Tips to get rid of vertigo......

Conservative Treatment:

Vertigo treatment focuses on treating the underlying condition.

• If caused by drugs, stop using them is usually enough to relieve vertigo.

• If caused by benign paroxysmal positional vertigo (BPPV)., the most effective treatment is through canalith repositioning procedure, also known as Epley maneuver. This procedure involves a series of maneuvers (moving) head to remove calcium deposits from the posterior semicircular canal to the other parts in the ear canal.

• Vertigo can also be treated with vestibular rehabilitation therapy which involves a series of specific exercises guided by a physical therapist that is designed to minimize dizziness. The effectiveness of treatment depends on many factors, including age and health condition of the patient, the severity of the condition, and the patient's cognitive function.

• If vertigo is caused by a bacterial infection, antibiotic ear drops may be prescribed.

• If caused by Meniere's disease, taking diuretics and reducing salt intake can help reduce complaints.

• Additionally vertigo disorders can be reduced by taking enzyme Bromelain, Magnesium, Vitamin B12 which serves to regulate the balance of the nervous system. Ginger and Ginko is also very useful to improve circulation to and within the brain.

• For the case of vertigo that still light, aromatherapy is helpful to stabilize the nervous system, both inhaled (breathed in) or massage.

• Have a healthy diet that is low in sodium and sugar. Make sure you get your essential vitamins and minerals. If you are doing salads, add lemon peel to boost that vertigo-fighting meal.

• Lastly, talk to your doctor about the best treatment. Each individual may have a different case and require different types of treatment

• Suppression of the vestibular system by Labyrinthine sedatives.

•  Suppression of patient’s emotional reaction by mild tranquilizers.

• Wait for compensation. Compensation can be hastened by specific vestibular exercises.

•  Acceptance of the problem and using appropriate aids like walking stick.

Tips to overcome the vertigo attacks quickly

1. Sleep with your head a little high
 
2. Get up slowly and sit down before you got up from the bed
 
3. Avoid bending position when lifting objects
 
4. Avoid tilting the head position, for example to take an object from a height
 
5. Move your head carefully if your head in a flat position (horizontal) or when the neck in up position

physical therapy,goals,outcomes,and interventions:

• bed rest: brief ,useful during initial stages only;prolonged bed rest may delay recovery.

• implement safety measures;teach sensory substitution,compensatory strategies ;provide ambulatory aids as indicated;eg:cane ,walker.

• provide active exercises to promote vestibular adaptation[recalibration of system]

1.  habituation training:  repetition of movements and positIons that provoke dizziness and vertigo.

encourage movement; engage VOR and VSR as much as possible.  

                        

• eye and head exercises:eg; eye movements up and down,side to side;head movements up and down,side to side progressing slow to fast .                                                                                            

• exercises to improve postural stability;sitting and standing ,static and dynamic activities.eg:bending forward,turning,swiss ball exercises.

• emphasize functional mobility skills;walking,turning,stairs,community activities,activities with spatial and timing  constraints.

• relaxation training; decrease anxiety levels

• begin conservatively ,avoid excessive exacerbation of symptoms.

• recovery is better,generally faster in unilateral than bilateral vestibular dysfunction

• provide psychological support and reassurance. 

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness, most often 
 experienced when patients lies down.

Because BPPV is not intrinsically life threatening and symptoms are usually self limiting patient is usually kept under watchful wait but as BPPV can last for much longer than 2 months, it is better to treat it actively by Epley maneuvers or Semont Maneuver.

The Semont and Epley maneuvers may improve or cure benign paroxysmal positional vertigo (BPPV) with only one procedure however some people may need multiple sittings.

CRP / Epley maneuver/  Canalith repositioning procedure




The Canalith Repositioning Procedure (CRP) or epley’s maneuver is a rehabilitation treatment for Benign positional vertigo.  CRP is very effective, with an approximate cure rate of 80%. The recurrence rate for BPPV after these maneuvers is low. However, in some instances additional treatment may be necessary.

Canalith/otolith/or otoconia are small crystals of calcium carbonate attached to the otolithic membrane in the utricle of the inner ear. Because of trauma, infection, or aging, canaliths can detach from the utricle and collect within the semicircular canals. Here these canaliths shift with the head movement  and stimulate sensitive nerve endings to cause dizziness.

Epley’s maneuvers 

 involve a series of specifically patterned head and trunk movements performed by a trained professional. This head position change, moves the canaliths from the problematic location in one of the semicircular canal to the utricle.

Procedure: The procedure takes approximately 20-30 minutes.

You will be placed on a table and then laid back with your head hanging over the end of the table.

If you have a “positive” response in this position you will then be moved through the procedure.



A. Patient is placed in sitting position on the edge of the examination table (Position A).

B. Head is rotated 45° towards the affected ear, and the patient is swiftly placed in lying position with the head hanging 30° below the horizontal over the table edge (Position B). Positive response (primary stage nystagmus) is observed position is maintained for 1-2 minutes.

C. The head is rotated 90° towards the opposite ear while maintaining the head hanging position. (Position C)

D. Patient is turned further 90° towards the unaffected side to face the floor. (Position D)
The patient’s eyes are observed for secondary-stage nystagmus, it should be in the same direction as the primary-stage nystagmus.

E. Position is maintained for 30 to 60 seconds, and then again laced in sitting position (Position E). Upon sitting, there should be no vertigo or nystagmus in a successful maneuver.


Instructions Following the Canalith Repositioning Procedure

Wait for 10 minutes after the maneuver is performed before going home. Don’t drive yourself home.
For first 48 hours–

1. Do not tip your head up or down or bend at the waist. Use of the cervical collar will help prevent you from tipping your chin down.

1. Do not visit the places that require you to lie down or tilt your head (hairdresser, dentist, chiropractor or barber).

1. Avoid tipping your head up or down when brushing teeth, shaving or washing your hair.

1. Sit down and get up from chairs while keeping your back straight, without bending forward and avoid tilting your head forward.

1. Housework such as cooking or cleaning should be avoided for the next 48 hours.    

Do Not Lie Flat in Bed: 

 

Sleep semi-recumbent for the next night. This means sleep with your head halfway between being flat and 

upright (a 45 degree angle) by using a recliner chair or by using pillows arranged on a couch

 
 The Following Week:

• Do Not Sleep on your treated side

• Use two pillows when you sleep.

• Avoid sleeping on the “bad” side.

• Don’t turn your head far up or far down

(Like head extended positions at the beauty parlor, dentist’s office, and while undergoing minor surgery).

• No “sit-ups” for at least one week and no “crawl” swimming.

After 1 week you can resume your daily activities without any restrictions. Move around as you wish.

 
Contraindications to perform Epley Maneuver

• Unstable heart disease

• High grade carotid stenosis,

• CNS disease (stroke or Transient Ischemic Attack),

• Physical limitation– neck disease (rheumatoid arthritis, cervical radiculopathies, ankylosing spondylitis, cervical spine fracture or surgery)

• Pregnant women beyond the 24th week of pregnancy  

 

 

 

 

 

 

 

Semont Maneuver

The Semont maneuver (liberatory” maneuver) involves a procedure whereby the patient is quickly moved 

from lying on one side to lying on the other side.

Position 1. Patient is made to sit on the examination table with legs hanging over the edge and head turned 45 degrees horizontally towards the unaffected ear.

Position 2. While maintaining head rotation patient’s upper body is swiftly moved to side lying position on the affected side with head resting on examination table and nose pointed upwards. Position is maintained for 3 minutes or till vertigo and nystagmus subsides. This step moves the debris to the apex.

Position 3. Patient is rapidly moved through the sitting position (Position 1) to lying on the opposite or unaffected side (maintaining same head rotation) with nose pointed to the ground. Position is again maintained for 3 minutes or till the vertigo and nystagmus subsides. This maneuver moves the debris towards exit of the canal.
Idea is to move the debris into the utricle where it will no longer cause vertigo.
Semont maneuver is 90% effective after 4 treatment sessions


 Home exercise:

Brandt daroff exercises:

                   

 
                              

 vestibular suppressant medications :prolonged use may delay recovery ;severe cases may require ablative surgery

Surgical:

It is rarely used. It also depends on the cause of Vertigo. It is indicated in cases resistant to Conservative management. The various options available are Vestibular nerve section, and destruction of balance organ in the inner ear (labyrinthectomy) by chemical or surgical method. If the cause of Vertigo is an Intracranial then the disease is treated accordingly

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