From the Guidelines
The treatment for Benign Paroxysmal Positional Vertigo (BPPV) in a 90-year-old female should primarily involve canalith repositioning maneuvers, specifically the Epley maneuver for posterior canal BPPV, which is most common, as recommended by the clinical practice guideline: benign paroxysmal positional vertigo (update) 1. This procedure involves a series of head position changes to move displaced calcium crystals from the semicircular canals back to the utricle where they belong. For elderly patients, modifications may be necessary, including:
- Performing the maneuver more slowly
- Providing adequate support to prevent falls or injury. The maneuver can be performed in-office and taught to caregivers for home treatment. Some key points to consider in the treatment of BPPV include:
- Vestibular suppressant medications like meclizine (12.5-25mg every 4-6 hours as needed) should be used sparingly and only for severe symptoms, as they can cause sedation and increase fall risk in the elderly, as noted in the clinical practice guideline 1.
- These medications should not replace repositioning maneuvers and should be discontinued as soon as possible.
- Physical therapy with vestibular rehabilitation exercises may be beneficial for residual symptoms or recurrent BPPV, as suggested by the guideline 1. Special considerations for a 90-year-old include:
- Ensuring adequate neck mobility before attempting maneuvers
- Having assistance available during treatment
- Implementing fall prevention strategies, as falls are a significant concern in the elderly with BPPV, with a high rate of recurrence and associated falling tendencies, as discussed in the guideline 1. BPPV treatment is effective regardless of age, with the repositioning maneuvers addressing the underlying mechanical problem of displaced otoconia in the semicircular canals. It is essential to educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up, as emphasized in the guideline 1.
From the Research
Treatment for Benign Paroxysmal Positional Vertigo (BPPV)
The treatment for BPPV in a 90-year-old female typically involves a canalith repositioning maneuver (CRM), such as the Epley or Semont maneuver 2.
- Epley Maneuver: This is a safe and effective treatment for posterior canal BPPV, with a significant reduction in vertigo symptoms and conversion of a positive Dix-Hallpike test to a negative test 3, 4.
- Self-Treatment at Home: Following the Epley maneuver with self-treatment at home using a modified Epley procedure can improve outcomes 2.
- Postural Restrictions: Postural restrictions are not necessary after CRM treatment 2.
- Medications: Medications do not work as well as CRM, but studies comparing treatments are limited 2.
- Adverse Effects: Adverse effects of the Epley maneuver are infrequently reported, with no serious adverse effects of treatment, although some patients may experience nausea during the repositioning maneuver 3.
- Case Reports: There have been rare reports of serious adverse events, such as hemorrhagic stroke, following the Epley maneuver, but these are extremely rare and do not warrant a change in treatment patterns 5.