Home Benign Positional Vertigo Exercises
The Brandt-Daroff Exercises are a method of treating BPPV, usually used when the office treatment fails.They succeed in 95% of cases but are more arduous than the office treatments.These exercises are performed in three sets per day for two weeks. In each set, one performs the maneuver as shown five times.
1 repetition = maneuver done to each side in turn (takes 2 minutes).
Suggested Schedule for Brandt-Daroff exercises:
|Morning||5 repetitions||10 minutes|
|Noon||5 repetitions||10 minutes|
|Evening||5 repetitions||10 minutes|
Start sitting upright (position 1).Then move into the side-lying position (position 2), with the head angled upward about halfway. An easy way to remember this is to imagine someone standing about 6 feet in front of you, and just keep looking at their head at all times. Stay in the side-lying position for 30 seconds, or until the dizziness subsides if this is longer, then go back to the sitting position (position 3). Stay there for 30 seconds, and then go to the opposite side (position 4) and follow the same routine.
These exercises should be performed for two weeks, three times per day, or for three weeks, twice per day. This adds up to 52 sets in total. In most persons, complete relief from symptoms is obtained after 30 sets, or about 10 days. In approximately 30 percent of patients, BPPV will recur within one year. If BPPV recurs, you may wish to add one 10-minute exercise to your daily routine.
HOME EPLEY MANEUVER
The Epley and/or Semont maneuvers as described above can be done at home. We often recommend the home-Epley to our patients who have a clear diagnosis.This procedure seems to be even more effective than the in-office procedure, perhaps because it is repeated every night for a week.
The method (for the left side) is performed as shown on the figure below. One stays in each of the supine (lying down) positions for 30 seconds, and in the sitting upright position (top) for 1 minute.Thus, once cycle takes 2 1/2 minutes.Typically 3 cycles are performed just prior to going to sleep. It is best to do them at night rather than in the morning or midday, as if one becomes dizzy following the exercises, then it can resolve while one is sleeping.The mirror image of this procedure is used for the right ear.
There are several problems with the “do it yourself” method. If the diagnosis of BPPV has not been confirmed, one may be attempting to treat another condition (such as a brain tumor or stroke) with positional exercises — this is unlikely to be successful and may delay proper treatment. A second problem is that the home-Epley requires knowledge of the “bad” side. Sometimes this can be tricky to establish. Complications such as conversion to another canal (see below) can occur during the Epley maneuver, which are better handled in a doctor’s office than at home.
Finally, occasionally during the Epley maneuver neurological symptoms are provoked due to compression of the vertebral arteries. In our opinion, it is safer to have the first Epley performed in a doctors office where appropriate action can be taken in this eventuality.