Dix hallpike manoeuvre

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hi guys sorry i have 1 more question. still trying to figure out wat bppv is as I'm still stuck in bed. I've just been told to do the hallpike manoeuvre if that's how you spell it. he said if its positive meaning i get vertigo then i have bppv but my question is wat if the crystals in your ear are in the right place would this still cause vertigo because I'm quite sure I've tried this before and it didn't do anything but at the time i didn't have any symptoms and feeling good. would this be the sane case for eply manoeuvre? so should you only do these manoeuvres when you have symptoms of vertigo or other dizziness?

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  • Posted

    It's hard to see how one would perform the Dix-Hallpike maneuver on their own. Your eye movements, nystagmus, are key to determining where the loose crystals may be located. The person performing the maneuver would observe the movement of the eyes in order to determine which canal the crystals were located in.

    Vertigo is caused by the crystals, calcium carbonate, becoming dislodged from the walls of the inner ear canals and floating freely. They then cause vertigo because they disrupt the free flow of fluid against the hair like structures in the inner ear that allow our brains to sense motion. This causes mixed signals to be sent to the brain by the hair like structures and in turn causes the eye nystagmus. The involuntary movement of the eyes, nystagmus, results in vertigo.

    Doing the maneuvers without them being needed may or may not cause vertigo dependant upon whether or not you have crystals that are in the process of dislodging. I don't believe they would actually cause a dislodging. It is important to know which canal, as there are 3, may have dislodged crystals in order to perform the correct maneuver. If a procedure is performed incorrectly it is possible to move the dislodged crystals from one canal into another. Each canal performs a different function relative to providing information to the brain as to the position of the head during movement.

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    • Posted

      thank you so much for the reply. none if this is stated on the internet and i didn't realize their are 3 canals. mite explain my constant dizziness. fortunately i don't get vertigo when standing or walking even when moving my head i only get it when in bed such as sleeping flat or turning on my bad ear. i was feeling good yesterday until i did the eply but i suppose it could of been dislodged while sleeping with 1 pillow as for the past month I've been sleeping up right. i was thinking today i could have meniers or vestibular migraine as since the eply im still feeling dizzy but no vertigo. thank you so much for explaining this in detail. i did the hallpike with a friend I'm sure of it but once again i didn't have any symptoms at the time. ill need to perform this with the doctor but unfortunately i didn't get the vertigo when he did it and i don't always get it because i was very insure when to do it. meaning after ive had an episode of vertigo or whether to wait a day until i feel better.

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    • Posted

      If vertigo is caused from being flat and rolling over onto a certain side, I would think your issues are more related to BPPV. By having a specialist perform the Dix-Hallpike maneuver they will watch the reaction of your eyes to detect the direction of the nystagmus. The direction of the nystagmus identifies which of the 3 inner ear canals has loose particles. It can take multiple Epley maneuvers to get the dislodged crystals to exit the canal and fall into the utricle. Also, performing the Epley incorrectly can move loose crystals from one canal into another. The key is to rotate the head in such a manner that the crystals move out of the canals.

      If you Google the inner ear anatomy you will see the 3 canals that are part of each inner ear. They provide input to the brain as it relates to vertical and horizontal placement of the head.

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    • Posted

      thanks for reply. you have given me more information than my doctor thank you. and so doing the dix hallpike would the crystals need to be dislodged for it to cause vertigo and these eye movements? and its Been 2 days since i got vertigo from the eply and still feel spaced out and the feeling I'm on at boat which comes and goes is this normal? sorry for the questions you've been so helpful and more helpful than my own doctor. i think ill have to wait until i see a specialist my doctor told me to do eply and vestibular exercise and to check the internet on how to perform it. cant thank you enough 😃

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    • Posted

      When the Dix-Hallpike maneuver is performed, if there are loose crystals it is supposed to elicit the feeling of vertigo, so yes. That, the Dix-Hallpike, is the gold standard test for diagnosing BPPV. If you got vertigo from the Epley, it is similar to having the Dix-Halpike performed in that it causes any loose crystals to flow in the inner ear canal against the hair like structures that sense motion when the head moves. This is just like rolling over in the bed and having it cause vertigo. The issue with the crystals is that they disrupt the free flow of the fluid in the inner ear canals and bounce off of the motion sensing hair structures. BPPV is the major cause of vertigo elicited by head movement. The issue in treating BPPV is determining which inner ear canal is affected. Vertical canal BPPV produces vertical nystagmus. Posterior canal is upbeat, anterior canal (rare) downbeat. This is why I cannot understand why any physician would leave it to a patient to determine how they need to be treated.

      When I had the Epley performed it took me 2 or 3 days to get over the symptoms. After performing the maneuver you should not lay flat for 48 hours in order to allow the loose crystals to flow out into the utricle. Vestibular rehabilitation is of no benefit until BPPV is cleared. If your symptoms began by simply rolling over in bed to a certain side it would appear that you have BPPV, in my mind. Sounds like you need a new doctor.

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    • Posted

      thanks for the reply. I'm finally feeling a bit better this is day 3. my doctor didn't tell me any of that about laying flat for 48hrs. he told me to do the eply and vestibular exercises and i was doing these exercises after performing the eply because i had horrible dizziness afterwards.

      once again thank you for the advice much appreciate it and unfortunately it was a trainee doctor who i saw.

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