Epley Maneuvers and other BPPV Treatments
Often the first line treatment for dizziness is pharmaceuticals. However, medications have been shown to be largely ineffective with BPPV.
Particle repositioning maneuver (Epley Maneuver)
In 1992 Epley published his first report on the “canalith repositioning procedure” (CRP). This Epley Maneuver has since been modified and is commonly referred to as the Particle Repositioning maneuver. This maneuver is the standard of practice in the offices of many Otolaryngologists. Its success has been reported at around 82% with a single maneuver.
The DizzyFIX device is designed specifically to enable anybody to perform a correct particle-repositioning maneuver. The visual feedback from the device guides patients through the most effective treatment for BPPV. Since the maneuver can be conducted at home it can be repeated as often as necessary.
Anti-Nausea drugs cover up the symptoms associated with BPPV but do not have any effect on the prognosis or duration of BPPV. Gravol, Maxeran, Ondansetron, Antivert, Dramamine, are examples of commonly used anti-nausea medications.
Sedatives (Anxiolytics) can also be used to mask the disabling symptoms associated with BPPV. These medications may still have a role to play in the management of BPPV but do not effect the course of the disease. Ativan and Lorazepam are commonly used as well as mild sedatives such as Benadryl.
Other medications called Beta-Histones are available in some countries, which may have an effect on the dizziness caused by the ear. Serc is commonly prescribed for conditions such as Meniere’s Disease. Its role in BPPV is still unclear.
Surgery for BPPV is reserved for the most severe cases which are intractable and which are not associated with other pathology. All surgical interventions carry with them the risk of anesthesia and the risk of injury to the nerve that moves the face and may also cause permanent and total deafness in the affected ear.
Posterior semi-circular canal occlusion is the simplest procedure, which addresses the cause of the dizziness at its source. The posterior semi-circular canal is surgically plugged. This prevents any loose particles from causing vertigo.
Singular Neurectomy involves the surgical cutting of the nerve that goes to part of the balance organ. It carries with the same risks as brain surgery as well as the possibility of injury to the hearing apparatus and the nerve to the face.
Vestibular Neurectomy involves the surgical cutting of all the nerves to the entire balance organ on the affected side. It is not the recommended procedure for BPPV. As above it has significant risks and will permanently remove the balance function on the affected side.
Labyrinthectomy involves the removal of the entire balance organ. In some cases this can be done with chemicals but is more commonly performed surgically. Surgical removal causes deafness on the affected side. This procedure is reserved for surgical approaches to tumors of the brain and for the treatment of refractory Meniere’s disease. It is not the recommended treatment of BPPV.
Brant-Daroff exercises have been used in the past to treat BPPV. Since the development of the Particle repositioning maneuver they are uncommonly recommended. The main downside is that they require patients to intentionally make themselves dizzy on a regular basis for a period of weeks. Their efficacy has been shown to be no greater than other treatments.
Vestibular Physiotherapy is reserved for patients with a permanent or transient loss of balance function. These exercises, including Cawthorne-Cooksey exercises, help the brain to relearn how to use the injured balance organ. The mechanism of disease in BPPV does not suggest that their use would be effective.