![]() ![]() ![]() After performing CRP successfully, the newly cleared particles are located just outside the opening to the common crus of the semicircular canals. Only the latter is useful when self-applied by a patient, because in the absence of a viewer there is no benefit to maximizing nystagmus, which causes dizziness that can be severe enough to cause vomiting.Ī second limitation is the possibility of horizontal canal BPPV (H-BPPV). It is useful to the operator during the Epley maneuver because the nystagmus is enhanced, because it allows diagnosis to take place at the start of a maneuver, and because it moves the particles in the direction of the canal exit. The DH causes ampullofugal fluid and particle movement in the posterior canal, maximizing the sensation of vertigo and the resulting nystagmus. The posterior semicircular canal is most sensitive to ampullofugal movements (movement of fluid or particles in the stimulatory direction) and is much less sensitive to ampullopetal movements (the inhibitory direction). ![]() This is useful in diagnosis because it places the patient’s eyes in a favorable position for viewing by the physician, and it is designed to trigger a particularly severe spell of nystagmus that is thus more easily observed. The initial step in the Epley maneuver is the Dix Hallpike (DH) maneuver, a variation of which is also used in the Semont maneuver. Usually patients with recurrences return to clinic for further maneuvers, but home exercises should be more cost-effective. Because particles can again become displaced into the semicircular canals over time, it is possible to have recurrences, which approach 50% over 1–3 years. Ideally a maneuver is applied several times in the course of one treatment session, until no further symptoms can be elicited. Other maneuvers have been described for the horizontal and anterior canal variants, and a number of minor variations of all these maneuvers have been reported. In the 1980’s, two treatments for the posterior canal variant, the Epley and Semont maneuvers, were independently devised, and both have been found to be similar in efficacy, which exceeds 90%. This is usually performed by a clinician or therapist. These can be cleared from the semicircular canals by canalith repositioning (CRP), resolving the dizziness. We believe that both exercises can be self-applied to control symptoms, but the half somersault is tolerated better and has fewer side effects as a home exercise.īenign paroxysmal positional vertigo (BPPV) is a common vertigo disorder in which otoconia normally adherent to the utricle become displaced into the semicircular canals. During the 6-month follow-up, the Epley group had significantly more treatment failures than the half somersault group. The Epley maneuver was significantly more efficacious in reducing nystagmus initially, but caused significantly more dizziness during application than the half somersault. Both exercises resulted in a significant reduction in nystagmus after two self-applications. Outcome measures were the reduction of nystagmus intensity, tolerability of induced dizziness, and long-term efficacy. Subjects performed exercises twice while observed, were re-tested with the Dix Hallpike, and then reported on exercise use for 6 months. In this randomized single-blind study, we compare the efficacy of our exercise to self-administered Epley maneuvers in patients with BPPV. ![]() We designed a self-administered exercise, the half somersault, for home use. Benign paroxysmal positional vertigo (BPPV) frequently recurs after treatment, so a home exercise would be desirable. ![]()
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