What should I do if I still have vertigo after the benign paroxysmal positional vertigo manipulation?

       Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders causing vertigo. The vertigo occurs suddenly when the head position changes, and the patient feels intense rotational vertigo, usually lasting less than 40 seconds, which is self-limiting and gradually resolves in a few days or months. The common triggering positions are getting up, lying down or turning over in bed, turning the head, and also when suddenly accelerating or decelerating in a car. Although the duration is only a few seconds to a few minutes, the psychological threat posed by the patient’s fear is much greater than the disease itself.  The cause of BPPV is otolithiasis, trauma, inadequate blood supply to the inner ear, etc. BPPV is confirmed and manipulated by the postural Dix-Hallpike and Roll tests. This step is usually performed in the hospital. It is often normal for some patients to continue to have a dizzying sensation after manipulation, which usually lasts 3-7 days. So, what if the patient continues to have a sensation of rotation?  The first step is to maintain the healthy side of the body. Usually, when completing the postural Dix-Hallpike and Roll test in the hospital, if it is positive, the doctor will tell the patient whether the lesion is on the left or right side, and then we maintain the healthy side of the body for a day.  The next step is Brandt-daroff habituation training, also called vertigo habituation training. The patient sits on the edge of the bed with the head at a 45-degree angle to the healthy side, and quickly reclines to the affected side with the head at a 45-degree angle to the oblique upper side. Wait for the vertigo to disappear and then stay for 30 seconds. Sit up and wait for the vertigo to disappear again, then repeat the above action to the opposite side, stay for 30 seconds and sit up. Repeat the whole treatment exercise 10-20 times, 3 times a day. Stop 2 days after the vertigo disappears. The vertigo will disappear after two weeks of this treatment.  In addition, some common vestibular rehabilitation methods can be applied to patients who need vestibular rehabilitation for long-term vestibular hypofunction, which are suitable for patients to train by themselves at home. It is normal to induce vertigo during training, so there is no need to be nervous.  1.Head training: (1) lowering and raising the head; tilting the head from side to side (ears against shoulders); (2) turning the head to both sides; (3) the above actions are performed with eyes open and closed, respectively.  2. Gaze training: (1) turning the eyeballs up and down, left and right; (2) hanging a marker on the wall and gazing at the marker while moving the head; (3) family members moving with the marker in their hands and the patient gazing at the marker while moving the head.  3. Position training: (1) Sitting on a stool with head down and tying shoelaces; (2) Bending over and tying shoelaces, turning the head first to the left foot and then to the right foot; (3) lying down and turning over to one side; (4) lying in bed and sitting up from lying; (5) the above actions were performed with eyes open and eyes closed respectively.  4, posture training: (1) feet close together, standing; (2) stand on one foot; (3) walk in a straight line; strengthen the straight line movement – toes next to the heel of the front foot; (4) repeat head and eye movements in standing and walking situations; (5) find a center point and walk in a circle. (6) go up and down the stairs; (5) the above actions are performed with eyes open and closed, respectively.  5, training requirements: (1) two times a day, 15 minutes each time; (2) step by step, mild vertigo is normal during training; (3) training involving standing and walking, especially with eyes closed, requires appropriate family protection.