Benign Paroxysmal Positional Vertigo You have Ben diagnosed wit Benign Paraxysmal Psitional Vertig. Ths brochures designed to help nsease your understanding of his eiorder and it potential treatment, WHAT IS BPPV? Boars zee vsti wt (oi er oe iro. Pn wh FF pty et ence ble epliodes of vertigo (laziness) when they change the position oftheir head wth respect gravity. Aprosimately 20 percent of all vertigo is due to BPPV. WHAT CAUSES BPPV? BT Meuse 10 be ae t 87 gpacnon crv crystals, calle otaconia, that have collected STRAIGHT LATERAL within a sensitive part ofthe inner ear. Otocania are cystal of clcum carbonate that are normally located in a structure of the ear ale the uric. Dizziness occurs when the cstals are displaced from ‘the utile int the semicircular carals ofthe inner ea. ‘toconia may become displaced wien the tle sn jue, if tere isan ffection or other disorder of the £Z oisersceo Inner ear, or simpy due to advanced age. When you change the posten of your head, the otoconia move within the semicircular eanale and this causes the diz. ess, The diziess subsides when the otoconia stop The most common cause of BPPY in people underage 50 is head Injury tn older people, the most commen cause is degeneration of the vestibular system ofthe inne ear. BPPV becomes much mow common with advancing age. Othe causes include minor stokes, Meniere's disease, and viuses suchas those casing vestibular reurts In approximately half o al BPPV cases, no cause canbe determined WHAT ARE THE SYMPTOMS? ne symptoms cf BPPV include diziness or vertigo, lightheadedness, imbalance, and nausea. Acts that ‘rng on symptoms vary among individuals, but symptoms are usualy associated wth a change in the 2osition of the head with respect to gravity. Getting cut af bed, ring over in bed, and tipping the head back to bok up are common “prablen’ motions. The use of shampoo bonis in hair salons may bring on symptoms. An iternittent pater is common. BPPY may be present for afew weeks, then stop, and then come back again.HOW IS BPPY DIAGNOSED? PV is diagnosed with the Dix Halle test, This test involves observing the eyes with the heat and body positioned in specific ways. It can be performed either by the clinician, or as part ofa laboratory test called an electronystagnograpty, or ENG If the Dill testis abnormal and the findings are “clase” for BPP, then additional testing ie not nacateary. IF the results ae normal or not “lassie than the dagnoss of PPV i less certain and other tests may be suggested, WHAT ARE THE TREATMENTS FOR BPPV? There ove fur oppoeces to treating BPP 1. DO NOTHING AND WAIT FOR TT TO GO ANAY BY ITSELF BPPV symptoms sometimes go aay within six months of onset, therefore you might want to wait and see if your symptoms subside on their awn. During this waiting period, medications to prevent motion sites o nausea are Sometimes helpful in contling the rausea associated with BPP. 2. PSIEALNAREWERS PERFORMED INTHE CDC Che ley and Seno Haestes) The Ee an Senor mae, ad fr thr ieros ae et mets that ae pore inthe ne These eaters we spec Cy intended to rve the cra om te sear aa fo 2 ess ems ton win he ne en Yur nan See he tetnert tat ios prot fr ou. tach of thse eaters takes at 15 ies ad ales symptons a about 8 pert of pate. ay nthe emg 20 pret, a sic tester ay et be ect ryt mayb tc to prom he Dena execs (Hoe Fate) ein proce) ad prise pstonig, i 2 cee in ich the con noes yur hod {into five postions maintaining each position for ap- roxinately 30 seconds, The Semont maneuver 3 * called the beat maneuver) fa procedure In which the clinician apy moves you from tying on one sie ve = te yng onthe oter sige, These maneuvers may not be a ceproprat for points with nck or bockproblars.Pa- ton & rections tients who experince nauses or anxiety may wish to take medication prior the treatrent. The Epley ManeuverINSTRUCTIONS FOR PATIENTS AFTER CLINIC TREATMENTS Follow these structions after the Epley or Semont manewet. By doing so you wil minimize the opportunity for ataconia ta eum to the somiciuar canals af the inner ear and rac the patti that your dizziness wil recut Watt at least 10 minutes after the maneuver before going home, Tis isto avoit “quick spins” or brief bursts of vertigo asthe tzconia reposition themselves imnedi- ately after the maneuver. If posible, arange to have someone dive you home, ‘The following two days: Sleep semirecombent forthe nex wo nights This means sleeping with your head halfway between fat and upright, at s° 3 45-degies ange. Tis s most easly dane by seping in & rediner chr or by sleeping with pillows appropriately arranged on 2 couch Dug the 6, ty to beep your head vertical A sot neck _Swageste seeping postion brace maybe help Do not go to the bare, harresser or dentist, When shaving, keep your head vertical by Bending fornard a your hips with your nck cane f you need to administer eye dons, try to keep your head as vertical as possible Stam oo only under the shone During the fellowing week, avoid provoking head positions that might bring on BPPV. Use tw plows when you sleep. ‘void sleeping on the affected sige, Dont turn your head far up o Fat down, ‘Ayoldtitieg your head back espcially when ying on your back wth your heed turned toward the affected side. If posible, postpone elective surgery and going tothe beauty parlor or the dentist's ofie. Avoid for headformard positions and exercises where the heads not kept upright, for example toe touches. ‘The effectiveness of the clinic treatment cannot be determined for one week. ‘Wat one week after treatnent to test the effectiveness of treatment. Place yourself nthe position tht usually makes you diz. Be sure to position yourself cautiously and under conditions in which you cena fall or et your.3. HOME TREATMENT OF BPPY (randt-aroff Exercises) \When the clinic teatment (ple or Semon fas, when the involved sides nt determined, or when a casos mild ‘the Brandt Daroff xrcises may be recomended. These eecisessuceed in 95 percent of cases but tale Longer to work than the clinic treatments, You should perform these eer ss only if instructed todo so by your clinician. I your c= ‘ian performed the Eley or Semont monevvr, yoo must wait one week ofter thot weotment before you begin che Brand Daroffevercss, ‘These exercises should be performed on a fat su face, without a plow, Start siting upright a ven x an thee ofthe bed ron the floor (P= sion 3). Tim your head 48 degres to the let and ie down on you it side p ps (Poston 2). When in he Ht ei 4 Pal position, your head shoud be at a dS-e- ge ange tured halfway between the fet surface and the cen, Stay nthe sieving pesition for atleast 30 seconds Ifyou ae stil dy stay until the dizziness subsides or one minute, whichever fs less. Then sit up (Position 3) and stay in the siting psi- tion for 30 seconds. Tun your head 45 dearest the right ard Fe dawn on your lft sie (Postion 4), again keeping your head tured halfay toward the cling for 30 seconds ‘oc unite dzins subsides. Return to Position 1 (sit upright for 30 seconds. This sone repetition Oe set (ve repetition) takes shut 10 minutes to complete and should be performed each moming,miéday and evering. Brandt-Doroff exercises The Brand-Daroff exercises shoul be performed fortwo wees, tte sets each yo for thee wees, two sets each day (52 sets total), Tn most individuals, complete rele fom symptoms is obtained ar 30 ses, o about 10 ays {In apprximately 30 percent of patients, BPP wil cur within oe ear. 1 BPPY recurs you may wish to ad one 10 minute exercise (one set) to your diy routine, 4, SURGICAL TREATMENT OF BPPY 1f the maneuvers or exercises donot contol symptoms that have persisted for a year or longer and the agnosis i ‘very clea, sugary may be recommended, The mest common sual procedure, called posterior carl plugang, blocks most ofthe posterior canals function without affecting the functions ofthe other canal or parts ofthe ea That is, howoves, a smal rik of hearing Loss This surgery is effective in about 90 percent of individuals Who have rot responded to ater treatments and when symptoms ae severe and longstanding ate Neri Uy. une ey 9 tay hel ian or asc pp at tan sat [criti ns el ne oer oo ed ‘eh fn "isons ed y heer fey af mn De