Treatment tailored to the underlying cause of dizziness (vertigo). The Epley maneuver is used in BPPV, while medication and rehabilitation are combined for vestibular disorders.
Indication
- Brief positionally triggered dizziness (benign paroxysmal positional vertigo, BPPV)
- Inner-ear disorders with recurrent attacks (Ménière's disease)
- Persistent imbalance after vestibular neuritis or labyrinthitis
- Migraine-related dizziness (vestibular migraine)
- Chronic imbalance in elderly patients at risk of falling
- Suspected central (brainstem or cerebellum) dizziness
- Evaluation of drug-related or psychogenic dizziness
Preparation
- Note the onset, duration, triggers and accompanying symptoms (hearing loss, tinnitus, nausea)
- Bring a list of all medications used (sedatives, antihypertensives, antidepressants, etc.)
- Have any prior hearing tests, brain MRI/CT or ear evaluation reports available
- If the Epley maneuver is planned, comfortable clothing and an accompanying person are recommended
- A light meal before the procedure (do not stay fasting for long periods)
How it's performed
- The physician differentiates the type and duration of dizziness from the history; eye movements (nystagmus) are observed
- If BPPV is suspected, the Dix-Hallpike test is performed; if positive, the Epley repositioning maneuver is applied in the same session
- When indicated, vestibular tests (videonystagmography, caloric test, vHIT) and a hearing test are planned
- If a central cause is suspected (new headache, double vision, balance loss), brain imaging is requested
- The treatment plan is individualized: maneuvers, medication (antiemetics, vestibular suppressants, prophylactic drugs), salt/caffeine restriction, vestibular rehabilitation exercises
- Home exercises (Brandt-Daroff, etc.) and fall-prevention recommendations are provided to the patient and relatives in writing
Post-procedure
- Follow-up within the first 1-2 weeks after the Epley maneuver; the maneuver is repeated if needed
- Patients starting vestibular rehabilitation are evaluated at 4-6 weeks
- In Ménière's disease, follow-up every 1-3 months for salt restriction, drug response and attack frequency
- Emergency referral if new headache, double vision, speech disturbance or arm/leg weakness develops
- Home safety and physiotherapy guidance for patients at high risk of falling
Risks
- Nausea, vomiting and transient severe dizziness during positional maneuvers
- Cervical disc herniation, advanced osteoarthritis or vascular disease may require additional evaluation before maneuvers
- Drowsiness and delayed restoration of balance with long-term use of vestibular suppressants
- Recurrence despite treatment (especially in BPPV, 15-50%)
- Delayed diagnosis of an underlying neurological disease if central causes are missed
FAQ
Does the BPPV maneuver work immediately?
Many patients experience clear relief in a single session; some may need a second session. Mild imbalance for 24-48 hours after the maneuver is possible.
How long are medications for dizziness used?
Vestibular suppressants are generally used for a few days, at most 1-2 weeks. Long-term use can delay the central nervous system's adaptation and balance recovery.
When is dizziness considered an emergency?
If accompanied by new severe headache, double vision, speech disturbance, facial or arm weakness, or inability to walk, you should go to the emergency department without delay.
Can vestibular rehabilitation exercises be done at home?
Yes, exercises shown by the physiotherapist or physician should be continued regularly at home. Regular practice produces noticeable improvement in balance over a few weeks.
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