WHAT IS VERTIGO AND HOW IS IT TREATED?

Vertigo is the sensation that you or your environment is moving or spinning. Other symptoms of vertigo can include dizziness, nausea, loss of balance, ringing in the ears, headaches, or nystagmus (abnormal eye movements).

CAUSES OF VERTIGO

One of the most common causes of vertigo is BPPV (Benign Paroxysmal Positional Vertigo). BPPV is a problem that occurs when the tiny calcium crystals (otoconia) in the inner ear become loose from their normal location and move to the posterior semicircular canal (SCC). This causes a build-up of fluid within the canal which stimulates the balance nerve resulting in vertigo and nystagmus. Factors that cause the crystals to move include head trauma, whiplash, concussions, ear infections, or sitting too long in a dentist chair or the sink at a hair salon.
Positional head changes, i.e. rolling over in bed, looking up or down while walking, or moving from the lying to seated position will trigger vertigo.

DIAGNOSES, TESTS, AND TREATMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

BPPV can be easily diagnosed by your doctor or physical therapist with an examination including the patient’s medical history, and observation of the patient’s eyes for abnormal involuntary movement with change in head position.

The gold standard test would be the Dix- Hallpike maneuver. The test is performed by quickly moving the patient from sitting to lying with the head rotated 45 degrees to the right side. Wait and observe the eyes for 30-60 seconds then return the patient to the sitting position. If no nystagmus is observed then repeat the procedure on the left side. If dizziness or nystagmus occurs, then the left ear is the affected ear. A positive Dix Hallpike can then be treated with the canalith repositioning procedure or the Epley Maneuver. This maneuver is a series of slow head movements of your head and neck performed to move the loose crystals within the inner ear back to their normal position. It is important to do the steps slowly.

Steps of Epley Maneuver:
-sit upright on exam table with legs out straight
-rotate head 45 degrees to the side that has the worst vertigo
-quickly lie patient back(with the head still turned) and head extended off table about 20 degrees
-wait 30-60 seconds or when nystagmus or dizziness stops and turn head 90 degrees to other side, wait another 30-60 seconds
-turn the patient on to their side and tilt the chin down so the patient is looking down at the table
(45 degrees) wait another 30-60 seconds
-have the patient sit up with the head still rotated to the side then slowly face head forward.

Wait 10 minutes after Epley maneuver before going home. Usually, symptoms start to resolve in one to three treatments.

Contraindications:
Cervical diseases or fracture, vascular conditions, retinal detachment

Posted in: Vertigo

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