Treatment

BPPV can be effectively treated in most cases by a physical maneuver that is performed in the office. The particle repositioning maneuver (also called the Epley maneuver, after the doctor who devised it) redistributes the particles of calcium that cause the vertigo. The procedure is effective in a single session in a large percentage of cases. The remainder usually improve after a second session.

The particle repositioning maneuver is illustrated below. With the patient seated, the head is first brought into the position that triggers the vertigo. After the vertigo is allowed to pass, the head is then rotated 180^o to the opposite position, allowing the calcium crystals to disperse into an area of the ear where they no longer cause vertigo. The patient is then brought upright, and after a pause, the maneuver is repeated to be certain that it was effective in clearing the problem.

After the procedure, the patient is instructed to sleep at home in a semi-reclining position (two pillows under the back), and to avoid the position that triggered the vertigo for at least two nights.

The particle repositioning maneuver for BPPV:

A. The patient’s head, viewed from the top, is brought back into the position that causes the vertigo; in this case, with the right ear down.
B. The head is then turned 90 degrees, then
C. 180 degrees to the opposite side.
D. The patient then sits up, and, after a pause, the maneuver is repeated until the vertigo is eliminated.

If the procedure doesn't work

The procedure is effective in most cases. You will be asked to return in one to two weeks for a check-up. If the vertigo persists or recurs after one treatment, a second maneuver in the office is usually effective.

In a few cases, the vertigo will not respond to this treatment, or it may improve temporarily and then recur. In these cases, a search may be made for an alternative explanation or diagnosis.

Certain treatments may be prescribed if the vertigo does not respond to head maneuvers at all:

• Brandt-Daroff exercises. Modified head maneuvers (Brandt-Daroff exercises) can be performed at home, or you can even attempt the Epley maneuver on your own.
• Physical therapy. More intensive head exercises can be performed by a licensed physical therapist.
• Medication. Prescription medications may quiet the vertigo long enough for it to go away on its own.
• Surgery. A surgical procedure can be performed to inactivate the balance canal that is causing the problem (posterior semicircular canal occlusion).

Home exercises for BPPV

Brandt-Daroff exercises are modified head maneuvers that can be performed at home, as follows:

• Sit on the edge of your bed, with your legs dangling over the side.
• Put your head down quickly, with the bad side down, resting on the mattress. If this causes vertigo, wait for the vertigo to subside.
• Sit up quickly, then put your head down to the other side.
• Wait the same length of time, then sit up.
• Repeat this sequence five times. Perform the exercise twice daily, until it no longer produces vertigo

If your doctor advises you to do so, you may perform the Epley maneuver at home. Lie across your mattress, with your head dangling over the side. Follow the sequence illustrated above. If you experience vertigo after any of the steps, wait for the vertigo to subside completely. After sitting up, wait several minutes before attempting to get up and walk.

We can help

U.S. News & World Report ranks The Mount Sinai Medical Center among the top 20 hospitals in the United States for the treatment of ear, nose, and throat disease. Our Hearing and Balance Center has considerable experience in treating BPPV. Please call our Hearing and Balance Center at 212-241-9410 to schedule an appointment.