This theory has been explored by Faralli et al: It is plausible that it takes some time for the brain to readjust to a newly healthy labyrinth. With canalith repositioning, there is not a gradual recovery, but rather an immediate repair. It is also possible, but currently unproven, that the brain’s response to intermittent bursts of increased unilateral discharge (which occurs with BPPV) is to dampen it’s connection to the affected ear, or maybe just the affected canal. We know that the brain has the ability to reduce the gain of the vestibular ocular reflex (VOR) in the healthy ear following an acute unilateral vestibular loss. I can’t add much to that discussion, but a review of available literature can be found here.Ī second theory is that there is a neural dampening or “cerebellar clamp” process. A damaged utricle is the source of BPPV (that is where the otoconia debris comes from). One theory involves utricular dysfunction. There are two schools of thought regarding these residual symptoms. Residual Non-Vertigo Dizziness Following the Epley ManueverĪ high percentage of patients will report resolution of positional vertigo after undergoing a repositioning treatment, but more than one in three will continue to describe more vague symptoms of imbalance and movement related visual disorientation and instability in the days to weeks following treatment. There is a recommended treatment for this, known as the Gufoni maneuver, but it does not enjoy nearly the same success rate as the Epley maneuver for posterior canal BPPV. This form of BPPV is characterized by ageotropic horizontal nystagmus where the nystagmus beat to the left after rolling onto the right side, and then change to right beating horizontal nystagmus after rolling onto the left side. One particular form of horizontal canal BPPV, where the otoconia is believed to be in the long arm of the canal, close to the ampulla, is particularly resistant to repositioning. There are procedures for horizontal canal BPPV, but with lower success rates. The Epley maneuver is specifically for posterior canal BPPV and would not help BPPV of the horizontal canal. There are other forms of BPPV where the otoconia enter the horizontal canal, and very rarely the anterior canal. Numerous studies put the success rate for BPPV of the posterior canal in the high 90% range. In fact, success rate is so high that if the treatment fails, it is more likely that the diagnosis is wrong than it is that the repositioning procedure failed to move otoconia out of the posterior canal. First, no treatment works on everybody, but repositioning for BPPV has a very high success rate. Some patients continue to complain of positional vertigo after undergoing treatment with the Epley maneuver. Residual Dizziness: Repositioning Failure? So let’s revisit that and explore some related newer reports, as well as talk about people that do not improve after repositioning for BPPV type of vertigo. J Int Adv Otol 2019 15(3): 420-4.A few years ago, I did a post here discussing patients that continued to complain of imbalance and “fleeting disorientation” after successful treatment using the Epley maneuver or some other form of canalith repositioning. Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV. On the other hand, after the reassessment, VAS and total DHI scores were both significantly reduced in the treatment group (p<0.001, p<0.001, respectively), but no reduction in either score was found in the control group (p=0.216, p=0.731, respectively).ĬONCLUSION: This study showed that elderly patients with S-BPPV benefit from the Epley maneuver, in particular global and disease-specific quality of life.Ĭite this article as: Uz U, Uz D, Akdal G, Çelik O. No significant differences were observed for baseline VAS and total DHI scores between the groups (p=0.636, p=0.846, respectively). RESULTS: A total of 50 patients were randomized into two groups: 25 to the treatment group, and 25 to the control group. Ten days after the first assessment, all patients were reassessed using VAS and DHI. Groups were defined as treatment (treated with Epley maneuver bilaterally) or no treatment control (no treatment modality or canalith repositioning maneuver). Individuals were evaluated by visual analog scale (VAS) and dizziness handicap inventory (DHI). MATERIALS and METHODS: This controlled, prospective randomized clinical trial was conducted in elderly patients aged 65 years and above with a positive history of benign paroxysmal positional vertigo (BPPV), presence of vertigo, and no observable nystagmus during the Dix-Hallpike test, so-called Subjective BPPV (S-BPPV). OBJECTIVES: This study aimed to evaluate the efficacy of the repositioning maneuver on quality of life in elderly patients with dizziness and/or vertigo.
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