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BPPV

 
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BPPV - November 21, 2005 12:37:00 PM   
JSPT

 

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Another therapist asked me to eval her pt. she suspected of BPPV. In both testing positions, he demonstrated low amplitude horizontal nystagmus that beat to the R. He gets dizzy in all positions, so I suspect that BPPV may only be part of the puzzle.

I know that nystagmus beats to the intact side, so the L side would be involved. Does this mean that the treatment position should begin with the patient's head to the L to treat the L inner ear(using the Epley maneuver)?

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JS
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Re: BPPV - November 21, 2005 10:43:00 PM   
wjPT

 

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JS,

Here is a link for a good review article I used for a presentation on BPPV with illustrations of the two main repositioning manuevers (Epley and Semont) http://www.ecmaj.ca/cgi/content/full/169/7/681

Literature that I found stated that the Semont manuever may be more efficacious for the initial treatment, but if that is not effective than the Epley manuever would be more effective with repeated treatments.

warren

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Re: BPPV - November 22, 2005 7:28:00 AM   
JSPT

 

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Thanks for the response, Warren. I didn't run across any decent articles during my search, and the one you provided is perfrect.

Thanks again!

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JS

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Re: BPPV - November 23, 2005 12:35:00 PM   
cej7

 

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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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Re: BPPV - November 23, 2005 7:16:00 PM   
ehanso

 

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I have seen some fairly good results with the "Brandt-Daroff" positioning routine. It is easy to do and patients can do it as a home program. This has worked for me when Epley's has been marginal.

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Re: BPPV - November 23, 2005 9:22:00 PM   
wjPT

 

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Liz,

I am not sure what you are referring to? I did not state "what two testing positions" but I did state the two repositioning manuevers, the Epley or canalith repositioning manuever or the Semont or Liberatory manuever. I was not referencing any of the diagnostic manuevers.

I have also seen that algorithm in my past internet searches, and have found other algorithm in research articles I have reviewed.

warren

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Re: BPPV - November 24, 2005 2:04:00 PM   
cej7

 

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Warren--oops, I intended to respond to JS, not your message!! I see why you would be confused. My apologies.

~liz

(in reply to JSPT)
Post #: 7
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