BPPV (Vertigo) with the Dix-Hallpike and Epley Maneuvers
BPPV is benign paroxysmal positional vertigo, which is one of the most common types of vertigo. Vertigo is essentially the sensation that everything outside of oneself is spinning or rotating. BPPV is often triggered by sudden movement or positional changes of the head, such as turning or looking up or down. BPPV is a type of positional vertigo that is caused by dislodged crystals in the inner ear. These crystals may settle in a position that irritates a specific canal in the inner ear, which leads to vertigo or spinning sensations that may be brief and can range from mild to intense.
A very reliable way to determine BPPV is through the Dix-Hallpike maneuver. Essentially, this involves the patient to be quickly assisted to a position lying face up with the head turned in a specific manner by a chiropractor. The chiropractor will look for quick movements of the eye, known as nystagmus.
A general torsional or rotation movement of the eyeballs is indicative of BPPV. BPPV can be improved or cured by the Epley maneuver. First, the patient is seated, and I turn the head horizontally at 45 degrees, just toward the ear that is affected.
Next, I place the patient in a horizontal position, and the patient’s head is kept hanging at 30 degrees, at a 45 degree turn. This may cause a vertigo attack, so the patient is held in the position for up to a minute, until the vertigo stops. I then turn the patient’s head to the unaffected ear, in a 90 degree turn.
The patient needs to roll to the unaffected ear side to look at the floor. This again could cause vertigo, so the patient remains in this position for up to a minute. Finally, I help the patient back to a seated position. Often, symptoms will subside with one treatment.
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