Please Help BPPV

[tynribs]

Hi everyone,
Please can you help. 6weeks ago I awoke with spinning vertigo-it was terrifying. I went to GP who performed dix hallpike & nystigmas was noted as i was left side positive. He performed epley manouver and spinning stopped but I am left with disequilibrium,false movement/nausea/panic. He has since performed another epley with little effect to aforementioned symptoms. I paid to see ENT consultant who did audiology/neuro/halpike test. No nystigmas noted. He is referring me for a caloric test (I dont understand what this will do) & has sent me a diagram sheet of home epley in the post but has not said how often I do this-does anyone know?

Also, Im confused because I thought the whole point of epley was to return particles, and as my spinning stopped after 1st epley with GP (which i presume cause the spinning) why am I being asked to do this now & can it cause any settled particles to come whizzing out again??

I tried home epley yesterday but It made me feel awful for the rest of the day-why is this?

Im so worried & confused. Ive tried ringing ENT but everythings getting muddled. They are telling me 6 week wait for caloric but Ive been off work for 6 weeks already and I dont know what to do?

Can anyone tell me how I can find a neuro-otologist in Manchester, or a VRT physio or do you think I should stay with my current consultant....sorry for rambling but Im desperate, frightened and confused.

Please help, I would be grateful for any advice

Thanks

[IceMan]

Hi

I don't have time for a detailed reply tonight but did the gp you saw give you any follow up exercises to do? They are typically called habituation exercises the most commonly instructed being Brandt-Daroff exercises. They're basically designed to desensitize the symptoms of nausea, vertigo, dizziness etc.

[tynribs]

Hi Iceman,
thank you for taking time to reply. I have been given no other excercises than home epley. I got myself into such a state y.day the consultant rang me back. He said its expected that Ill feel awful following & to continue once per day epley to get my particles back? Still very confused about it all (*original post) thanx

[IceMan]

Hi tynribs

It sounds like your GP is wanting you to do the epley as means to desensitize your symptoms, in other words to make your brain ignore the false signals that are being sent to it by the vestibular part of your inner ear.

When initially performed in the clinic the epley is designed to facilitate the drainage of crystals out of the affected semi-circular canal (or so the theory goes). Often times the Epley maneuver is very effective and patients have a complete relief of vertigo but occasionally there are some residual symptoms.

When you do have the residual symptoms treatment usually shifts from that of removing "crystals" to desensitization. Initially these desensitization exercises will cause your symptoms to increase but the more you do them the more your symptoms will fade as your brain compensates to the repetitive stimuli. So for now go ahead and try doing the Epley once a day as instructed and you should hopefully start to see an improvement in your symptoms in a few days (you'll have to push through the initial period of increased symptoms which obviously can be very frustrating).

My treatment of choice after administering the Epley to the patient would be Brandt-Daroff exercises which would be performed 10 times for 3 times a day (probably for 2 weeks and then done once a day in the morning if the symptoms have resolved for maintenance). Try this interactive link to see what the exercise entails. In your case you would lay down to your left side first because that is your positive side.

So if you don't seem to be improving with the self Epley ask him if he thinks Brandt-Daroff exercises would be appropriate. If he doesn't know what those are you should probably find a specialist who does. Unfortunately I live in the States and have no idea where you'd find one in England. Over here a large number of physios are trained to treat BPPV. I'm not sure if that's the case in England. Perhaps some physios from England on this forum could assist you with that.

BTW the Caloric test is a means to test your vestibular system in regards to its responsiveness and symmetry of response between the ears.

Hope that helps. Good Luck!

[tynribs]

Hi Iceman,
Thank you so much for replying and for the information. I am trying to continue with the epley by doing it last thing at night 30 mins after taking prochlorperazine to help with nausea/false movement afterwards. I find it exhausting to try and sleep upright (as some recommend following epley) so am sleeping on my right (and hoping this is not affecting crystals) as positive side left & am also struggling with panic attacks. I have an MRI scan booked for this weekend to rule out any nasties but as you say I will try and push on with the programme.

Q ?Do you suggest brandt daroff excercised with epley ?

Thank you once again I appreciate it.

Does anyone know of English physio trained in treating bppv near Manchester, England please?

[IceMan]

Originally Posted by tynribs

Hi Iceman,
Thank you so much for replying and for the information. I am trying to continue with the epley by doing it last thing at night 30 mins after taking prochlorperazine to help with nausea/false movement afterwards. I find it exhausting to try and sleep upright (as some recommend following epley) so am sleeping on my right (and hoping this is not affecting crystals) as positive side left & am also struggling with panic attacks. I have an MRI scan booked for this weekend to rule out any nasties but as you say I will try and push on with the programme.

At this stage don't worry about not sleeping on your left side or in an upright position. As I've said before you're doing the self epley as a means to desensitize yourself from experiencing your symptoms and not to drain the crystals out of the semicircular canals of the inner ear. The latest research suggests that the patient stay upright a few hours after the initial epley and then to avoid sleeping on the positive side for a week. Its been a while since your initial epley maneuver was done in the clinic so for now you can sleep in any position.

Originally Posted by tynribs

Q ?Do you suggest brandt daroff excercised with epley ?

No. I would do one or the other. Talk to your GP or ENT before changing your home program.

[psychophysio]

When I treat BPPV at work I usually do one Epley, then get the patient to start the Brandt Daroff exercises 48 hrs after that.

We recommend the Brandt-Daroff exercises 3x per day, building up to 5 reps per side. Start with 2-3 reps per side and stay down until your symptoms stop. We get the pt to do the exercises for 7 days, or for 2 days after vertigo symptoms cease.

an interesting website with some nice diagrams is:

BPPV -- BENIGN PAROXYSMAL POSITIONAL VERTIGO

I would ignore the surgical bit etc as this shouldn't apply to you and I have never seen a patient who has had surgery for BPPV.

Are your symptoms still short duration (<1 minute) positional (triggered by particular movements) vertigo? The caloric testing and ENT opinion will further evaluate your vestibular system. I agree as well that you can sleep how you like.

[tynribs]

Originally Posted by psychophysio

When I treat BPPV at work I usually do one Epley, then get the patient to start the Brandt Daroff exercises 48 hrs after that.

We recommend the Brandt-Daroff exercises 3x per day, building up to 5 reps per side. Start with 2-3 reps per side and stay down until your symptoms stop. We get the pt to do the exercises for 7 days, or for 2 days after vertigo symptoms cease.

an interesting website with some nice diagrams is:

BPPV -- BENIGN PAROXYSMAL POSITIONAL VERTIGO

I would ignore the surgical bit etc as this shouldn't apply to you and I have never seen a patient who has had surgery for BPPV.

Are your symptoms still short duration (<1 minute) positional (triggered by particular movements) vertigo? The caloric testing and ENT opinion will further evaluate your vestibular system. I agree as well that you can sleep how you like.

Hi thank you for replying.
My symptoms of false movement (not spins) nausea/feeling unbalanced, usually happen on movement although I have had it when im sat still. This can be worse when i turn onto my left side and really anytime i move my head. It feels like things are moving for split seconds and sends a wave of nausea and panic through. Compilled into a 24/7 x 7 week experience Im knackered with it all. Its completely taken over my life and I would say before this I was a rationale level headed person. I feel it is exacerbated when i go into a crowded place and it feels like there are too many movements things happening & Im walking on cotton wool. I have had my MRI scan this morning which was not as bad as i expected. Awaiting caloric test now although the date ive been given is 2 days before I should fly to spain on holiday. Doesnt look like Ill be going anyway. I am wondering if to start brandt daroff excercise as I dont want to make things worse? ENT consultant advised that I do home epley once per day & Ive been doing that. what do you think??
Thank You so much