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cej7 -> Re: BPPV (November 23, 2005 7:35:00 AM)
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wjPT,
What do you mean by "both testing positions"? Dix-Hallpike & roll test, or R/L? And have other etiologies been considered or ruled out? Here is a algorithm happen to like (for starters), if your interested:
http://www-surgery.ucsd.edu/ent/DAVIDSON/Pathway/Vertigo.htm
I have also found the eMedicine summary to be good, and consistent with current literature.
http://www.emedicine.com/ent/topic761.htm
Typically, with a +Hallpike, I see a rotatory nystagmus with an increased intensity when the head is positioned towards the involved side. Just be sure to be tidy about your testing positions, so you do not impact more than one canal, or your results will be confusing.
I have great success using the Epley for cupulolithiasis, and use the Semont less frequently for canalithiasis.
My primary advice would be if you feel that it is BPPV and your treatment doesn't resolve the issue, refer to someone who routinely treats patient's with vestibular dysfunction. Here is one organization to try: http://www.vestibular.org/
btw: I am not affiliated with any of the listed organizations, however, I have just seen plenty of improperly treated patients that I have compassion for the issue :)
good luck!
~liz
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