Vertigo is the sensation that the room is spinning. In benign paroxysmal positional vertigo (BPPV), the most common type, this sensation occurs when the position of the head changes with respect to gravity. The vertigo lasts for less than a minute and varies in intensity from mild to severe. Nystagmus (rapid, involuntary eye movements) occurs with BPPV. Other symptoms, such as dizziness, lightheadedness, nausea, vomiting, and a sense of imbalance, may also accompany the episode.

Although BPPV is not a sign of serious problems, and oftentimes resolves on its own in a few weeks, the symptoms can be very upsetting. In addition, the unsteadiness can lead to falls and injury.

BPPV is actually a disorder of the inner ear, which is involved in your sense of balance. Otoconia, or calcium carbonate crystals, move into and become trapped within the semicircular canals of the inner ear. When you change the position of your head, the otoconia shift within the canals and stimulate semicircular canal organs, leading to vertigo. Quickly changing the orientation of the inner ear is believed to release the otoconia from the canal. These positioning maneuvers, which include the Epley procedure and the Semont maneuver, are traditionally administered by trained professionals and have high success rates.

A study recently published in the July 13, 2004 issue of Neurology looked at whether or not subjects could effectively self-treat their own BPPV using modified versions of the Epley procedure and the Semont maneuver. The researchers found that they could.

About the Study

The study enrolled 70 patients with so-called posterior canal benign paroxysmal positional vertigo (PC-BPPV) who had not participated in any positioning maneuver during their initial presentation. The patients were randomized to either the Modified Epley Procedure (MEP) group or the Modified Semont Maneuver (MSM) group (see tables below for descriptions of procedures).

The MEP or MSM sequence of head and neck movements were explained to each study participant, depending on the procedure assigned to that participant. Patients then performed the maneuver once under the supervision of the instructing physician. In addition, each person received an illustrated instruction card of the procedure. Patients were to perform the procedure three times a day until the positional vertigo had subsided for at least 24 hours.

The maneuver was considered successful if, at the one-week follow-up, the positional vertigo and the nystagmus had stopped. When patients returned for the one-week follow-up, they were asked to perform the maneuver to determine if they were doing so correctly.

Instructions for Left Ear Posterior Canal Benign Paroxysmal Positional Vertigo (PC-BPPV):

Modified Epley Procedure (MEP)
1. Start by sitting on a bed with your head turned 45° to the left. Place a pillow behind you so that on lying back it will be under your shoulders.
2. Lie back quickly with shoulders on the pillow, neck extended, and head resting on the bed. In this position, the affected ear is underneath. Wait for 30 seconds.
3. Turn your head 90° to the right (without raising it), and wait again for 30 seconds.
4. Turn your body and head another 90° to the right, and wait for another 30 seconds.
5. Sit up on the right side.
Modified Semont Maneuver (MSM)
1. Sit upright on a bed with your head turned 45° toward the right ear.
2. Drop quickly to the left side, so that your head touches the bed behind your left ear. Wait 30 seconds.
3. Move head and trunk in a swift movement toward the other side without stopping in the upright position, so that your head comes to rest on the right side of your forehead. Wait again for 30 seconds.
4. Sit up again.

The Findings

After one week, 35 (95%) of the patients in the MEP group had no symptoms of PC-BPPV, compared with 19 (58%) of the patients in the MSM group. In addition, seven (19%) of the patients in the MEP group and 12 (36%) of the patients in the MSM group performed the procedure incorrectly. Interestingly, performing the maneuver incorrectly did not affect the treatment outcome in the MEP group, but was responsible for significantly more treatment failures in the MSM group.

The researchers concluded that with one week of self-treatment, MEP was more effective to stop PC-BPPV compared with MSM. Based on previously published studies, however, the response rate in both groups was higher than the researchers expected.

How Does This Affect You?

The study’s authors found that MEP may be considered as first-line, self-treatment for BPPV. In addition, this study’s results are good news for patients who do not respond to a single therapist-guided maneuver or patients with frequent recurrences.

Considering that BPPV affects about 64 people in every 100,000, that almost 50% of people age 65 and older experience BPPV at some point, and that BPPV recurs on average about 15%, that’s a significant number of people who could potentially benefit from self-treatment.

If you are experiencing vertigo, do not try to self-treat without seeing your doctor first. Your vertigo may be due to something other than displaced otoconia. If your doctor determines that positioning maneuvers are right for your situation, and you do not resolve from an in-office attempt or your symptoms recur, performing the Modified Epley Procedure at home apparently can be a safe and effective complementary therapy.