Week 9, Spring 2008

The client was an older women who visited West Virginia University Hearing Center with complaints of residual positional vertigo that persisted for three weeks following treatment for BPPV.

The client first noticed true vertigo in the early 1990s, but had experienced intensified symptoms for the last three months. Following a worsening of symptoms, the client visited her primary care physician. The client stated that she was diagnosed with an “inner ear infection” and, subsequently, was prescribed an antibiotic. After finishing the full course of the antibiotic, the client’s symptoms did not improve, so the client sought clinical evaluation at the WVU Hearing Center three weeks prior to the current visit.

At that time, the client reported true vertigo lasting less than one minute that was initiated from lying down/getting up from bed; bending down/rising up; and turning right and left. The client noted that the dizziness was worse when turning to the right side and was often accompanied by nausea and vomiting. The Dix-Hallpike maneuver revealed a small amount of rotational nystagmus on the right side only. Two rotations of the Epley maneuver were performed, and the client reported lessening of symptoms. She was asked to return to the WVU Hearing Clinic for additional treatment if her symptoms persisted more than one-week post-treatment.

At the current visit, the client described a complete elimination of symptoms four days post-treatment; however, she stated that symptoms returned two-weeks later. Currently, she described true vertigo, lasting less than one minute, initiated by leaning forward, lying down, or turning to the right or left. She reported that symptoms were worst when turning to the left.

When the Dix-Hallpike maneuver was performed on the left side, no nystagmus was observed. When the Dix-Hallpike maneuver was performed on the right side, a small amount of rotational nystagmus was observed. Two rotations of the Epley maneuver were performed on the right side directly following positive findings for Benign Paroxysmal Positional Vertigo (BPPV).

Following two rotations of the Epley maneuver and re-administration of the Dix-Hallpike maneuver on the right side, no rotational nystagmus was observed. Alleviation of true vertigo was noted by the client after the second rotation.

Results were discussed with the client, and she was informed that some residual dizziness could persist for approximately one week following treatment. However, she was strongly encouraged to schedule a follow-up appointment if residual symptoms persisted more than one week or if vertigo returns. No post-treatment restrictions were prescribed.

On a really awesome note ... this client was so over-joyed to be symptom-free that she hugged my supervisor and me!!! :-)

Health-Related Quality of Life in Patients over Sixty Years Old with Benign Paroxysmal Positional Vertigo by Maria Gámiz and Jose Lopez-Escamez.

Thirty-two patients with BPPV were included in the study. Twenty-four were between 60 and 70 years old, and 8 were older than 70 years. Subjects in this study had been diagnosed with unilateral BPPV based on a history of recurrent positional vertigo and a positive Dix-Hallpike test. A full neurotologic examination, including pure-tone audiometry, Romberg, Barany and Fukuda tests, was conducted at the initial visit. All patients were treated by a single rotation of the Epley manuever without mastoid oscillation, and they were instructed to sleep sitting in a recliner or propped up in bed for the first 2 nights post-treatment.

To assess BPPV health-related quality of life in elderly the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S) was used.

The study established that the SF-36 shows high internal consistency reliability and validity in elderly patients with BPPV for all dimensions. BPPV has a significant impact on individuals’ perception for role limitation due to physical problems, body pain, role limitation due to emotional problems, and mental health. After treatment, all SF-36 scale scores improved, and showed significant improvement after 30 days. role limitation due to physical problems, body pain, vitality, social function, and mental health.

DHI-S total score significantly decreased from 17.19 prior to treatment to 9.70 at 30days post-treatment. They also found that BPPV treatment in the elderly was just as effective as treatment of younger individuals.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=26&hid=101&sid=5077a623-7531-4b3a-a840-604f8d099f9b%40sessionmgr106

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