| Brandt -- Daroff Exercises |
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The Brandt Daroff exercises are used as a treatment option for posterior canal cupulolithiasis or persistent posterior canalithiasis BPPV. These exercises are intended to dislodge debris believed to be attached to the cupula in the posterior canal or habituate a patient's symptoms of dizziness through central adaptation. Patients are instructed on this exercise as a home program
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| Dix Hallpike Test |
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The Dix-Hallpike test is the standard for diagnosis of benign paroxysmal positional vertigo (BPPV).
When you are performing the Dix Hallpike test, you should record the nystagmus with videonystagmography (VNG) as the nystagmus may only occur briefly and may be difficult to observe. VNG allows you to review the nystagmus and compare nystagmus to subsequent visits. VNG also prevents the patient from fixating on a target, suppressing the nystagmus. If VNG is unavailable, Frenzel lenses should be used to prevent the patient from fixating.
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| Epley Canalith Repositioning Proced |
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This procedure was designed by Epley for the treatment of BPPV. This procedure can be modified to exclude vibration.
When performing the canalith repositioning maneuver, it is helpful to utilize videonystagmography in order to monitor the patient's nystagmus. If reversal of nystagmus is noted during the canalith repositioning maneuver, modifications can be made during the maneuver to promote proper migration of the otoconia through the canal
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| Guffoni (Apogeotropic) |
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This maneuver can be used to convert apogeotropic horizontal canal BPPV to geotropic horizontal canal BPPV.
When performing this maneuver, it is helpful to utilize videonystagmography in order to monitor the patient's nystagmus. If conversion to geotropic horizontal nystagmus is noted during the maneuver, the Lempert 360? roll can be performed in order to promote proper migration of the otoconia through the canal.
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| Guffoni (Geotropic) |
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This maneuver can be used as an alternative for the treatment of geotropic horizontal canal BPPV.
Demonstrated for treatment of the left horizontal canal
To perform this maneuver:
Have the patient begin by sitting with their legs dangling over the side of the exam table.
Move the patient rapidly down into a side lying position toward their affected side.
Rapidly rotate the patient's head 45? down toward the table.
Maintain his position for approximately 2-3 minutes
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| Lempert 360? Roll |
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The Lempert 360? roll is the treatment of choice for geotropic horizontal canal BPPV.
When performing the Lempert 360? roll, it is helpful to utilize videonystagmography in order to monitor the patient's nystagmus. If reversal of nystagmus is noted during the maneuver, modifications can be made to promote proper migration of the otoconia through the canal.
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| Roll Test |
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The roll test is used to identify horizontal Canal BPPV.
When you are performing the Roll Test, you should record the nystagmus with videonystagmography (VNG) as the nystagmus may only occur briefly and may be difficult to observe. VNG allows you to review the nystagmus and compare nystagmus to subsequent visits. VNG also prevents the patient from fixating on a target, suppressing the nystagmus. If VNG is unavailable, Frenzel lenses should be used to prevent the patient from fixating.
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| Semont Maneuver for Anterior Canal |
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The Semont maneuver or liberatory maneuver can be used as an option for treatment of anterior Canal BPPV.
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| Semont Maneuver for Posterior Canal |
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The Semont maneuver or liberatory maneuver is an option for treatment of posterior canalithiasis BPPV, and is more frequently used for the treatment of posterior cupulolithiasis BPPV
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| Vannucchi-Asprella Maneuver |
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This maneuver is reported to be effective at treating geotropic horizontal Canal BPPV, and may be effective at converting apogeotropic horizontal Canal BPPV to geotropic horizontal Canal BPPV.
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| Conversion From Posterior to Lateral Canal |
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Note: This subject was taken into the left Dix Hallpike position. The subject developed upbeat left torsional nystagmus. Nystagmus is being viewed from the right eye; therefore, torsion may not be as severe as if viewed from the left eye. An Epley canalith repositioning maneuver was performed for the left posterior canal, this portion of the video was cut due to the length of the video. There was no reversal of nystagmus throughout the Epley canalith repositioning maneuver.
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| Horizontal Canalithiasis 1 |
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Note: This subject presents with geotropic horizontal nystagmus. During the first portion of the video, the subject is rolled onto their right side and presents with a right beat nystagmus. Note the degree of nystagmus as the subject is lying on their right side. The subjects also reports more severe symptoms while they are lying on their right side
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| Horizontal Canalithiasis 2 |
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Note: During this video the subject is moved from the sitting position to the supine position, then from the supine position to the right sideline position, then back to the supine position, and finally to the left sideline position.
Observe the brief up -beat physiological nystagmus as the subject is moved from the sitting position to the supine position.
Once in the supine position, the subject moves into a right sideline position. This is indicated by the eyes moving toward the right during the roll. Once in the right sideline position, a left beating horizontal nystagmus (apogeotropic) is observed.
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| Post Head-Shaking Nystagmus with Horizontal Canal BPPV |
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Note: This subject was taken into the left Dix Hallpike position. The subject developed upbeat left torsional nystagmus. Nystagmus is being viewed from the right eye; therefore, torsion may not be as severe as if viewed from the left eye. An Epley canalith repositioning maneuver was performed for the left posterior canal, this portion of the video was cut due to the length of the video. There was no reversal of nystagmus throughout the Epley canalith repositioning maneuver
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| Posterior BPPV & Hypofunction |
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Note: Mild physiological nystagmus is observed as the subject is moved from the sitting position into the Dix Hallpike right position. Once the subject is in the Dix Hallpike right position, left beat horizontal nystagmus is observed. After a positively latency of approximately 10-13 seconds, brisk upbeat right torsional nystagmus is observed. Once the upbeat torsional nystagmus subsides, there continues to be a persistent left beat horizontal nystagmus.
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| Posterior Canalithiasis 1 |
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The marks on this subject's eye make it easier to identify the direction of nystagmus. Choose one mark on the subject's eye to focus on during nystagmus in order to observe the direction of torsion. It is often helpful to focus on a blood vessel or any obvious identifier; in this case the shape of the pupil can help to identify torsion.
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| Posterior Canalithiasis 2 |
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Note: The degree of torsion is mild compared to the upbeat component of the nystagmus. This is common when you observe nystagmus from the eye on the opposite side of the affected ear. In this video, you are viewing the right eye during a Dix Hallpike left test; which is positive for left posterior canalithiasis. If the left eye had been recorded versus the right eye, the degree of torsion may have been much more remarkable.
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| Posterior Canalithiasis 3 |
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Note: In this video, observe how the subject's eye is pulled toward the right upper pole. This may occur if the subject is gazing toward the right or may occur when the degree of nystagmus more severe - holding the eye in the upper pole. Torsion becomes more notable by the end of the nystagmus.
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| Posterior Canalithiasis 4 |
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Note: In this video, observe how the subject's eye is pulled toward the left upper pole. This may occur if the subject is gazing toward the left or may occur when the degree of nystagmus severe - holding the eye in the upper pole. Torsion becomes more notable by the end of the nystagmus. The subject is also observed returning to the sitting position. Note the change in direction of nystagmus on return to sit. The nystagmus becomes downbeat with a mild right torsional component.
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| Posterior Canalithiasis 6 |
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Note: The subject is placed in the supine head center position in order to test the lateral canals prior to Dix Hallpike testing. The subject is asked to turn their head to the right (the subject presents with full cervical rotation; therefore, rolling into a right sideline position was not required to complete the Roll test). Once the subject's head is turned to the right, the subject develops brief right upbeat torsional nystagmus with symptoms.
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| Posterior Cupulolithiasis 5 |
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Note: This video was cut short as the video and nystagmus continued on for greater than 1 1/2 minutes without significant change in the degree of nystagmus. Notice how the patient gazes toward the left. This can be helpful in identifying the direction of nystagmus. As the patient gazes toward the left observe the blood vessels, notice them move quickly in an upward direction. This can help distinguish between upbeat and downbeat torsional nystagmus.
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| Test Video2 |
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This is a SHORT DESCRIPTION of information for testing purposes
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