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Previously on ENT Weekly, we learned about the dizzying effects of benign paroxysmal positional vertigo (BPPV). As a note, BPPV is fairly common, affecting one per 1000 people with an overall prevalence of 2.5% in the overall population. This disease is fairly rare in children but can affect adults of any age, especially seniors. Although the vast majority of cases occur for no apparent reason, associations have been made with trauma, migraine, inner ear infection or disease, diabetes, osteoporosis, reduced blood flow, and possible genetic predispositions as causes of BPPV.

To treat BPPV, otolaryngologists (ENT) doctors and physical therapists alike use the Epley maneuver to move displaced otoliths out of the semicircular canals. Throughout the course of these exercises, they may provoke the sensation of dizziness. If this happens, try to continue the exercises after pausing to rest.

  1. Beginning in the sitting position, the upper body and head is held still. Moving only the eyes, the patient looks up and down 10 times. This task is followed by looking left and right 10 times.
  2. Moving the head, the patient now looks up, down, left, and right 10 times.
  3. Lying down, the patient goes from prone to upright to prone again, completing one set.

 Patient undergoing osteopathic treatment with the help of a physical therapist

Image Source: Burger/Phanie

Upon successful completion of several repetitions, the dislodged otolith should have exited the semicircular canals. During this treatment, the physician may prescribe a short course of Meclizine, a central nervous system depressant, which can help decrease the sensation of dizziness and nausea. Its mechanism of action is still not understood very well and it treats only the symptoms, not the underlying problem. Common side effects include drowsiness, lethargy, and dry mouth (xerostomia). Before beginning Meclizine or if BPPV symptoms persist despite the Epley maneuver, check in with your nearest otolaryngologist!

Feature Image Source: Justin Chin

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