefore, the treatment is a very safe and effective way to reduce the risk of falling and relieve symptoms. The otoconia usually dissolve on their own after some time (usually within six weeks). In the meantime, you should pay specific attention to your head position to reduce the number of recurrence episodes and their severity. 

References:

  • https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv retrieved on February 2022. 
  • https://www.healthline.com/health/semont-maneuver retrieved on February 2022. 
  • https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/?gclid=CjwKCAiAgbiQBhAHEiwAuQ6BkgC8mPe510VjQvjnKcN0l3ydz39dxn9_Biu_T42GxFilE8rv2RDmXhoC040QAvD_BwE retrieved on February 2022. 
  • https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055 retrieved on February 2022. 
  • https://www.webmd.com/brain/benign-paroxysmal-positional-vertigo retrieved on February 2022. 
  • https://www.uofmhealth.org/health-library/hw263714 retrieved on February 2022.
  • https://dizziness-and-balance.com/disorders/bppv/bppv.html retrieved on February 2022.
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