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Vertigo And A Low-Tech Cure

Posted by medconsumers on October 1, 2004

Benign Positional Vertigo: A Common Problem With a Low-Tech Cure

Dizziness and nausea. When these two symptoms come on suddenly, they can continue for weeks or even months. In most people over the age of 50 years, the problem is entirely benign and so is the solution. Benign positional vertigo (BPV) is the diagnosis—but it is made only after brain tumor and stroke are ruled out. A series of doctor-guided head exercises called the Epley Maneuver proved to be a successful treatment in a small randomized clinical trial reported recently in the journal Academic Emergency Medicine. It was conducted by Andrew K. Chang, MD, and colleagues at the Emergency Medicine Department of Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.

They randomly assigned 22 consecutive adults who came to their emergency room with BPV to receive either the Epley Maneuver or a placebo (useless) maneuver. The severity of each participant’s vertigo was evaluated on a 0 to 10-point scale before and after treatment. The Epley group showed larger decreases in vertigo severity scores than the placebo group. If their symptoms did not improve, people in the placebo group were given the Epley maneuver. Dr. Chang and colleagues found that the relief was immediate in most of the people given the Epley Maneuver after only one or, in some cases, two treatments.

This study confirms the findings of three earlier randomized trials which found “a statistically significant effect in favor of the Epley Maneuver” (Cochrane Review, 2/25/04). Furthermore, there were no serious adverse effects associated with the treatment.

In young people, BPV is usually the result of a head trauma. When it occurs in people over the age of 50 years, the cause is thought to be due to debris that collects within a part of the inner ear. Sometimes called “ear rocks,” the debris consists of small crystals of calcium carbonate that break loose from a portion of the inner ear called the utricle. According to the American Hearing Research Foundation, “The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age.”

The BPV symptoms, which are often intermittent, are almost always precipitated by a rapid change of position of the head, such as getting out of bed or rolling over in bed. Motion sickness drugs are not particularly useful. BPV is a self-limiting condition, which means that it will usually go away on its own without treatment.

But the few studies that have been conducted on the Epley Maneuver show that it can provide relief for at least 80% of the people given this treatment. It has the added advantage of requiring no laboratory or imaging tests, according to Dr. Chang. The Web site listed below illustrates a physician performing the Epley Maneuver by gently turning of the head to each side while patient lies flat on his or her back.

Dr. Chang was asked whether people with BPV could easily find a physician who knows how to do the Epley Maneuver. “Many patients with sudden onset of severe BPV and vomiting end up going to the ED (emergency department) because they are often unable to see their doctor or a specialist that same day,” wrote Dr. Chang in an e-mail response. “Unfortunately, many emergency physicians do not know of this maneuver, though I am working on changing this. For example, I am teaching a vertigo workshop in San Francisco in several weeks at my specialty’s (American College of Emergency Physicians) largest conference.”

On the question of whether primary care physicians are knowledgeable about this simple treatment, Dr. Chang was not encouraging. “I doubt that most family physicians would know of this maneuver, although one study, which was conducted in the office setting, was published in 2000. Since the maneuver was only recently described by Epley in 1992, there are still a number of specialists (neurologists and otolaryngologists) who are unaware of this treatment option.”

For more information:

For illustrations showing the Epley maneuver, including self-treatment exercises, click here.

Maryann Napoli

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