Ask a Neurologist. Get Answers to Your Neurology Questions.
The success of the procedure can be predicted by inspection of nystagmus during the second position of the Epley's procedure; reversed nystagmus direction or no nystagmus observed at this point suggests that the procedure will not be efficacious. You should see your ENT and evaluate the success.
After successful re-positioning treatment, up to 37 percent can still have some mild non-positional vague imbalance and dizziness for two to three weeks; this is more common in older patients and in those whose BPPV had been present for over a week before treatment. In some patients, debris may re-enter another canal, most commonly the horizontal, causing ‘transitional BPPV’. This may resolve on its own or require treatment with the horizontal canal maneuvers. If the symptoms are not resolved within two to three weeks, you should see your doctor.
The method has been dubbed the "barbecue rotation" maneuver, and is known as the Lempert roll maneuver. Another option is the Gufoni maneuver. The reason is unknown.
There is no risk of worsening if it is horizontal canal debris. There are 2 forms (geotropic and apogeotropic) of Horizontal canal (HC) BPPV. The nystagmus is elicited by a lateral head turn in the supine position (McClure-Pagnini maneuver). In geotropic HC-BPPV, horizontal nystagmus beating toward the floor begins after one to eight seconds of turning the affected ear down; it lasts approximately one minute, and after a few seconds of inactivity is followed by a reversal of the nystagmus, which also lasts up to one minute. In contrast, in apogeotropic HC-BPPV, the induced nystagmus beats toward the uppermost ear.