Now we’ve completely turned upside down our notion of what causes peptic ulcers.” Marshall, with J. “It took him 10 years to get his stuff published because we all thought it was Type A personalities and acid in the stomach, and we prescribed all these antacids. Marshall, who in the 1980s discovered the bacterium that causes peptic ulcers. He likened Epley’s travails to those of Barry J. “It’s human nature that people don’t like to have changes in their construct of reality,” he said. I asked Edlow why it has been so difficult to establish as common practice a simple, easy, nonpharmaceutical therapy for a common debilitating condition. How Can a Phone Survive a Fall From a Plane Without Cracking? Let’s Look at the Physics. The Surprising Antidote to Impostor SyndromeĮlon Musk Is Realizing He Should Have Bought TikTok So Many People Are Angry at a Very Unpopular Streaming Service Right Now The Epley maneuver is designed to guide the ear rocks out of the canal, a bit like those puzzle toys you tilt to roll a ball bearing through an enclosed maze. Changes in head position can shift the canaliths in the fluid, causing it to send disorienting signals to the brain. What exactly does a canalith repositioning maneuver, like the Epley, do? BPPV occurs when canaliths-tiny particles of calcium carbonate sometimes informally referred to as “ear rocks”-escape from one part of the inner ear into one of the semicircular canals filled with fluid that play a key role in the vestibular system, which maintains our sense of balance and our position in space. Edlow is the co-author of a systematic review of randomized controlled trials that concluded, “These data suggest that a canalith repositioning maneuver, and not vestibular suppressants, should be the primary treatment for benign paroxysmal positional vertigo.” He cautioned that vertigo can have other causes and patients should consult a doctor, ideally after “keeping a diary of their symptoms, such as ‘Rolled over in bed, had 30 seconds of dizziness, went away, was fine the rest of the day.’ ” Bhattacharyya stressed, “For somebody over 65 who believes they have BPPV, you still do need to see a provider who can diagnose and rule out other potential serious causes.īeing aware of the characteristic symptoms of BPPV can help patients be their own advocates, and can prevent physicians from recommending expensive diagnostic tests such as MRI or CT scans, which cannot detect BPPV, and meclizine or other vestibular suppressants, which often have unwanted side effects, in addition to not being effective against the vertigo itself. In 2008 Bhattacharyya was part of a panel of experts selected by the American Academy of Otolaryngology to write a set of clinical practice guidelines for diagnosing and treating BPPV. Neil Bhattacharyya, professor of otolaryngology at Massachusetts Eye and Ear and Harvard Medical School. BPPV is “a fairly common diagnosis,” said Dr. ![]() In a 2022 paper titled “ Acute dizziness: A personal journey through a paradigm shift,” Edlow describes a transformation in emergency medicine protocol from one that focused on “symptom quality”-that is, on asking the patient to better define what they mean by “dizzy”-to one that zeroes in on “timing and triggers”: what events or actions, such as rolling over in bed, preceded the dizzy spell, how long it lasts, and in what circumstances it subsides. I made an appointment with my GP and saw a physician assistant there. But she never mentioned the Epley maneuver or any of the other maneuvers developed to treat BPPV. That doctor prescribed meclizine, an anti-nausea drug, which, although it didn’t stop the vertigo, did make me feel a little better, since I’ve always been prone to motion sickness. Maybe I wasn’t doing it properly? I decided to call the telehealth service offered by my insurance. The next year, it happened again, and this time it took several performances of the maneuver to get to the point where I could walk without worrying I’d pitch sideways into a wall. Apart from a faint sensation of lightheadedness that dissipated by the end of the day, my vertigo was cured. While it’s surely better to perform the maneuver with professional help, it is quite possible to do it on your own. ![]() I found the same videos Maria’s husband had, and followed their instructions myself. Then, I reached for my iPad and feebly typed in “vertigo maneuver,” since I couldn’t remember the name of the doctor, John M. It’s typical of BPPV that movement, particularly of the head, will trigger it and that remaining still will cause it to temporarily subside. ![]() When my spin cycle started, I at first tried to stay motionless.
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