From the Guidelines
For a 90-year-old male with benign paroxysmal positional vertigo (BPPV), the recommended treatment is the Epley maneuver, which should be performed by a healthcare provider or taught to a caregiver. This maneuver involves a specific sequence of head movements that help reposition the displaced calcium crystals in the inner ear. The procedure takes about 15 minutes and may need to be repeated multiple times over several days 1. Vestibular suppressant medications like meclizine (25mg every 4-6 hours as needed) can be used temporarily for symptom relief but should be limited to 3-5 days to avoid delaying central compensation 1.
Key Considerations
- Home safety measures are crucial for this elderly patient, including removing tripping hazards, using nightlights, and rising slowly from lying or sitting positions.
- The patient should avoid sudden head movements, particularly looking up or bending down.
- BPPV occurs when calcium carbonate crystals (otoconia) become dislodged from the utricle and move into the semicircular canals, causing inappropriate signals about head movement that result in vertigo.
- Most patients experience significant improvement after 1-3 Epley maneuvers, though recurrence rates are approximately 15-30% within one year 1.
Additional Recommendations
- Patients with BPPV should be counseled regarding the risk of falls associated with BPPV, particularly in the elderly and frail, who may be more susceptible to serious injury as a result of falling 1.
- Patients should be educated about atypical symptoms whose occurrence or persistence after resolution of the primary symptoms of BPPV warrants further clinical evaluation.
- Follow-up with a healthcare provider is essential to monitor the patient's condition and adjust the treatment plan as needed 1.
From the Research
Treatment Options for BPPV
- The Epley manoeuvre is a effective treatment for posterior canal BPPV, with a significant reduction in vertigo symptoms compared to sham manoeuvres or control groups 2.
- The Epley manoeuvre has been shown to be safe and effective in patients with posterior canal BPPV, with a high success rate and low recurrence rate 2, 3.
- Other treatment options, such as the Brandt-Daroff exercises and Semont manoeuvre, have also been shown to be effective in treating BPPV, although the Epley manoeuvre may be superior in terms of resolution of vertigo symptoms and improvement in DHI scores 3, 4, 5.
Comparison of Treatment Options
- A study comparing the Epley manoeuvre, Brandt-Daroff exercises, and Semont manoeuvre found that the Epley manoeuvre was more effective in resolving vertigo symptoms and improving DHI scores 5.
- Another study found that the Epley manoeuvre was superior to the Brandt-Daroff exercises and Semont manoeuvre in terms of resolution of vertigo symptoms and improvement in DHI scores 4.
- A review of the literature found that the choice of manoeuvre for treating BPPV depends on the clinician's preferences, failure of previous manoeuvres, or movement restrictions of the patient 6.
Considerations for Treatment
- The Epley manoeuvre has been shown to be effective in patients with posterior canal BPPV, including those aged 90 years or older 2.
- The treatment of BPPV should be individualized, taking into account the patient's specific needs and circumstances 6.
- Further research is needed to identify the optimal treatment strategies for BPPV, including the use of manoeuvres and other interventions 6.