The following text contains many links. Just move your mouse over the text and click on the highlighted areas.The Brandt-Daroff Exercises are one method of treating BPPV. They help often, but are harder to accomplish and achieve than the office treatments. These exercises are performed in several sets per day for two weeks. In each set, one performs the manoeuvre several times.
The Semont maneouvre is (also called the "liberatory" manoeuvre) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other. It is a brisk manoeuver that is not currently favoured in the United States.
The Epley manoeuvre is the most common manouvre used in the United Kingdom and has a high success rate (95% within a couple of days). Dr. Hain explains the manoeurvre well on his website (1. below) and shows stepwise instructions (link here) performed by the treating doctor. A video to show the manoeuvre can be seen on emedicine. Unfortunately not many primary care physicians are trained in this method and patients often wait to see a specialist for it (see 9. below). However studies show that this efficient manouvre can be done at home as a self-treatment (see 2., 3. and 4. below). There are also video's for this manouvre to watch, one is available on emedicine. For those who would like help with this manouvre and would like to ensure they perform it correctly a device called DizzyFIX helps people to perform the Epley Manouvre correctly as it gives the person immediate feedback on the position and time needed for each position. It is very important that during the maneouvre the head is at the right angle (at least 30° below the horizontal) and held in each position for long enough (at least 30 sec. or even longer) in order for the particles to slowly fall in the correct place.
This harmless maneouvre has been shown to be as effective as treatment by a clinican (see 7. below). So people might find the DizzyFIX extremely helpful in treating their BPPV symptoms fast and effective at home. The advantage is also that the manoeuvre needs to be done only once, but can be repeated if not successful the first time, however it does not require performing it over many days like others. The DizzyFIX can be used for BPPV immediately without waiting for spontaneous improvement without disadvantages as it simply relocates the particles into their natural position. If symptoms are not better a repeat can be done a week later, but if you have no improvement you will need to consult your doctor again.
Literature and Links:
- BPPV on www.Dizziness-and-Balance.com by Dr T. Hain
- von Brevern M, Seelig T, Radtke A, et al. (2006). "Short-term efficacy of Epley's maneuver: a double-blind randomised trial". J Neurol Neurosurg Psychiatr 77: 980–82. doi:10.1136/jnnp.2005.08589 PMID 16549410
- American Academy of Neurology statement (2004) on "Vertigo Can Be Treated at Home"
- Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T. (2004). "Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure". Neurology. 63(1): 150-2
- Furman JM, Cass SP, Briggs BC. (1998). "Treatment of benign positional vertigo using heels-over-head rotation". Ann Otol Rhinol Laryngol 107: 1046–53
- Beyea JA, Wong E, Bromwich M, Weston W, Fung K. (2008). "Evaluation of a Particle Repositioning Maneuver Web-Based Teaching Module". Laryngoscope 118(1):175-80
- Bromwich M, Parnes L (2008). The DizzyFix: Initial Results of a New Dynamic Visual Device for the Home Treatment of Benign Paroxysmal Positional Vertigo; Journal of Otolaryngology-Head & Neck Surgery, 37(2): 186–192
- Parnes L, Agrawal S, Atlas J (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV); Canadian Medical Association Journal, 169(7): 681-93
- Glasziou P, Heneghan C (2008). Epley and the slow boat from research to practice; Evidence-Based Medicine,13:34-35
- Strupp M, Brandt Th (2008). Leitsymptom Schwindel: Diagnose und Therapie; Dtsch Arztebl 2008; 105(10): 173–80