3 Incredibly Effective Exercises to Treat BPPV

March 12, 2018, Langley Dental Practice

Let's have a brief roundup of the condition and its implications.

Meaning
BPPV, by definition, means a non-dangerous sudden and short vertigo spell ( https://www.neuroequilibrium.in/vertigo-dizziness-symptoms-causes-treatments/)  that is the result of a particular head position.

Medically, what happens in BPPV is, the calcium carbonate crystals or otoconia migrate from utricle to the inner ear canals called as semi-circular canals. The semi-circular canal has 3 canal parts that comprise of fluid and minuscule sensors; that sends the signal to the brain to balance the body in the context of head position.

Otoconia are distinctly tiny, and gravity-sensitive calcium carbonate particles present in utricle and saccule in the vestibular region. These crystals help sense the horizontal and vertical movement of the body. Semicircular canals mainly sense angular head movements.

The dislodged otoconia meddle with the semicircular canals' sensory system and start flashing false signals to the brain about the relative head position and induce dizziness or vertigo.   

The associated symptoms of BPPV other than vertigo are nausea, vomiting and wobbliness.

Many people experience unsteadiness while they turn the head suddenly or look up and down or change sides on the bed or hold their head in a particular position without realising that it is a functional disorder of their inner ear and is treatable.

Treatment
Canalith repositioning is an ideal treatment for BPPV. There are mainly 3 exercises that are popular and yield fast relief to BPPV sufferers.
• Epley Maneuver
• Semont Maneuver
• Brandt-Daroff Maneuver
The first two maneuvers are widely in use as compared to Brandt-Daroff exercises. Nevertheless, all these exercises bring noticeable relief from BPPV discomfort.

Epley Maneuver
John Epley introduced this exercise. Epley Maneuver repositions the dislodged otoconia from the posterior canal and helps subside vertigo.
How to do this
1. Sit upright on a flat surface such as a table or a bed, with your legs stretched straight in front of you.
2. Turn your head to the right at 45-degree angle (if you have dislodged otoconia in the right ear) and hold it till vertigo stops. If you have a problem in the left ear, you should turn your head to the left, instead of right.
3. Next, turn your head to the left forming a 90-degree angle and be in that position till your spinning sensation stops.
4. Turn to your left, without altering the head position. Now, you would be looking down at the floor.
5. Be there for 30 seconds or till your vertigo sensation ceases.
6. Slowly get up, sit for a while until you feel comfortable to move.
This exercise is very effective from the first session itself if a trained therapist is conducting this on you. You may learn and practice this maneuver at home, with varied results.

Semont Maneuver
This exercise is proposed by A Semont and is similar to Epley maneuver. It helps in removing the otoconia from the semicircular canals to reduce vertigo.

How to do this?
1. Sit on the bed or a table (in case a therapist is conducting the exercise) with legs left down.
2. Turn your head to 45-degree angle to the right (if you have a problem in the left ear) and lie on the left side. In this position, you will be facing up towards the ceiling.
3. Be in the position until the time your vertigo stops.
4. Maintaining the head position, get up and lie on the other side. Now you will be facing down to the floor.
5. Repeat step 3
6. Sit up and wait until all the discomfort subsides before standing up.

Brandt-Daroff Maneuver
Introduced by Thomas Brandt & Robert Daroff, this maneuver helps in retraining the brain to adjust to the confusing signals.

How to do this?
1. Sit straight on the side of a bed or table with your legs down.
2. Turn your head 45-degrees to your left and lie on your right side. In this position, you will be looking up at the ceiling.
3. Hold the position as long it is required to stop the vertigo sensation.
4. Raise and sit up like in step 1.
5. Now, turn your head 45-degrees to your right and lie on your left side, face up towards the ceiling.
6. Repeat step 3.
7. Slowly sit up. Stand up once you regain your balance.
It is best to do all these exercises under the supervision of a trained practitioner. If you have to do it at home, ensure you have someone to watch your back, so that you don't topple and hurt yourself.

Author Bio: Dr Anita Bhandari is an MS(ENT). She has done a fellowship in Otology and Neurotology from Singapore and is practising Neurotologist in Jaipur, India. She is associated with Jain ENT Hospital as Senior Consultant. She has authored chapters on various ENT topics for textbooks and had 3 patent pending technologies to her credit. Anita was associated as Principal Investigator with a UNICEF initiated a project for 3 years. She tours across the globe to impart talks on vertigo and balance disorder management in international conferences. NeuroEquilibrium ( https://www.neuroequilibrium.in/)is her dream project that aims at assisting vertigo patients to restore their balance and lead healthy lives.

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