BPPV Dix-Hallpike findings without Vertigo

Hi Kate

Do you know if you could have BPPV without the eye movements or is it the eyes that confirm you have it when you have the hallpike test. I've been told I have Vestibular neuritis but when I lie down I feel very dizzy like I'm on a boat and sometimes I feel as though there's a bigger 'wave' that makes my stomach lurch. It's as if I'm going to get really dizzy but it doesn't happen if that makes sense?

I've been really messed around with ENT being told I had crystals then a month later told i hadn't. Only just realised last night I hadn't even had the Epley done but just talked through the Brandt daroff exercise with the Dr standing away from me. Just because I felt dizzy doing that he confirmed BPPV and never looked at me eyes. A month later I had the dix hallpike test done and a different ENT said I didn't have BPPV. Then months later an audiologist told me to do the Brandt daroff exercises in case I have any debris left? Not crystals but debris?

Anyway now I'm seeing a physio and doing VRT. I just want to be sure I haven't got BPPV.

Thanks

Pinky x

Hi I bave VN and BPPV

The cross over of symptoms makes it hard to decided what's causing what but yes you do need nystagmus if u have the crystals

What you describe is perfectly normal for both in my bad days and on a bad day I feel I get into bed and i am on a boat.

So the crystals do not have to be present each time you are tested they can come and go i went to see my consultant last year and I know I had them the night before but on testing the next day was negative.

Debris is another word used for the left over damage that the crystals cause when in the wrong canal as your brain will automatically start to cope with crystals in wrong canal then when they are moved the brain then starts again.

No one should offer you any excercises without testing, I read on here lots of people swaping excercises but everyone's ability to compensate is different and doing the wrong excercises will make it all worse.

My VRT will be different to someone else's.

Where are you in the country ? If you are in the uk?

When you start your VRT it will highlight if you have crystals still is will soon become apparent on head movements.

If you can get the bppv under control you will have a much better chance of compensating.

VRT does work it's a long long road and one step forward 20 steps back and if you have the right excercises you will feel worse to start with but do carry on and push on through.

I used to see my consultant weekly and say I felt so bad he would say " good good I'm glad the worse you feel the better it is " !

Thanks so much for your reply. That makes so much sense.

Yes I'm in the UK and have been seeing my VRT physio since September.

The VRT does make me feel slightly worse and like you said, that's a good sign and shows it's working.

When you said about the head movements would show if I have crystals do you mean I would have nystagmus when doing them?

No not unless u did them with your head hanging off the bed lol

If you have the VRT where u stare at a point and move your head left to right you will often get dizzy as you turn your head or as you get to the left or the right the point u stare at May bounce a little to.

U can check your own crystals as long as you have some one to look in your eyes but I wouldn't get to hung up on the nystagmus u need to focus on your progression and VRT.

I have a dizzy friend who's crystals shred every day she has the the ear canal plugging twice and now they have come in another canal she epleys sometimes 4 times a day.

For me I had a 3 year break without them and I got to 80% compensation on my VN it was amazing !!!! I then got sick and all kinds of stuff and i de compensated massively and the crystals came back. Mine come and go as they please i have been having months of dental work which does not help.

Things I avoid:

Washing hair over bath

Putting head to far back in shower

Having hair wash at hairdressers can bring mine Back

Looking down at an angle for to long

I try not to look up much at all i walk backwards till I can see what I want.

Swimming under water

swimming full stop but that's my choice.

Sleeping is a tough one I used to have 6 pillows and now have 3. My left side is my bad side so I sleep on my right or on my Back.

I know when I have crystals on left the minute I try and lay on that side with the false motion and falling feeling sometimes I wait it out other times I move.

Evening and in bed are maybe my worse times same as morning they can sometimes be the same.

Where r u in uk?

As I'm sure that you know, the Dix–Hallpike test is performed with the patient sitting upright on the examination table with the legs extended. The patient's head is then rotated to one side by approximately 45 degrees. The clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension. This extension may either be achieved by having the clinician supporting the head as it hangs off the table or by placing a pillow under their upper back. The patient's eyes are then observed for about 45 seconds as there is a characteristic 5–10 second period of latency prior to the onset of nystagmus. If rotational nystagmus occurs then the test is considered positive for benign positional vertigo. During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closer to the ground. The direction of the fast phase is defined by the rotation of the top of the eye, either clockwise or counter-clockwise. Home devices are available to assist in the performance of the Dix–Hallpike Maneuver for patients with a diagnosis of BPPV.

Positive test

There are several key characteristics of a positive test:

Your doctor will carefully observe any involuntary eye movements (nystagmus) that may occur during this test to determine if the cause of your vertigo is central or peripheral. Central vertigo is caused by a problem inside the brain, and peripheral vertigo is caused by a problem with the inner ear or the nerve leaving the inner ear.

Latency of onset (usually 5–10 seconds)

Torsional (rotational) nystagmus. If no torsional nystagmus occurs but there is upbeating or downbeating nystagmus, a central nervous system (CNS) dysfunction is indicated.

Upbeating or downbeating nystagmus. Upbeating nystagmus indicates that the vertigo is present in the posterior semicircular canal of the tested (lower ear) side. Downbeating nystagmus indicates that the vertigo is in the anterior semicircular canal of the contralateral (upper ear) side.

Fatigable nystagmus. Multiple repetition of the test will result in less and less nystagmus.

Reversal. Upon sitting after a positive maneuver the direction of nystagmus should reverse for a brief period of time.

To complete the test, the patient is brought back to the seated position, and the eyes are examined again to see if reversal occurs. The nystagmus may come in paroxysms and may be delayed by several seconds after the maneuver is performed.

Negative test

If the test is negative, it makes benign positional vertigo a less likely diagnosis and central nervous system involvement should be considered.

Advantages

Although there are alternative methods to administering the test, Cohen proposes advantages to the classic maneuver. The test can be easily administered by a single examiner, which prevents the need for external aid. Due to the position of the subject and the examiner, nystagmus, if present, can be observed directly by the examiner.

Limitations

The negative predictive value of this test is not 100%. Some patients with a history of BPPV will not have a positive test result. The estimated sensitivity is 79%, along with an estimated specificity of 75%.

The test may need to be performed more than once as it is not always easy to demonstrate observable nystagmus that is typical of BPPV. The test results can also be affected by the speed the maneuver is done in and the plane the occiput is in.

Haha I'm imagining doing my VRT that way!! 😀 I think you're right and stop stressing and just focus on VRT and getting better.

Getting up to 80% must have felt fantastic and you'll get there again.

I'm in rossendale, Lancashire. What about you?

And thanks so much for all the info you've given me.

Pinky x

Wow thanks Terry. That's so informative. I got really panicked last night. I've seen quite a few in the medical profession about this as I know people on this forum have. I realised I have never had the Epley performed even though about 5 months in I was told I had BPPV. I've always worried what the Dr did wasn't the Epley and realised last night it was the Brandt daroff exercise he talked me through.

I panicked thinking I haven't been diagnosed correctly and if I would have had the proper treatment I might be cured now!! But I think from yours and Kate's postings I haven't got BPPV.

How are you? Are you over your virus and getting better?

Thanks again for the advice and info!

Hi it's all about VRT and keeping positve which on a bad day is damn hard !

I am in Poole Dorset.

Hormones will maybe pay havoc with your dizzies to .

I have a 7 yr old and got VN and BPPV at 7 months pregnant saw 2 Drs an an ENT who had no idea so i did lots of research and luckily found my consultant known him 7 yrs now is the best in UK, he, the physio and my determination got me far, I used to have to crawl to my daughter as a baby as I couldn't stand un aided was hell BUT the good days make every bad day better.

I still worry and panic and tend to go out with someone with my daughter most of the time just in case but on a good day i do far far far to much and pay the price !

Friday night I went out of dinner 4 hrs wearing heels to was busy lots of movement etc but I was just fine however Saturday I couldn't walk straight and felt sooooo bad but picked up in the afternoon.

Always try to keep doing a little every day try not to lay in bed, when you feel dizzy and horrid keep pushing on through don't let the brain accept those dizzy signals as correct by laying down, if something makes you dizzy do it more.

Happy to help and support and give advice if I can.

Walls feeling like they are moving - normal

Objects tend to Bob about - normal

Gaze stabilision - VRT good for this

Nausea - so normal keep extra strong mints with u always !

Walking in different shoes, soft stuff like sand - awful hate it.

I am starting my VRT wearing high heels 4 times a day for 15 mins so I can get used to them again - extra strong mints at the ready !

Thanks so much for all the advice and support Kate. You've come so far and I wish you the very best.

Good luck with the VRT in your heels too!! I try to wear different heel heights too for work.

I always carry stemetil even though I haven't taken any since last March but they're in my bag just 'in case'!! I also have Gaviscon tablets for the nausea which I find help.

Thanks again and take care x

No prob I don't write much un less something catches my eye as your post did.

Good idea with the heels.

Have a fav saying my dizzy friend told me :

Run or walk, crawl if u must but don't u quit.

Fingers crossed for you you will get there.

I had a great day today did my usual far to much so now on he mints and resting!

I carry Sturgeon with me as a just incase to!

As far as the VRT excercises go, I assume any exercise that evokes dizziness that will challenge your brain to compensate for it would be good, but that's again my assumption. I don't see how any could be "incorrect"... it's just if they work for you or not.