ACRO E-mail Archive Thread: Wobblies
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From: Tim Bastian <timothy607 at earthlink.net>
Date: Sun, 17 Nov 1996 05:55:55 UTC
Just got this in my E-Mail and thought it might clear some things up. Please read it. I think you'll find that it explains the Wobblies and what can be done about them. a fully illustrated guide can be obtained directly from the Vestibular Disorders Association <veda at teleport.com> by sending them and E-Mail with your name and mailing address. See ya, Tim Bastian >From: Vestibular Disorders Association <veda at teleport.com> >Date: Mon, 11 Nov 1996 16:27:46 -0800 (PST) >To: timothy607 at earthlink.net >Subject: BPPV >> > >R-5: BENIGN PAROXYSMAL >POSITIONAL VERTIGO > >By Timothy C. Hain, MD >Chicago, Illinois > >Benign Paroxysmal Positional Vertigo >(BPPV) causes dizziness due to debris >which has collected within a part of the >inner ear. (See picture.) You can think of >this debris as "ear rocks." Chemically, ear >rocks are small crystals of calcium >carbonate. They are derived from >structures in the ear called "otoliths" that >have been damaged by head injury, >infection, or other disorder of the inner >ear, or degenerated because of advanced >age. > >The symptoms of BPPV include dizziness >or vertigo, lightheadedness, imbalance, >and nausea. Activities which bring on symptoms will vary in each person, but symptoms >are almost always precipitated by a position change of the head with respect to gravity. >Getting out of bed or rolling over in bed are common "problem" motions. Because >people with BPPV often feel dizzy and unsteady when they tip their heads back to look >up, sometimes BPPV is called "top shelf vertigo." Women with BPPV may find that the >use of hair dryers in beauty parlors brings on symptoms. An intermittent pattern is the >usual situation. BPPV may be present for a few weeks, then stop, then come back again. > >WHAT CAUSES BPPV? The most common cause of BPPV in people under age 50 >is head injury. In older people, the most common cause is degeneration of the vestibular >system of the inner ear. However, in perhaps half of all cases, BPPV is called >"idiopathic," which means it occurs for no known reason. > >HOW IS THE DIAGNOSIS OF BPPV MADE? Your physician can make the >diagnosis based on your history, findings on physical examination, and the results of >vestibular and auditory tests. Blood pressure will be checked lying flat and standing. >Other diagnostic studies may be required. An ENG may be needed to look for the >characteristic nystagmus (jumping of the eyes). An MRI scan will be performed if there is >any possibility of a stroke or brain tumor. A rotatory chair test may be used for difficult >diagnostic problems. It is possible to have BPPV in both ears (bilateral), which may >make diagnosis and treatment more challenging. > >HOW MIGHT BPPV AFFECT MY LIFE? Certain modifications in your daily >activities may be necessary to cope with your dizziness. Use two or more pillows at night. >Avoid sleeping on the "bad" side. In the morning, get up slowly and sit on the edge of >the bed for a minute. Avoid bending down to pick up things, and extending the head, >such as to get something out of a cabinet. Be careful when at the dentist's office, beauty >parlor, or in sports activities or positions where the head is flat or extended. > >HOW IS BPPV TREATED? BPPV has often been described as "self-limiting" >because symptoms often subside or disappear within six months of onset. Symptoms tend >to wax and wane. Motion sickness medications are sometimes helpful in controlling the >nausea associated with BPPV but are otherwise rarely effective. However, various kinds >of physical maneuvers and exercises have proved effective. Three varieties of >conservative treatment, which involve exercises, and a treatment that involves surgery are >described on the next page. > >WHERE ARE BPPV EVALUATIONS AND TREATMENTS DONE? > >This list contains people who are known for treating BPPV. > >Physical Treatments > >Midwest: Dr. T. Hain (Northwestern Memorial Hospital, Chicago, Illinois) > Dr. N. Shepard (Taubman Medical Center, Ann Arbor, Michigan) >West Coast: Dr. J. Epley (Portland Otologic Clinic, Portland, Oregon) > Dr. F. Black (Dow Neurological Institute, Portland, Oregon) > Dr. R. Baloh (UCLA, Los Angeles, California) >Mountain States: Dr. I. Arenberg (Denver, Colorado) >East Coast: Dr. D. Zee (Johns Hopkins Hospital, Baltimore, Maryland) >South: Dr. S. Herdman (Miami, Florida) > Dr. J. Li (Palm Beach Gardens, Florida) > Dr. R. Steenerson (Atlanta, Georgia) > Dr. J. Soileau (Baton Rouge, Louisiana) > Kathleen Deyo, P.T. (Houston, Texas) >Canada: Dr. L. Parnes (London, Ontario) >Europe: Dr. A. Semont (Paris, France) >Europe: Dr. J. Juvanon (Nemours, France) > > > > >OFFICE TREATMENT OF BPPV >(The Epley and Semont Maneuvers) > >There are two treatments of >BPPV that are usually >performed in the doctor's >office. Both are very effective, >with roughly an 80% cure rate, >according to a study by >Herdman and others (1993). > >The maneuvers are named after >their inventors. They are both >intended to move debris or "ear >rocks" out of the sensitive back >part of the ear (posterior canal) >to a less sensitive location. Both >maneuvers take about 15 >minutes to accomplish. The >Semont maneuver (also called >the "liberatory" maneuver) >involves a procedure whereby >the patient is rapidly moved >from lying on one side to the other. The Epley maneuver (also called the particle >repositioning, canalith repositioning procedure, and modified liberatory maneuver) is >shown in the figure above. It involves sequential movement of the head into four >positions. The recurrence rate for BPPV after these maneuvers is about 5 percent, and in >some instances a second treatment may be necessary. > >After either of these maneuvers, you should be prepared to follow the instructions below, >which are aimed at reducing the chance that debris might fall back into the sensitive >back part of the ear. >INSTRUCTIONS FOR PATIENTS >AFTER OFFICE TREATMENTS >(Epley or Semont Maneuvers) > > >1. Wait for 10 minutes after the maneuver is performed before going home. This is to avoid >"quick spins," or brief bursts of vertigo as debris re-positions itself immediately after the >maneuver. Don't drive home yourself; have someone else drive you. > >2. Sleep semi-recumbent for the next two days. This means sleep with your head halfway >between being flat and upright (a 45 degree angle). This is most easily done by using a >recliner chair or by using pillows arranged on a couch. During the day, try to keep your >head vertical. You must not go to the hairdresser or dentist. No exercise which requires >head movement. When men shave under their chins, they should bend their bodies >forward in order to keep their head vertical. If eyedrops are required, try to put them in >without tilting the head back. Shampoo only under the shower. > >3. For at least 1 week, avoid provoking head positions that might bring this on again. > > Use two pillows when you sleep. > > Avoid sleeping on the "bad" side. > > Don't turn your head far up or far down. > > Be careful to avoid head-extended position, in which you are lying on your back, > especially with your head turned towards the bad side. This means be cautious at > the beauty parlor, dentist's office, and if having minor surgery done. Ask them to > keep you as upright as possible. If appropriate, exercises for low-back pain should > be stopped for a week. No "sit-ups" for at least one week. No "crawl" swimming. > (Breast stroke is OK.) > > Avoid far head-forward positions such as might occur in certain exercises > (i.e. touching the toes). > >4. At one week after treatment, put yourself in the position that usually makes you dizzy. >Position yourself cautiously and under conditions in which you can't fall or hurt yourself. >Let your doctor know how you did. > >WHAT IF THE MANEUVERS DON'T WORK? These maneuvers don't always work >(only 80% of the time), and if they don't, then your doctor may wish you to proceed with >the Brandt-Daroff exercises, as described below. If a maneuver works but symptoms >recur or the response is only partial, another trial of the maneuver might be advised.HOME TREATMENT OF BPPV >(Brandt-Daroff Exercises) > >The Brandt-Daroff Exercises >are a second method of treating >BPPV, usually used when the >office treatment fails. They >succeed in 95% of cases but are >more arduous. These exercises >are performed in three sets per >day for two weeks. In each set, >one performs the maneuver >below five times. > >1 rep = maneuver done to each side in turn (takes 2 minutes) > >Suggested Schedule: >Time Exercise Duration >Morning 5 reps 10 min >Noon 5 reps 10 min >Evening 5 reps 10 min > >One starts upright. Then, one moves into the side-lying position, with the head angled >upward about half way. An easy way to remember this is to imagine someone standing in >front of you, and just keep looking at their head at all times. Stay in the side-lying >position for 30 seconds, or until the dizziness subsides if this is longer, then go back to >the sitting position. Stay there for 30 seconds, and then go to the opposite side in the >same way. > >If, during a session, the exercise fails to produce symptoms, stop the exercises for that >day. If no symptoms can be produced during the first session of the next day, then stop >the exercises entirely. In most persons, complete relief from symptoms is obtained by one >week. The Brandt-Daroff exercises as well as the Semont and Epley maneuvers are >compared in an article by Brandt (1994), listed in the reference section. > >SURGICAL TREATMENT OF BPPV >(Posterior Canal Plugging) > >If exercises are ineffective in controlling symptoms and they have persisted for a year or >longer, a surgical procedure called "canal plugging" may be recommended. Canal >plugging completely stops the posterior canal's function without affecting the functions of >the other canals or parts of the ear. This procedure poses a small risk to hearing. REFERENCES CONCERNING BPPV: > >Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo, Arch >Otolaryngol, 1980, 106:484-485 (Brandt-Daroff Exercises) > >Brandt T, Steddin S, Daroff RB. Therapy for benign paroxysmal positioning vertigo, >revisited. Neurology 1994, 44:796-800 > >Epley JM. The canalith repositioning procedure: For treatment of benign paroxysmal >positional vertigo. Otol Head Neck Surg 1992: 107: 399-404 (Epley Maneuver) > >Froehling DA, Silverstein MD, Mohr DN, Beatty CW, Offord KP, Ballard DJ. Benign >positional vertigo: incidence and prognosis in a population-based study in Olmsted >county, Minnesota. Mayo Clinic Proc, 66, 1991, 596-602 > >Harvey S, Hain T, Adamiec L. Modified liberatory maneuver: effective treatment for >benign paroxysmal positional vertigo. Laryngoscope 104: October 1994 (Epley Maneuver) > >Herdman, S. Treatment of benign paroxysmal vertigo, Physical Therapy 70, 1990, 381-388 >(All maneuvers) > >Herdman S, Tusa R, Zee D, Proctor LR, Mattox DE. Single treatment approaches to >benign paroxysmal positional vertigo. Arch Otol Head Neck Surg 1993, 119;450-454 >(Epley and Semont maneuvers) > >Parnes LS, McClure JA. Posterior semicircular canal occlusion for intractable benign >paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1990, 99:330-334 (surgical >treatment) > >Parnes LS, Price-Jones RG. Particle repositioning maneuver for benign paroxysmal >positional vertigo. Ann Otol Rhinol Laryngol 1993,102:325-331 (Epley maneuver) > >Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv >Otolaryngol 1988, 42, 290-293 (Semont Maneuver) > >Welling DB, Barnes DE. Particle Repositioning maneuver for benign paroxysmal >positional vertigo. Laryngoscope 104; 1994, 946-949 (Epley Maneuver) > >Rev. 10-17-96 > >