eMedicine Specialties > Emergency Medicine > Neurology
Benign Positional Vertigo: Multimedia
Updated: Aug 24, 2009
Multimedia
 | Media file 1: Anatomy of the semicircular canals. |
 | Media file 2: Epley maneuver. Move the patient back in the gurney such that when he lies down, his or her head will hang over the edge of the gurney. Emphasize to the patient to keep his or her eyes open during each position so that nystagmus can be observed. Lower the guardrails of the gurney on the opposite side from which the patient's head is turned. |
 | Media file 3: Epley maneuver. Turn the patient's head 45° to the side that had the most prominent symptoms during the Hallpike test. In this example, the patient's head is turned 45° to the left. With both hands holding the patient's head, gently lay the patient down in the supine position with the head hanging over the edge of the bed. Note: Each maneuver does not need to be performed rapidly. The Epley maneuver is positional, not positioning. |
 | Media file 4: Epley maneuver. The patient's head should be at 45° and hanging off the edge of the bed. Observe the patient's eyes and look for torsional nystagmus. Keep the patient in this position for at least 30 seconds or until the nystagmus or symptoms resolve. |
 | Media file 5: Epley maneuver. Because the patient's head will be turned 90° in the other direction, the physician needs to move to the head of the gurney and regrip the patient's head so that the fingers are pointing toward the patient's feet. |
 | Media file 6: Epley maneuver. Turn the patient's head 90° in the opposite direction (in this case, the patient's head is now facing to the right). Again, observe for nystagmus and hold this position for at least 30 seconds or until nystagmus or symptoms resolve. |
 | Media file 7: Epley maneuver. Close-up view of step shown in Media file 6. |
 | Media file 8: Epley maneuver. Ask the patient to turn onto his or her shoulder. |
 | Media file 9: Epley maneuver. Guide the patient's head down so that he or she is looking at the ground. Again, wait for at least 30 seconds. |
 | Media file 10: Epley maneuver. Close-up of view shown in Media file 9. |
 | Media file 11: Epley maneuver. The patient's head needs to be regripped again. Then, the patient needs to sit up with the legs hanging over the side of the gurney (which is why the guardrails need to be lowered before the start of the procedure). |
 | Media file 12: Epley maneuver. The patient is now sitting upright. |
 | Media file 13: Epley maneuver. Move the patient's head slightly forward. This completes the Epley maneuver. The maneuver may be performed multiple times. |
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This feature requires the newest version of Flash. You can download it here. | Media file 14: Hallpike test. In this example, the right posterior semicircular canal is being tested. Note that the head extends over the edge of the gurney. The thumb can be used to help keep the eyelids open since noting the direction of the nystagmus is important. |
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This feature requires the newest version of Flash. You can download it here. | Media file 15: Epley maneuver. In this example, the left posterior semicircular canal is being treated. In this clip, the maneuvers are performed quickly. In a real patient, each position should be held for at least 30 seconds or until resolution of the nystagmus and vertigo. |
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This feature requires the newest version of Flash. You can download it here. | Media file 16: Semont maneuver. Generally reserved for the cupulolithiasis form of benign positional vertigo, in which the otoliths are attached to the cupula of the semicircular canal. This maneuver has to be performed rapidly to be effective, and it is not recommended in elderly persons. In this example, the right posterior semicircular canal is being treated. |
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This feature requires the newest version of Flash. You can download it here. | Media file 17: Bar-b-que maneuver. This maneuver is used to treat horizontal canal benign positional vertigo. In this example, the right horizontal canal is being treated. Each position should be held at least 20-30 seconds. |
More on Benign Positional Vertigo |
| Overview: Benign Positional Vertigo |
| Differential Diagnoses & Workup: Benign Positional Vertigo |
| Treatment & Medication: Benign Positional Vertigo |
| Follow-up: Benign Positional Vertigo |
 Multimedia: Benign Positional Vertigo |
| References |
| « Previous Page |
References
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[Guideline] Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. Nov 2008;139(5 Suppl 4):S47-81. [Medline]. [Full Text].
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[Guideline] Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. May 27 2008;70(22):2067-74. [Medline]. [Full Text].
Epley JM. Particle repositioning for benign paroxysmal positional vertigo. Otolaryngol Clin North Am. Apr 1996;29(2):323-31. [Medline].
Baloh RW. Dizziness and vertigo. In: Samuels MA, Feske S. Office Practice of Neurology. London: Churchill Livingstone; 1996:83-91.
Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. Aug 1980;106(8):484-5. [Medline].
Chang AK, Schoeman G, Hill M. A randomized clinical trial to assess the efficacy of the Epley maneuver in the treatment of acute benign positional vertigo. Acad Emerg Med. Sep 2004;11(9):918-24. [Medline].
Froehling DA, Bowen JM, Mohr DN, et al. The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clin Proc. Jul 2000;75(7):695-700. [Medline].
Lempert T, Gresty MA, Bronstein AM. Benign positional vertigo: recognition and treatment. BMJ. Aug 19 1995;311(7003):489-91. [Medline].
Marill KA, Walsh MJ, Nelson BK. Intravenous Lorazepam versus dimenhydrinate for treatment of vertigo in the emergency department: a randomized clinical trial. Ann Emerg Med. Oct 2000;36(4):310-9. [Medline].
Massoud EA, Ireland DJ. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol. Apr 1996;25(2):121-5. [Medline].
Troost BT, Patton JM. Exercise therapy for positional vertigo. Neurology. Aug 1992;42(8):1441-4. [Medline].
Further Reading
Keywords
benign positional vertigo, benign paroxysmal positional vertigo, BPV, vertigo, dizziness, dizziness symptoms, dizziness treatment, inner ear, Hallpike test, Epley maneuver, lightheadedness, canalolithiasis theory, otoliths, Brandt exercise, Daroff exercise
near-syncope, dysequilibrium, disequilibrium, orthostatic hypotension, vasovagal episode, neurocardiogenic syncope, disorder of thevestibular proprioceptive system, labyrinthitis, vestibular neuronitis, nystagmus, torsional nystagmus, rotatory nystagmus, dizzy, head-hanging maneuvers, labyrinthine disease, otoconia, psychophysiologic dizziness
