Habe BBPV, bin mir unsicher, ob ich das Epley-Manöver versuchen sollte

Ohren, Nase und Hals
1

I’ve had BBPV for the last two weeks, and am trying to decide whether or not to get the Epley Maneuver done. I would go to a physiotherapist as I would not want to try it on my own. I am hoping for any advice anyone can give!!

I should first mention that I’ve had vertigo three times before - once in 2016, once in 2017, and once last December. Those three times, it only lasted a few hours. It was positional but would be provoked by different head movements than my current bout. Those three times, I simply lay in bed in a “good” position until the vertigo went away on its own (i.e. until the head movements no longer triggered it).

My current bout of vertigo began two weeks ago (Jan 13). I woke up in the middle of the night, lying on my right. When I went to turn left, I felt the spinning and immediately recognized it as vertigo. So I turned back to the right and fell back asleep. For the next four or so days, lying on my right was perfectly fine, and getting up and going about my day was perfectly fine, but when I tried to turn left lying down, the intense spinning would start before I could complete the left turn, and so I would give up and turn back to the right and the spinning would stop right away. By the fifth day, fortunately, my condition seems to have improved somewhat. I can complete the left turn and it is only a few seconds after I reach the pillow with my left side that the vertigo kicks in, and it just feels like a lurch forward followed by a few seconds of vague, low-intensity spinning. Nothing like the intense, fast-beating spinning I triggered during the first four days.

Five days ago (Jan 22), I went to the dentist to get my teeth cleaned, and when I got out of the chair, I started feeling like my eyes were darting around as I walked to the bus stop. When I got home, I tried to lie down on my right and this triggered vertigo (like I was falling into the pillow). So I actually slept on my left that night (which I had been completely avoiding since Jan 13). The next day, I sometimes felt like I was swaying when I was walking, and felt heavy-headed and off-balance. But by Jan 24, the swaying was gone, walking was fine, and lying on the right was normal again. So, essentially, I’ve gone back to just the pre-dentist, left-ear vertigo, where turning left lying down triggers the lurch and low-intensity vertigo.

My guess is that I have left-ear posterior-canal BPPV, and that the dentist’s chair may have triggered a short episode of right-ear BPPV (not sure which canal).

I did go to a walk-in clinic and the doctor says it’s BPPV. He looked in my eyes with me walking and with me moving my head while sitting and he observed no nystagmus. But, he didn’t do the Dix-Halpike test or ask me to lie down and trigger the vertigo, so he didn’t observe me with vertigo. He prescribed Serc and suggested I go to physio for particle repositioning.

Fortunately I haven’t had any nausea this entire time. And, aside from the post-dentist time (1-2 days), I haven’t felt off-balance or light-headed.

Based on all this, I have some questions… If anyone has any advice relating to any of these questions, it would be very much appreciated.

  1. Does Serc actually do anything for BPPV? I haven’t tried it yet.
  2. Would doing an Epley maneuver for the left-ear pose any risk to the right-ear? It seems to me from the dentist incident that the right ear has loose otoconia too.
  3. I’ve been reading about residual dizziness (RD) that happens post-Epley and am very afraid of getting this if I decide to do the Epley. I already am prone to lightheadness occasionally, basically if I lean back too far while on the computer or when in meeting rooms where I work (something to do with the lighting I think). My blood pressure is on the low side of the healthy range and so I do get headrushes if I get up too fast. I’m also afraid that, since it’s been two weeks of BPPV already, I have a higher chance of getting RD from the Epley than if I had done the Epley straight away. What do you think?
  4. If you get RD post-Epley, is there anything you can do to speed up recovery? Like certain exercises?
  5. If I just wait out the BPPV (which I understand can take weeks, months, or even a year), would there be any chance of having RD after it? Or is RD only caused by the sudden absence of the otoconia in the affected canal post-Epley?
  6. If you decide to wait out the BPPV instead of doing the Epley, do you feel it gradually getting better? i.e. as each week goes by, would provoking the BPPV produce a less intense form of vertigo?
  7. I’m only sleeping on my right since it is the good side (for now). I wonder if it would be okay to sleep on my left, provided that I don’t turn into the left position. i.e., if I sit up from lying on the right, turn while sitting, and then go into lying on my left from a sitting position. Always lying on my right gets uncomfortable after a few hours. And, I’m afraid that if my right ear also is prone to BPPV, then always lying on the right will increase my chances of moving the otoconia in the right ear into one of the semi-circular canals.
  8. I’ve heard magnesium supplements might help prevent BPPV, what do you think?

Thank you so much for reading!

2

I have had right sided BPPV badly twice. The first time was quite severe and started as with you, when I turned my head in bed. I had the sensation of falling and had to grip the sides of the bed to keep stable. I also had nystagmus. I was meant to be chairing an interview panel that day and had to cancel. That first time, after diagnosis, I had the Epley maneuver done by a physiotherapist and afterwards, I was fine and did not have it again for four years. The second time, I went again to the physio- a different one who I don’t think was very up to date with Epley. It did not go away despite repeating it three times so I was referred to the hospital and saw an ear nose and throat consultant who called in medical students to witness the nystagmus which she said was classic. She made me close my eyes and do several walking exercises that were diagnostic. I also had an MRI of my ears which did not show anything sinister. She then proceeded to do a very vigorous version of the Epley and advised me to have it repeated within two weeks. Unfortunately, my next appointment was postponed by the hospital several times and eventually I was sent an appointment for a year later. This was because of a shortage of consultants at that hospital. So I never did get the second one in a two week framework and though the BPPV was considerable better, it had not entirely gone. Jump another three years and I have learned what provokes it and how to avoid it mostly. I did do some exercises for it and it kept it at bay, though I no longer sleep on my left side without triggering it somewhat.

I had pneumonia in November and they scanned my head. Incidentally, it turned out that I have Arnold Chiari’s malformation Type 1.You are born with it and it is rare (1 in 1000) but often found incidentally when you are scanned for something else. It is a condition where the lower part of the brain descends into the spinal column and it can obstruct the flow of spinal fluid. The symptoms include nystagmus and vertigo. Otherwise I have never had any other of the symptoms Chiair’s can cause luckily. I am now 76.

So, I’m unsure whether the BPPV which was carefully diagnosed might have just been symptoms of the Chiari’s or whether I just have both. The BPPV is supposed to be self limiting and mine has never completely vanished though it really does not bother me much now. I rarely sleep on my right side for long and I try not to look upwards and to the right as this can trigger it and I begin to feel the sensation of vertigo starting.

Not sure if this helps. It can be frightening and make you feel sick when you have it . If you go to a physio, make sure they really do know how to do the Epley maneuver properly.

3

Absolutely you should perform the Epley Maneuver. It is simple and why would you wait? I would just recommend a Dr. or practitioner that uses this regularly with lot’s of experience. Eventually you will be likely able to do it yourself but starting out have them do it.

4

Should go see a neurotologist to find out why it keeps coming back. bppv is usually a symptom. like when you had a cold or a infection. my doc says it shouldnt last that long. episodes of vertigo that last more than a few minutes are probably being caused by something else.

5

Hello Rebecca
I have had BPPV a few times and the only thing that has helped me is my ENT or physical Therapist performing Eply Maneuver. It has help me recover faster with vertigo, dizziness and the spinning. Don’t do it on your own have your ENT or a therapist do it.

I hope you feel better. :sunflower:

6

Your post sounds like I should has written it.

I get bppv seasonally. Usually March/April and then again in Sept/Oct. Got to wonder whether weather has something to do with it. Yes, it will go away on its own, but why would you suffer. Mine usually last between 2 weeks and 6 weeks. It sure is not nice. The last time I had it, I waited 2 weeks, and then went to see a physiotherapist. He did the proper checks on me, and was able to tell me which canal it was in. Type of Maneuver is determined based on which way your eyes move.

It helped immediately, but I did have the lasting off balance feeling for some time, but I was good with that. Much easier to handle than the other.

I am hoping that since March is approaching I do not experience this, but time will tell

7

I meant to tell you also, that one time I went into a walk in clinic. The doctor checked me and told me yes it is bppv. He went over to his laptop and printed off the exercises for me to do at home. |He told me he was to busy to do it. Can you imagine???I just looked at him and walked out. Idiot???\

Alsi, I have had Serc over the years, and always have a supply. Not for bppv, but my doctor does give it to me for bppv. For me, it really does not help, so I do not bother with it. Serc is for meniere’s disease

8

Thank you very much, everyone, for your responses! I really appreciate it. I hope you are all doing okay now.

Angie and David - Fortunately there are some physiotherapists in my area who apparently specialize in vestibular rehabilitation, so I’m hoping they are well-versed in the Epley maneuver! I guess the doctors at my walk-in clinic don’t perform it. I don’t want to try it by myself for the first time.

Lolasmom - First, thanks for confirming my suspicion that Serc is probably not that helpful for BPPV. Second, you mentioned that you had the off-balance feeling (“Residual Dizziness”) after the maneuver. How long did it last and how bad was it? This is the main reason I’m hesitating about getting the Epley done! I’ve read that it’s a feeling of lightheadedness or unsteadiness that can last for weeks, and can be constant or intermittent. I’m afraid of getting it and not being able to concentrate at work. Currently, I feel 100% fine at work because I don’t have any light-headness or off-balance feelings with the BPPV. My only symptom is vertigo when I try to turn left lying down.

LynQ and Waffalobill - After reading your posts, I think it would be a good idea for me to see a specialist even if I get rid of this bout of BPPV, to see if there’s an underlying cause of the BPPV.

9

rebecca you should see a specialist. all of these general doctors say its BPPV-its all they know. they tell you that you will get better with time. i had been diagnosed with BPPV, then vestibular nueritis, now i have a correct diagnosis vestibular migraines. it may be BPPV- but there are so many other causes. i suggest finding a dizzy clinic in your area. seeing a nuero-otologist. otolaryngologist. regular nuero know zip. ENTs are limited. you should at least have MRI and catscans to rule out the most serious then things can be narrowed down. so many people here have been misdiagnosed. blood work should have been done. you should have caloric testing. and yes- the epley should be done. with me- it didnt work. people kept asking me why i still had vertigo weeks later because they had it and did the epley and it was gone. this was my first clue i was not disgnosed properly. my PCP-had never heard of anything other than BPPV

10

Hi there,
Once I had the maneuver done, I drove home on my own. I felt the off balance feeling probably for a couple of weeks, but each day it got better.
I would rather have the off balance feeling than the vertigo. Mine was also positional. Turning in bed, sitting up in the morning. Also if |I was having a bath, and laid down with my head in the water, that was tough.

After I had the maneuver done, I returned 2 weeks later. He redid the testing and there was no more vertigo.

I have suffered with this for a few years, and as I mentioned it was something I had in the spring and the fall. I am most anxious to see whether I get it this March/April. If I do I will not wait like I have done in the past. I will go for treatment right away. It is expensive where \I live, but I do not care. \It just seems ridiculous suffering for 6 weeks until it settles on its own. Never again

11

Thanks everyone.

I went to the physiotherapist on Wednesday. We did the Dix-Hallpike test as well as the test for lateral canal BPPV, and the tests were negative for both ears. She used the video goggles and observed no nystagmus, even though I felt vaguely dizzy during the left ear Dix-Hallpike test.

Unfortunately, when I sat up after the left-ear Dix-Hallpike test, I felt exactly the way I did after getting up from the dentist chair last week. My walking became unsteady, I felt as if my eyes were not tracking movements properly when I walked (especially when going downstairs), and I had that “swaying like on a boat” feeling in my head. When I went to lie down at home, as I went to lie down on the right, it felt like I was falling onto the pillow. Sitting up from that position made me feel the swaying/heavy-headedness. So since Wednesday, I am sleeping on my left to avoid this. I hope this stuff clears up, because it did clear up last week a couple of days after the dentist triggered it.

If that goes away, then I’ll just be left with the short-lasting lurch/vague dizziness feeling whenever I turn left on the pillow. The PT thinks this is probably a conditioned response as a result of the vertigo. It seems that my true vertigo only lasted from Jan. 13th to the 17th or so, and that the mild lurch and vague dizziness since Jan 17th when I turn left is just leftover, residual dizziness from that. I hope this will go away eventually. The PT said it would be okay to sleep on my left, because if it was BPPV, the crystals must have fallen out by now, considering my negative test results.

I will need to do some blood testing and get a referral to a neurotologist (I hope) so we can figure out why I got the vertigo in the first place, and why putting my head in that dentist chair/Dix Hallpike position triggers days of unsteadiness as well as difficulties getting into and out of a lying-on-the-right position.

The PT says it may have been BPPV, or maybe vestibular migraine.

12

Thanks hmoosey. Can vestibular neuritis be position-based like BPPV?

13

Thanks Lolasmom. I hope you don’t get it again as March/April approaches. Mine doesn’t seem to be seasonal, but possibly tied to my menstrual cycle…

14

what i know from when i was misdiagnosed with it, yes, it can affect one ear, a viral infection in a nerve in your inner ear. moving your head ect can cause dizziness, laying on one side may give you comfort versus the other side sends you in a tailspin. this is what the doctors told me when i was diagnosed. but i was misdiagnosed. moving just my eyes (not head) up and down or left to right would cause dizziness. shaking my head, tipping it back, vertigo. seeing the floor on the wall. but again i was misdiagnosed. first diagnosis BPPV- in the hospital. few weeks later, i was worse, back to hospital, diagnosis VN- given steroids. i was admitted for 4 days couldnt control the vomitting. dehydrated and serious vertigo. i went 3 months with trying the epley and other manuevers. didnt work. PT, chiro, doing them. all my symptoms from VN- matched vestibular migraines. BPPV- most people get the maneuver, and begin to settle and feel better. people who had BPPV- kept saying to me why arent you better, i had it, had the manuever, and was ok after. my PT- would do the manuever, she would say my symptoms were confusing her. My ENT- did it too and said my eyes were not reacting like someone with BPPV- that was the first sign that i was not diagnosed right. but yes, i was told because its an infection in one ear, you will feel worse on that ear. you will naturally keep your head leaning to one side, trying to stop the dizziness. my ENT- ordered a second catscan to focus on the small bones in my inner ear to see if they were wearing down. nope. my suggestion is really to try the maneuvers and see if you respond. PT- was helpful but you need to find a vestibular PT- they can do the epley and watch the reaction of your eyes. if it isnt BPPV- your eyes will show differently than someone who has it. there are so many different causes. BPPV- is the first thing they all say, its really the only thing they know. except for the specialists in the vestibular field. it took me 3 months of hell to get the right diagnosis, others here have taken years. so my suggestion is to not just accept the BPPV- its an easy out for a PCP- but rather try to find a specialist that i mentioned. the otolaryngologist that treats me now also has done the epley to watch my eyes. it was clear to him not BPPV.

15

i had docs brush me off saying bppv for 10 years. its so frustrating. repeat tests over and over. just wouldn’t admit they didnt know. finally it just wouldnt go away. vertigo and dizzy every day. turned out to be menieres. took a neurotologist to figure it out.

16

hmoosey, I hope you’re doing better now, that sounds awful.

I hope I can see a specialist soon to make sense of this. Basically, my spinning vertigo was only from Jan 13-17 and only when turning left in bed; since then, there’s a brief shadow of that vertigo when I try turning left in bed. But ever since doing the (negative) Dix-Hallpike test for BPPV on Wednesday, I feel dizzy (kind of like I’m falling) for a few seconds when I go to lie down on my right. That’s what I find really bizarre. During the actual days where I had spinning vertigo (Jan 13-17), there was absolutely no problem with lying on my right!

At least I think lying on my right is getting a bit better compared to Wednesday. I was a bit unsteady walking on Wednesday after the Dix-Hallpike and on Thursday, but since Friday or Saturday my walking now seems to be fine again.

The next time I have a vertigo attack (assuming there is a next time… there probably will be :frowning: ), it will be important to have someone check my eyes for nystagmus to see if it’s BPPV! But I’m afraid of the Dix-Hallpike test now. I’d never heard of anyone feeling dizzy because of the test. But at least I do seem to be getting better compared to Wednesday.

17

its just unbelievable the incompetence out there. there are so many of us. when this happened to me i thought i was alone. i am not. im glad you got to the right doctor who could help you. everyone always days BPPV- i started questioning things when it was weeks and people were saying why do you still have vertigo? thry had bppv and it went away quick. i hope you are on your way to recovery. i spent 3 months in hell with bad diagnosis. i thought i was going to die. i dont know how you suffered for 10 years.

18

rebecca, i am recovering now. i had what you describe. i would feel like i was falling in bed when i turned. i was dizzy most of time when i wasnt experiencing vertigo. do you have brain fog? trouble finding words, tripping over your feet? dont be afraid to question these doctors BPPV is all they know until you get to the right specialist.

19

its been 12 years now. still struggling. there’s no cure for menieres disease. had needles stuck threw my ear drums fir gentamicin injections, that did nothing. last march they drilled a hole in my head and put in a shunt. aka endolymphatic sac decompression. so far its a little better but still spend most the day in bed.

20

waffalobill- that is just absolutely horrible. i know how debilitating this is. i feel so grateful that i am on medication that has helped. i cannot imagine 12 years of this. may i ask why they decided to put a shunt in? may i ask have they ever tried an anti depressant like i am on to help. i was checked for menieres twice and both times was told no. back then, strange but true, i was hoping for a yes on any disorder just so i knew what the hell was going on.