I just spent over 5 weeks of dealing with this.. initially was right ear, then left. Epley’s were not working until vibrations were used. FINALLY starting to feel like normal.. was a terrible time. Seeing the nystagmus brings back everything. I no longer have vertigo or nystagmus while doing hall pike test but still feeling off.. hoping everyone out there suffering with this gets better soon!!
I've got 100 up on you.... Lol 29 months. I've been through it all of a stimular therapy days, weeks, months, years of the maneuvers. Most recently I got so desperate. I treated every single canal in each year over the course of a week or so. August 1st I started to feel better. Had almost 3 months of no vertigo in my sleep and very very very subtle but like feeling on occasion but really I felt great for the first time. Then all of a sudden it was back. Deep down I could tell it was underlying it just had not reared. It's ugly headed yet. So now I'm researching movement of eyes. I've learned a lot Over these last 29 months. What I'm curious is the holding up of the eyelid and sinus area? Is that doing something or is this doctor? Just trying to get a better look?
So many thanks Dr.Peter! I'm reading about this issue but textbook is so wordy and not interactive. Your video is so attractive to me, a young Vietnamese ENT doctor !
I only use vestibular sedatives if the patient can't tolerate the Dix-Hallpike or Epley maneuver. I'd say I have to use them in about 20% of cases of BPPV. I don't believe they will affect the diagnostic accuracy or effectiveness of the Dix-Hallpike test or the Epley maneuver.
I have a question, i tried doing dix hallpike test on the patient's leftside where there is left torsional but the nystagmus was beating towards the right? Is there such a case whereby nystagmus is horizontal during dix hallpike? Or would it be likely that I am seeing this wrongly. Or is there another condition i should be considering?
Great videos Dr Johns...very helpful! What is your guess for which canal is involved (and then which therapeutic maneuver would be indicated?) for the patient who has the most positive Dix-H test when looking straight ahead when lowered, and the head is not turned either left or right? Thank you for your advice!
@@PeterJohns Thank you for your prompt reply.... it was hard to see the nystagmus, but vertigo was clearly present; after it extingusihed moving the head to the down/left position reproduced the vertigo..not so much on the right side. Again, unfortunately the nystagmus was too subtle to discern...will try to video next time. DixH test was negative after the Epley. Just seemed odd that the vertigo was worse when the head was tilted straight back. Thanks again for your reply, and for your excellent videos!
@@israelcharo1563 could it be anterior canals and not the posterior? But interesting that the Epley helped. The Foster roll could help with anterior BPPV or if its a mixed kind; Gufoni maneuver.
In this case, I did, because she did say she was a tiny bit dizzy. Moving the otoliths (ear rocks) out of the canal is more like clearing out sand or sludge. You don't necessarily get all of it out in one go. I told her if she was still getting significant dizzy spells when lying down, getting out, or turning over in bed, she could do the Epley maneuver twice a day until it stops.
Yes, but i prefer the term "vertical upward and torsional towards the downward ear". This emphasizes that vertical upward nystagmus during the Dix-Hallpike test is a normal thing to see, and not indicative of a central cause. Many unwarranted and useless CT scans of the head have been done on patients with BPPV because the examiner thought that all vertical nystagmus is worrisome for a central cause.
@PeterJohns youtube.com/@PeterJohns Hi Dr Peter , Your videos are really informative and have been of real help for me.. So firstly thank you . I am a practicing ENT Physician from India. Wanted to know, about pediatric BPPV.. I had a 11 yr old boy, with symptoms of rotatory giddiness, 2 episodes over a span of 1 month,. triggered by lying on the bed, no h/o headaches... On dix hallpike , he experienced giddiness on right side.. but there was no nystagmus . Do i treat it as BPPV.... ? Or.. is there something else that need to consider ..
Very happy you could help her.
I just spent over 5 weeks of dealing with this.. initially was right ear, then left. Epley’s were not working until vibrations were used. FINALLY starting to feel like normal.. was a terrible time. Seeing the nystagmus brings back everything. I no longer have vertigo or nystagmus while doing hall pike test but still feeling off.. hoping everyone out there suffering with this gets better soon!!
I've got 100 up on you.... Lol 29 months. I've been through it all of a stimular therapy days, weeks, months, years of the maneuvers. Most recently I got so desperate. I treated every single canal in each year over the course of a week or so. August 1st I started to feel better. Had almost 3 months of no vertigo in my sleep and very very very subtle but like feeling on occasion but really I felt great for the first time. Then all of a sudden it was back. Deep down I could tell it was underlying it just had not reared. It's ugly headed yet.
So now I'm researching movement of eyes. I've learned a lot Over these last 29 months.
What I'm curious is the holding up of the eyelid and sinus area? Is that doing something or is this doctor? Just trying to get a better look?
What kind of vibration?
People don’t realise how horrible this condition can be until you experience it, the saving grace it can be as simple as this to fix
I had BBPV for a week and it was awful. We did this and had instant relief.
So many thanks Dr.Peter! I'm reading about this issue but textbook is so wordy and not interactive. Your video is so attractive to me, a young Vietnamese ENT doctor !
Same here.... Thanks from a Physiotherapist from 🇨🇦
Incredible. Thank you!
Yup- just went thru this- her voice gave me PTSD😅
Wow ... M happy for this lady...
Bppv is nightmare 😢
very nice thank you
How do betahistine and vestibular sedatives affect these tests? Are they useful in patients who are already taking these drugs?
I only use vestibular sedatives if the patient can't tolerate the Dix-Hallpike or Epley maneuver. I'd say I have to use them in about 20% of cases of BPPV. I don't believe they will affect the diagnostic accuracy or effectiveness of the Dix-Hallpike test or the Epley maneuver.
@@PeterJohns thanks... Greatly appreciate your input
I have a question, i tried doing dix hallpike test on the patient's leftside where there is left torsional but the nystagmus was beating towards the right? Is there such a case whereby nystagmus is horizontal during dix hallpike? Or would it be likely that I am seeing this wrongly. Or is there another condition i should be considering?
Great videos Dr Johns...very helpful! What is your guess for which canal is involved (and then which therapeutic maneuver would be indicated?) for the patient who has the most positive Dix-H test when looking straight ahead when lowered, and the head is not turned either left or right? Thank you for your advice!
Please describe the nystagmus produced.
@@PeterJohns Thank you for your prompt reply.... it was hard to see the nystagmus, but vertigo was clearly present; after it extingusihed moving the head to the down/left position reproduced the vertigo..not so much on the right side. Again, unfortunately the nystagmus was too subtle to discern...will try to video next time. DixH test was negative after the Epley. Just seemed odd that the vertigo was worse when the head was tilted straight back. Thanks again for your reply, and for your excellent videos!
@@israelcharo1563 could it be anterior canals and not the posterior? But interesting that the Epley helped. The Foster roll could help with anterior BPPV or if its a mixed kind; Gufoni maneuver.
When you do the re-test dix hallpike, do you also "finish" with another (I assume here) epley maneuver, even if the patient doesnt have symptoms?
In this case, I did, because she did say she was a tiny bit dizzy. Moving the otoliths (ear rocks) out of the canal is more like clearing out sand or sludge. You don't necessarily get all of it out in one go. I told her if she was still getting significant dizzy spells when lying down, getting out, or turning over in bed, she could do the Epley maneuver twice a day until it stops.
Nice
Is it up beating torsion nystagmus??
Yes, but i prefer the term "vertical upward and torsional towards the downward ear". This emphasizes that vertical upward nystagmus during the Dix-Hallpike test is a normal thing to see, and not indicative of a central cause. Many unwarranted and useless CT scans of the head have been done on patients with BPPV because the examiner thought that all vertical nystagmus is worrisome for a central cause.
Is there a particular maneuver that someone could do once a day as a precautionary, just to catch a bad bout of bppv before it happens
Not, there isn't.
Great question, I move my head around daily trying to ward off any further bouts of this!
@@patriciakelly8149 yeah it's a pain.
@PeterJohns
youtube.com/@PeterJohns
Hi Dr Peter , Your videos are really informative and have been of real help for me.. So firstly thank you .
I am a practicing ENT Physician from India.
Wanted to know, about pediatric BPPV.. I had a 11 yr old boy, with symptoms of rotatory giddiness, 2 episodes over a span of 1 month,. triggered by lying on the bed, no h/o headaches... On dix hallpike , he experienced giddiness on right side.. but there was no nystagmus . Do i treat it as BPPV.... ? Or.. is there something else that need to consider ..