Benign Paroxsymal Peripheral Vertigo
The aim of canalith repositioning procedures (CRPs) is to treat people with benign paroxysmal positional vertigo (BPPV). It is believed that BPPV is caused by tiny crystals (also known as otoconia) becoming dislodged from their normal place inside the inner ear, and moving into another area responsible for sensing rotation (the semicircular canals). When the crystals move around in this part of the ear it causes dizziness. Canalith repositioning procedures involve a sequence of specific head and upper body movements that may be able to move the crystals back to their correct place in the ear.
The two main CRP treatments are the Epley maneuver and the Semont (Semont-Liberatory) maneuver. These maneuvers must be only performed by a trained specialist to prevent the risk of neck and back injuries. The maneuvers are not appropriate for everyone. In particular, the maneuvers will not be suitable if you have pain or stiffness in your neck or if you have had a neck injury.
Exercises of Semont
The Semont maneuver for right-sided BPPV. (1 ) Patient is seated in the upright position; then the patient’s head is turned 45 degrees toward the left side, and the patient is then rapidly moved to the side-lying position as depicted in position (2). This position is held for approximately 30 seconds, and then the patient is rapidly moved to the opposite side-lying position without pausing in the sitting position and without changing the head position relative to the shoulder, resulting in position (3). This position is maintained for 30 seconds and then the patient gradually resumes the upright sitting position.
Bhattacharyya, N. & Baugh, Reginald & Orvidas, L. & Barrs, David & Bronston, L.J. & Cass, S. & Chalian, Ara & Desmond, Alan & Earll, J.M. & Fife, Terry & Fuller, D.C. & Judge, James & Mann, N.R. & Rosenfeld, Richard & Schuring, L.T. & Steiner, R.W. & Whitney, Susan & Haidari, J.. (2008). American Academy of Otolaryngology-Head and Neck Surgery Foundation Clinical Practice Guideline benign paroxysmal positional vertigo. Otolarygol Head Neck Surg. 139.
Brandt-Daroff exercises
Some cases of BPPV do not respond well to CRPs and are better managed by the Brandt-Daroff exercises. These exercises may also be advised if CRPs are not suitable.
Brandt-Daroff exercises are a treatment for BPPV that can be performed at home without the supervision of a specialist. It is unclear exactly how these exercises work. Repeated head movements may work by moving the crystals back to their correct position inside the inner ear (as with CRPs).
Alternatively, it may be that repeated exposure to movements that provoke dizziness symptoms teaches your brain not to listen to the signals it is receiving from the ears as much (vestibular compensation).
Sit on the edge of the bed and turn your head 45 degrees to one side.
Quickly lie down on your opposite side (to the left if you turned your head to the right, and vice versa) so that the back of your head behind your ear touches the bed.
Hold this position for about 30 seconds or until the dizziness symptoms stop.
Return to the sitting position.
Repeat steps 1-4 on the other side.
You should repeat these steps three times or until you have completed six repetitions on each side. Unless your specialist or Physical therapist has recommended otherwise, you should do the exercises two to three times a day for two weeks.
These exercises are likely to make you feel dizzy while performing the exercises, but it is important to persevere to feel any benefit.