Benign paroxysmal positional vertigo is the most common cause of vertigo, and otolith manipulation is an effective treatment for it, which is simple and easy to master, and is a practical clinical technique that every neurologist needs to master.
Through a series of head position changes, the otolith particles are displaced by gravity, and the otolith particles entering the semicircular canal are gradually moved out of the semicircular canal and back into the ellipsoidal sac, thus eliminating the effect of otolith particles on the jugular ridge and achieving the therapeutic purpose.
The most commonly used clinical otolith repositioning techniques include the Semont, Harvey and Epley methods. We will describe each of these three methods in detail.
Semont Release Method
Procedure.
The examiner stands behind the patient and holds the patient’s head.
1. Sitting with the head rotated 45° to the healthy side.
2. Lie down to the affected side.
3. Sit up and turn the patient’s head and body 180° rapidly from the affected side to the healthy side and 45° head down.
4.Sit upright.
Harvey tube stone release method
Operation steps.
1. The patient hangs his head in supine position.
2. Turn the head to the affected side at 45°, with the affected ear down.
3. After 2 minutes, slowly turn the head to the opposite side at an angle of 15°-20° at a time, stopping for 30 seconds at each turn and observing nystagmus until the head cannot be turned.
4. Turn to the healthy side and continue to turn the head to an angle of 135° with the horizontal plane, so that the head is turned a total of 180°.
5. Ask the patient to sit up straight and return the head to the starting position.
Epley’s method
Take the left ear as the affected side as an example, the operation steps are
1. Sit the patient on the bed, turn the head 45° to the left, and place a pillow behind the body (in the supine position, the pillow should be just under the shoulder).
2. Quickly lie on the back with the shoulders pressed against the pillow and the neck over the back, with the head on the bed (the affected ear is located just below in this position) for 30 seconds.
3. turn the head to the right by 90° for 30 seconds.
4.Continue to turn the head and body to the right by 90° for 30 seconds. 5.Sit on the edge of the bed and perform this movement 3 times a day until the positional vertigo disappears for more than 24 hours.
Precautions for manual repositioning
1. For those who cannot tolerate the treatment due to vertigo, take sedatives or vestibular suppressants before repositioning treatment.
2.Patients with high blood pressure or neck or back diseases should be cautious. 3.Avoid lying on your back for at least 2 days after manual repositioning.