Paroxysmal positional vertigo: maneuvers, exercises and daue

Benign paroxysmal positional vertigo is a disorder of the inner ear that causes:

• • Vertigo
  • Insecurity
  • Nausea.

This condition is not treated with medication or home remedies, but by means of mechanical therapy, which includes maneuvers and exercises.

What to do? Treatment of benign paroxysmal positional vertigo (BPLS)

Liberating manoeuvre in case of paroxysmal positional vertigo of the posterior semicircular canal

There are two very effective treatments for BPLS (cupulolithiasis or canalolithiasis), with a cure rate of about 80%.
This disturbance is caused by a positional anomaly of the otoliths (small stones) in the arcades.
The maneuvers serve to bring the otoliths from the sensitive part of the ear (posterior semicircular canal) into a position that no longer causes disturbance.
Each maneuver takes about 15 minutes.

The Epley maneuver provides for a sequence of movements of the head in four positions. Each position is maintained for about 30 seconds:
1) Starting position, the patient sits on a couch.
2) The patient quickly lies down over the upper edge of the couch and turns his head 45° to the side of the affected ear. The doctor stretches the patient’s head (about 20°) and holds this position for another 30 seconds.
3) The doctor quickly turns the patient’s head to the opposite side, but the patient’s body position is maintained.
4) The doctor continues to turn the patient’s head until he looks at the ground.
5) The patient returns to the sitting position on the couch.
Caution should be exercised in the Epley manoeuvre, as neurological symptoms could occur (for example, weakness, numbness, various visual disturbances caused by dizziness).
Sometimes these symptoms are caused by pressure on the vertebral arteries.

The Semont maneuver for diagnosis and therapy
The liberating maneuver according to Semont is a technique in which the doctor quickly turns the patient on the couch from one side to the other.
It is a maneuver that leads to the elimination of the problem in about 4% after 90 treatment sessions.

Starting position
The patient sits on a couch with his legs hanging down.
The head is rotated in 45° to the right side.

Movement sequence The doctor quickly places the patient on the left side. If nystagmus or dizziness occurs, it means that the diseased ear is on the left side.
In this case, the treatment (Semont maneuver) is carried out by placing the patient on the other side. There he remains until the dizziness passes (2-3 minutes). 

 How to sleep after carrying out the liberation maneuver?
After the treatment to reposition the otoliths, you should sleep for two nights in a semi-sitting position (head and shoulders tilted by 45°).

Liberation manoeuvre in case of paroxysmal positional vertigo of the lateral semicircular canal

The goal of this maneuver may be:

• remove the otoliths from the ampoule,
• Move the otoliths from the anterior to the posterior branch of the lateral semicircular canal. In this case, the apogeotropic nystagmus changes into a geotropic nystagmus.

According to a scientific study (Mandala M, Pepponi E, Santoro GP, et al. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal VPPB. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal VPPB. Laryngoscope 2013;123:1782-6.) the Gufoni maneuver is very effective.
It is performed on the opposite side in geotropic nystagmus (which turns towards the earth) but also on the opposite side in apogeotropic nystagmus (which turns upwards) on the same side.

Patient position
The patient sits on the couch with knees bent over the edge and feet hanging down.

Execution of the maneuver

• The examiner touches the patient’s neck and quickly brings him into the lateral position.
• Here, the patient’s head is turned downwards.
• You should now wait about two minutes or until the dizziness and nystagmus subside.
• After that, the patient quickly returns to the sitting position.

According to scientific studies, regularly performed exercises according to Brandt-Daroff can lead to a shortening of the recovery time by 10-14 days.
The aim of this exercise is to get used to and compensate for the balance system.

Liberation manoeuvre in case of paroxysmal positional vertigo of the anterior semicircular canal

The deep-head-hanging or yacovino maneuver serves to free the front or upper semicircular canal.

Patient position
The patient sits with his legs stretched on the examination table.

Execution of the maneuver

• The patient lies down on the couch, with the head protruding above the head end with a maximum stretch (head tilt backwards),
• Waiting until dizziness and nystagmus have passed,
• In the supine position, he bends his head forward as much as possible,
• Wait about 60 seconds for nystagmus and dizziness to pass.

Exercises for benign paroxysmal positional vertigo

Rehabilitation at home
Regardless of the affected arc channels, the exercise according to Brandt-Daroff can be useful:

• If the reposition maneuvers do not work,
• When patients do not tolerate the maneuvers.

Execution of the maneuver according to Brandt-Daroff
The patient should:

• Quickly lie down on one side,
• Sit down
• Lie down on the other side,
• Sit down.

Each position he should keep for at least 30 seconds
These exercises are repeated 5-10 times a day several times in a row until the symptoms disappear.

How long does benign paroxysmal positional vertigo last?

BPPV is usually a temporary disorder and can resolve over time even without treatment.
According to a report on the natural course of untreated BPPV, the following applies:

1. If the otoliths are located in the lateral canal, the person can recover in 16-19 days,
2. If the otoliths are located in the posterior canal, the disturbances usually disappear after 39-47 days (Review article: reflux and its consequences–the laryngeal, pulmonary and oesophageal manifestations).

A correct diagnosis and a correct liberation maneuver allow for an easy and quick recovery.

Recurrences of dizziness Dizziness
can recur after healing.
According to a scientific study, half of the patients experience at least one recurrence within a period of 10 years (Brandt T, Huppert D, Hecht J, Karch C, Strupp M. Benign paroxysmal positioning vertigo: a long-term follow-up (6-17 years) of 125 patients. Acta Otolaryngol. 2006;126:160–163.).

Generally, the problem recurs in the first year.

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