Since the topic that drew the most readers to this blog in 2013 involved BPPV, we will begin a discussion of home treatments available for this condition.
BPPV is a benign, self-limiting condition, but it is very bothersome and disruptive when active. When a patient has a history of BPPV, and has a positive Dix-Hallpike exam, Canalith Repositioning is the clear treatment choice. But, it doesn’t always go so smoothly. Some patients will have a history consistent with BPPV; however, Dix-Hallpike tests on the day of examination fail to provoke an episode of vertigo and rescheduling may be necessary. If an episode of BPPV can be provoked at a later date, appropriate repositioning can be completed. Occasionally, a patient will be unwilling or unable to return or may have a negative Dix-Hallpike test a second or third time. In these instances, home-based exercises may be recommended.
There are other circumstances when home treatments may be appropriate:
1. When you are not prepared to perform in-office repositioning: Horizontal Canal BPPV repositioning can be very difficult with large people, so it may be more effective to teach them to do the BBQ roll maneuver at home in a full-size or larger bed.
2. If you don’t have a proper exam table/chair: Many ENT offices have motorized chairs that make performing Canalith Repositioning difficult at best.
3. When you suspect fatigue: There is not much point in repositioning if you suspect a patient has fatigued the response prior to your exam. It is not going to hurt to try, and anecdotally sometimes proves successful. However, if you are dealing with fatigued BPPV and the otoconia debris is dispersed, repositioning is likely to be ineffective. It may be more effective doing exercises at home after the debris has settled.
4. Recurrence: If a patient has a history of Right Posterior Canal BPPV and has frequent recurrences, it is reasonable to recommend a few days of exercise before calling for an appointment. You must make it clear that there is no guarantee that their symptoms are the result of a recurrence of BPPV in the same ear and same canal, but the likelihood is high enough that a trial of home treatment makes sense.
For a good overview of the pros and cons of home treatment of BPPV, Click here[This is intended as a discussion among health care professionals and is not intended as medical advice. You should consult with your health care provider before attempting any home treatments]