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Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1985
Experience:  Neurosurgeon - Brain, spine, and peripheral nerve surgery
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My ENT RECOMMENDED I try The epley maneuver at home to try

Customer Question

Hi, my ENT RECOMMENDED I try The epley maneuver at home to try and relieve bppv symptoms I've been having. So I tired it at home 2 days ago, the procedure made me very very dizzy. But I'm now concerned something went wrong as I'm now experiencing new symptoms that I neverexperienced before. For example moving my head left to right or up and down was never an issue, now I feel mild symptoms when doing that, so i now have new symptoms after doing the maneuver, why would that happen? I'm wondering if I did something wrong or crystals have moved to another location? My bppv symptoms prior to doing the Epley were primarily felt only when laying down on my right side, that seems to have improved. Now after the Epley, just moving my head left and right I get very mild bppv feeling (not extreme vertigo),also my right eye lid has been twitching non stop since doing the maneuver. Is this change in how I feel the symptoms just something that just needs time to improve? or is it possible I didn't do the procedure entirely correct and caused myself an inner ear issue (ie crystals didnt move out or moved somewhere else?). Thinking about doing the procedure again but not sure if that's best. Is there a different test I should have my ENT perform? Appreciate your thoughts
Submitted: 1 year ago.
Category: Neurology
Expert:  khagihara replied 1 year ago.

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.

Customer: replied 1 year ago.
ok, but what about why I would have new symptoms? Why would that happen and what would be best way to approach that?
Expert:  khagihara replied 1 year ago.

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.

Customer: replied 1 year ago.
thanks,can you please provide the maneuver name for horizontal canal debris, I will discuss with my ENT if symptoms persist. also, just wondering, why/how does self resolution occur if debris entered horizontal canal ? Many Thanks
Expert:  khagihara replied 1 year ago.

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.

Customer: replied 1 year ago.
Thanks, ***** ***** those and they seem pretty easy to do. Is there a risk of worsening my symptoms by trying that maneuver?
Customer: replied 1 year ago.
Also is there a test my ENT can do to determine if debris did move to the horizontal canal?
Expert:  khagihara replied 1 year ago.

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.