Vertigo and Epley Maneuver

Thank you for your response. I saw a neurologist last week and he did some tests and said my right eye was twitching when I laid back and looked to the right. Laying in bed brings on vertigo worse. He showed me how to do the maneuver in the office and I felt better for a few days and now feel worse. 

Well, in that case I suppose it could be BPPV. Don't you get very dizzy and start falling when you stand up and tilt your head backwards and to the affected side though? That would be the norm with this condition. (If you're going to try this, make sure you're holding on to something solid!)

I hesitate to argue with a neurologist, but I still don't think the Epley should be self-performed. I'm also a bit puzzled about the pain in your ear, as BPPV doesn't cause any pain as far as I know.

There's an alternative to the Epley called the half-somersault manoeuvre, which is said to be suitable for self-administration as it's not as sensitive to exact timing as the Epley. You can google it. A couple of people who post on these boards swear by it, so it might work for you. I have to say I tried it during an attack of BPPV a year ago and it just made me feel very sick for a few minutes afterwards. I finally got an instant cure when a vestibular physiotherapist performed an Epley under control of infrared video goggles.

I hope you can find a solution.

Thank you for your response. I will call vestibular therapy on Monday to get an appointment. I felt so much better for about 3 days then today I’ve felt much worse. Maybe a side effect of the epley? When I did the dix Hall pike test today I was not dizzy as before. Now I feel like I am on a boat 

See my reply of a few minutes ago, which crossed with yours. It's normal to feel woozier than before for a few days after a successful Epley. Still not a bad idea to have a session with a vestibular specialist though.

Good luck!

I did the maneuver for 3 days and felt so much better but the 4th day I felt so much worse. Maybe the Chrystal’s are moving in my ear? I am hesitant to continue the maneuver. I probably haven’t kept my head super still but I do sleep propped up 

Normally the Epley will work first time if it's been done properly. Once the crystals get back where they're supposed to be, they should stay there. It isn't really intended for regular use.

The physio who performed mine told me to keep my head very still and stay upright for at least 12 hours afterwards. He also told me I had to sleep on the unaffected side for the whole of the first night - which took a bit of arranging.

The spinning attacks stopped immediately, but the sensation of being on a boat actually got quite a lot worse for the first few days after the Epley. However, the physio had warned me that I'd feel "a bit drunk" for a while, and it soon settled down.

 

That is a good point. I tried to preform the test myself and when I did, I felt equally dizzy on both sides. I did the maneuver for the right the first day, and the left the second and third day 

Bill is right. You could be really messing up if you're doing it randomly on both sides without knowing which ear is affected. You won't do yourself any lasting harm but you risk making yourself feel terrible. 

Since you say you have an appointment with a vestibular specialist, I'd advise stopping all "self-help" for the time being - which I'm sure you already have.

The real go-to for vestibular problems is a neurotologist (trained both in neuro and related areas of otology) but usually the next best is a specialist vestibular physiotherapist. The latter are expert in diagnosing whether or not it's BPPV, treating it if it is, and referring you to the right place if it's not. A few ENT doctors have experience in vestibular problems, but the evidence from these boards (and certainly my own personal experience) is that depressingly few know anything about this area.

Go and see your vestibular specialist, whatever his/her discipline, and I'm sure you'll get the best results.

Oh, and don't forget to come back here and tell us all how you got on!

Neurologist is a brain doc. Neurotologist deals with brain and connections to it from ears and vestibular system. If all others fail, he's the doc to see. The therapist should be able to tell you what side is bad. More so than a ENT. They deal with it every day. Very well trained. They told me what side was causing my problems when others had no idea. When my issues first started it wasn't so easy to tell. If the issue is in your right ear and you do the epely for your left, it can move the crystal deeper into the wrong spot. They get caught in the hairs and cause the false responses. If it can't be easily corrected it could take months to retrain your brain to deal with it or move it to a spot it won't cause the issues. Been dealing with these issues for 12 years. Seen alot if docs and 3 therapists. Currently seeing a neurotologist myself. These guys make a regular ENT look like an idiot.

Good point. I read that doing the epley to both ears can’t harm anything, but I certainly think that it can make it even worse. I was first told a few months ago I had vertigo on my right side to I preformed the maneuver on the right. However I felt super dizzy on the left also, so I did the maneuver twice for that side. I’m not sure if this is something that gets worse before it gets better or if it is actually worse now 

The therapist can do the hallpike. If it's not conclusive they have other tests will tell them what side it is. Docs won't go the extra mile like they do.

Very true!

I made the mistake of seeing an ENT doc at the start of my BPPV episode a year ago. He didn't bother to take a history, didn't want to hear about vertigo, and "communicated" via a series of caveman grunts. He looked in my ears, ordered his nurse to flush out a plug of wax from one ear, then had me do a hearing test. (Within just a minute or two of the irrigation, so it wasn't too successful on that side.) When I went back in for the second half of what was a total 5-minute consultation, I asked him about the vertigo again, and was rewarded with his first fully-articulated words: "The consultation is over". His student grabbed me by the arm and led me out of the room.

An excellent physiotherapist, recommended by my GP (PCP) diagnosed and fixed BPPV in a 20-minute session several weeks later. He told me he did upward of 30 Dix-Hallpikes a week, about a quarter of which were positive for BPPV, which he then went on to treat with the Epley or occasionally other manoeuvres.

Your last comment made me laugh.  The consultant neuro otologist told me similar saying I had wasted the past 2 years seeing ENT and now it was going to take me that much longer to recover after wasting my time with them.  What can you do at the time though when you don't know any better?

The thing is you can't just get a app with neurotologist without a ENT referral. Where I live you can't even find one. I have to go a hour and a half away to get to one. I saw neurologist he wanted to refer me to a neurotologist in Boston. I live in NY! My ENT said there's closer ones. Lol. Didn't take me to long to figure out most ENT docs are general practitioners. Most insurance companies won't pay for a neurotologist app if your primary refers you. They will want you to see a ENT first. My insurance does not require a referral to see a specialist. But my specialist does require a referral. So either way your stuck playing the game.

I know, you have to go all around on the merry go round to get to see the right person here too in the UK.  It took 2 years on the merry go round for me to get pointed in the right direction.  I was extra dizzy by the time I got off it and finally saw someone who might help. I think I read on here about neuro otologists. 

I went to my GP and asked to see a neuro otologist and he said he'd never head of that one but referred me anyway so it must have got to the right department.  When I saw the neuro otologist he said I had 2 conditions going on silent migraines and BPPV and not to get the 2 mixed up.  This was good advice to me as I thought it was all due to BPPV.  I was getting the visual aura of silent migraines and dizziness/balance issues and thinking it was all due to BPPV.

I know you have to go all around on the merry go round to get to see the right person here in the UK too..  It took 2 years on the merry go round for me to get pointed in the right direction.  I was extra dizzy by the time I got off it and finally saw someone who might help. I think I read on here about neuro otologist. 

I went to my GP and asked to see a neuro otologist and he said he'd never head of that one but referred me anyway so it must have got to the right department.  When I saw the neuro otologist he said I had 2 conditions going on silent migraines and BPPV and not to get the 2 mixed up.  This was good advice to me as I thought it was all due to BPPV.  I was getting the visual aura of silent migraines and dizziness/balance issues and thinking it was all due to BPPV.

What was your diagnosis eventually?  Hope you're feeling improved.

Was being treated for bppv for 11 years with no relief. Therapy wasn't working at all. Meds very little. Finally got to the point I been getting vertigo every day and dizzy 24/7. Finally referred to neurotologist. Diagnosed with menieres. Doc said without a doubt I have it. Why other treatments did nothing.

Sorry to hear, awful,  long time to be left with Menieres undiagnosed.  Is there a treatment that you found helped you after getting the diagnosis?

Tryed diuretics. Tryed inner tympanic gentamicin injections. Going in to have a shunt put in for endolympahtic sac decompression.

Bill, that's criminal! How could they have thought you had BPPV for 11 years?

Granted, it does take longer to resolve spontaneously than the usually quoted two months, but nothing like 11 years. And yes, it can come back from time to time - I've had it three times in 25 years, twice in the left ear, once in the right. But it doesn't come back that often. The symptoms are totally different too.

And for all that time your Ménière's was going untreated and getting worse. Isn't there anyone you can sue?

Lawyers don't like medical law suits. Only malpractice with permanent damage. These law suits take years to settle. Docs have the best lawyers. None will take a medical case unless they can settle early for a ton of cash. Had a hospital give me MRSA. Noone will touch it. Was told it can take 4 years to go to court. Many man hours to investigate the claim.

Disgraceful! But I suspect it's no better here in Europe.

Four years ago I could have died as a result of three hospitals ignoring/denying my symptoms - they said it was "all in my head". (Nothing to do with BPPV.) Afterwards, when I'd finally been diagnosed and successfully treated, I wrote to them all by recorded delivery, got the same answer from all of them: "looking into it..." then nothing. I admit I didn't take it further. After all, I'd had a lucky reprieve, and life is too short...