Thank you for this! I was able to do these maneuvers at home (after finally figuring out which canal was affected) and I can move around again. I’m a physician and had never really learned about anything other than PC BPPV, so this was incredibly helpful.
Great to hear you're feeling better. Horizontal canal BPPV is one of the most undiagnosed conditions that cause vertigo. We have to teach people that just doing a Dix-Hallpike test and seeing nystagmus is not enough.
Poor lady! Its a terrible affliction. Im glad to hear she was doing better. It definitely sucks! Its difficult to watch when i know how that feels. Just glad shes better now.
Great to hear! More and more studies show that if you know how to look for it, HC BPPV is about a third of the BPPV that comes in to ED (and probably in any situation where the patient seeks and receives treatment early.
Thanks Peter. Very helpful video as it showed initial failure to clear and conversion into post canalithiasis. It gives me confidence as a clinician to treat such cases. Thanks a bunch
I had 4 bouts of vertigo. Each one landed me in the er of the hospital. When the vertigo bout happened, I threw up violently. I had not thrown up for 40 years. When the first bout of vertigo happened, I was shocked as I did not know what was happening. I thought heart attack, stroke or brain hemorrhaging. I was really scared. I am 78 years old and never experienced anything like this before. I have no idea what brought this on. After the 4 visits to the hospital( which by the way, I was not in the hospital for the last40 years, also.) I ran across the head exercises that you have shown and explained. I have not had a vertigo episode for the last 7 months. It would be a great thing if I never have another one in my life. Thank you for your insight.
Thanks! Good question. The downward ear, on the side where the apogeotropic nystagmus is less intense, is considered to be the affected year. For instance in the model demonstration, the affected ear is the left one, so the apogeotropic nystagmus would be less intense when the head is turned to the left, and more intense when the head is turned to the right.
Thank you so mucho. Yes, my dr made me a videonistagmography and it turnos positional in the left and menier in the right. I inheritage that from mom and my grandmother. Thank you
this case is exactly what happened to me yesterday. now I'm dizzy laying straight back. was too sick to keep going. going back Tuesday to try and get it resolved. great video.
my right side was the affected side, they tried the bbq roll. I threw up several times. after the roll, my right side seemed better but I was dizzy straight on my back and they decided not to try anymore cause I was sick. . I hope they can resolve it Tuesday.
Thank you so much for a very informative video! I have trouble understanding nystagmus through textbooks and this real life nystagmus of a patient really helped ! :)
after a concussion I still knew i had something wrong... after doing the test and 2 of these maneuvers per my findings, This worked great.... I now can do the test with out spinning and nearly hurling...
@@cassiandadavis9566 same as me. I use dramamine or gravol, here in my country Costa Rica, I inyected myself TODAY. I AM better. I take betahistine 16 MG every day for the rest of my life. I cant complaine, I go downtown on a bus, by choice BECAUSE I LIKE the view. 10 years I stay at my house without going anywhere. I did gentamicine in my right ears 8 years ago in a private hospital just to kill the semicircular canal. 1 Year in bed with recovey excesices. A living hell. I AM 55 and got this since 18 years old. My father was a doctor, so he took me to Saint vincents hospital in LA, for test and scans, and so on. But in those years there were no thing to do. Until 2008. Then I saw Internet that the first astronauta,,, allan shepard had has menier. That confort me and I went to Florida to the hall of fame in 2011. As a promise for my bravery recoveres. Jojothank you for answer my question, take CARE and take dramamine and betaserc
Thanks! Nomenclature in vertigo is difficult, and I'm not sure I have it completely correct, but in an editorial by Dr. Kerber in Neurology, he mentions "the Gufoni maneuver for the geotropic form" as well as "a Gufoni maneuver adapted for the apogeotropic varient". So it's good enough for Dr. Kerber and Neurology, it's good enough for me!
My physical therapist diagnosed me with this today - it’s been 11 months since I was hit by a car while walking. I’m truly hoping this is finally the answer to why I’m unbalanced/dizzy. Though I am anxious because the first maneuver didn’t work and I was instructed to do it from home a couple times a day till my next appointment. Didn’t know I could develop regular BPPV 😬😬😬😬😬
Thanks for this informative video. I've had 6 days now of BPPV on BOTH sides (left and right ear) only brought on by ear to shoulder head movement in an upright position, and lying flat and turning my head to the left side and right side. I can't see a doctor until another week, so what manoeuvres would you recommend as it seems to be both ears with me? I take full responsibility for trying this at home and only asking for your expert opinion. Thanks, Roxana
i have cerebral palsy mild case never had dizziness until 14yrs ago i am 54 years of age it started 14 yrs ago it subsided after therapy and on its own , it has come and gone after eply manuevers , now it has started again severly after laying flat day befoe doing vng test what luck the results are not solid , they are confused because during the halpike test i remained with nystagmus waiting for doctors final word on what i should do , what do u think
I had the scariest vertigo episodes yesterday. It would be triggered by laying down, rolling over or sitting up, it would spin virgiously for a few seconds before settling down and i also felt slightly nauseous. My symptoms matched BPPV, though I never went to the doctor. Had the epley maneuver done on me and the vertigo disappeared after that, although I don't think my eyes twitched or we were just too amateur to tell. Could it have been BPPV after all or should i go to the doctor?
I get a little confused as to which is the affected ear. Am I correct in thinking that the affected ear will always be the side to which the fast beating component is going towards when turned towards the most affected side? This would follow for both geotrophic and ageotrophic.
Kevin Baughman That would be another way to think about it. But instead say "most intense response" side. "Affected side" is a term used to describe the ear that has the otolith problem.
Does the direction in which your surroundings are spinning (if you're the patient) say something about which canal is affected (horizontal, superior, posterior)? Or the type of movement that starts the spinning (turning head left to right, turning up and down, bringing the ear to the shoulder)? Wondering how to self-diagnose when you need the stop the spinning fast (because you need to be able to work the next day), and have no time to wait for an appointment with a PT. Or should you just try the epley first (on the correct ear of course), and if that fails after 3 tries, try the Gufoni/BBQ roll?
It would probably be easier to video your own nystagmus and then apply the appropriate treatment based on the nystagmus. I think this would be difficult for a lay person to do. However, my brother (with no medical training) did diagnose himself with geotropic BPPV and cure himself with the appropriate Gufoni maneuver. So it is possible.
Thanks for your reply. That's an idea. I'll start studying the material then, so I'll have the knowledge ready if a new attack comes. So far I've only had posterior canal bppv (easy to tell), and the Epley was always succesful.
I have this and it's easy to do the normal bppv test. Just sit up turn your head looking over your left shoulder and lie down with it in that position. If it is the left ear you will get vertigo and feel your eyes going tick, tick, tick. Use your phone to video the eyes if possible as it might help if you need it for a doctor to determine the more unusual type. If the left side doesn't reproduce vertigo, it's not your left ear. So try the right side. When you determine which side, do the "Epley maneuver." Unfortunately, it can take a few days to fully clear even if done properly. This video discusses a more unusual type which is horizontal. If Epley doesn't work, then suspect the horizontal kind and do the fix for that if the test is positive. If none of them are positive, you need to be evaluated for other ear problems, brain or CNS disorders. I almost always get it in the spring. Wish they would figure out why and prevent it.
I'm not sure but ,if anyone else wants to uncover cure vertigo with water try Magonsi Fast Vertigo Expert (do a google search ) ? Ive heard some great things about it and my brother in law got amazing success with it.
I'm not sure but ,if anyone else wants to uncover how to help vertigo try Magonsi Fast Vertigo Expert (Have a quick look on google cant remember the place now ) ? Ive heard some amazing things about it and my buddy got great results with it.
Hey Dr. Johns, Is there a reason why you did the lempert roll first vs. the gufoni? I have an elderly gentleman that I'm not sure he could perform the lempert roll....
Thanks for the question. No, there was no particular reason why we did the Lempert roll first. And the Gufoni maneuver was definitely easier to perform in this elderly lady.
great video - on the BBQ roll step 5 ( or the 2nd last maneuver on side of body), what could be the cause that the nystagmus movement continuing without settling down? For other steps, the nystagmus is short lived except for step 5. This is for a suspected left ear horizontal bppv. thanks
www.ncbi.nlm.nih.gov/pubmed/10431888 Well, a smarter man than me, (Dr. Robert Baloh) refers to them as otoliths. Admittedly, nomenclature in vertigo is one of the reasons that makes vertigo not an easy subject to understand.
Yes the more intense side was when she faced the left, and the video shows her eyes moving away from the floor. I thought the same thing as you and was wondering why @peterjohns didnt mention that.
Hi there. If a Dix-Hallpike is performed on a patient with horizontal BPPV, you highlight that the test would be negative, or it would produce atypical findings. What might be seen in terms of nystagmus? And would any harm be caused if you went on to try and treat it with an Eply (apart from it just not being successful)? Thank you.
Good question! You could see exactly what you would see in a supine roll test. That is, horizontal nystagmus either geotropic or apogeotropic on both sides. You would not see the typical vertical nystagmus with rotatory component towards the downward ear, on one side only, which is the typical positive Dix-Hallpike for posterior canal BPPV. No harm would be done.
i need help do you know if there's a dr. in houston tx that can do those maneuvers I have being with vertigo for 6 days and I can't carry my newborn cause I'm afraid I'll drop her please help me
For the treatment of geotropic HC BPPV, you mention using the Gufoni maneuver- should it be the Appiani (or are you using the terms interchangeably)? Versus treatment of apogeotropic HC BPPV with the true "Gufoni" maneuver (Which is confusing since he apparently developed both tests)? Thanks for the great video here!
Thanks Peter for a great video! 2 questions: 1. Do you ever try the BBQ roll for horizontal BPPV with apogeotropic nystagmus? 2. In the demo of the Gufoni maneuver, you mention turning the head 45deg toward the table but demonstrate 90deg. Is the amount of rotation critical with this procedure? Thanks!
1. I have not tried it, no. 2. I meant to turn it 45, I might have gone beyond that. I don't know how critical it is, but that's how it is described, 45 degrees.
hello dr, I've been battling vertigo for months now. it was a constant imbalance/light headedness issue, then all of a sudden I woke up in the middle of the night and everything was spinning. Dr diagnosed it as horizontal. after a couple days doing her exercise, room has stopped spinning. My head still doesn't feel right. How long do I keep doing the exercise? thank you.
Thanks a lot , in geotropic lat bppv the can we determine the side from the strongest symptoms on that side?? As severity of nystagmus s sometimes hard to measure..thanks in advance.
Yes, in geotropic HC BPPV, when the patient has their affected ear down, they experience more vertigo and nystagmus than the other side. If you're not sure, I'd do the Gufoni for the side you think is the affected ear, and after 15 minutes, do the supine roll test again. Sometimes on re-testing the affected ear becomes more apparent.
+Marwa1981 Ahamed As in the comment above, the affected ear in apogeotropic horizontal canal BPPV is the downward ear on the side which has the least intense response to the supine roll test. For example, if I had a patient with left ear apogeotropic horizontal canal BPPV, and I turned the patients head to the left, I would see horizontal nystagmus away from the ground (apogeotropic). If I then turned the patients head back to neutral and then to the right, I would again see apogeotropic nystagmus, but I should observe that the nystagmus is somewhat more intense when turned to the right then when I had turned the head to the left. Therefore the affected ear (the one with the misplaced otolith) is the left ear.
@@PeterJohns shouldn't the affected be the right side, but in the anterior part of the horizontal canal. Just the treatment is like for the posterior part of the left ear...
I think you're asking about what is termed subjective BPPV. If the patient has one side negative, and then the other side has latency, and the appropriate duration of vertigo, yet no nystagmus, I would try an Epley maneuver on that side. If the patient's Dix-Hallpike is negative when tested 10 minutes after the Epley, this would qualify as a cure in subjective BPPV.
I actually don't use the BBQ roll at all. I use the Gufoni for both geo and apogeo with great success. See the video described as "new and more concise" above.
I wish you were at every ER. Can someone create goggles using a VR headset & cell phone. Connect it to program that can analyze the nystagmus if you tell it (supine or dix halpike). It could determine geotrophic, ageo, torsional. Then it tells you what maneuver to do to clear it. If we can create a rocket to fly up and down to space, this is do able. I would buy it. Lost over 10 days of work through various episodes. Blessings
Hi Is is normal that, you can have this with interval of months or even years? And are the chances of felling the dizznes enhanced by alkohol/the hangover the day after?
I am sorry, my english is not adequate I guess. I will try again. Can bppv be present even if there is no nystagmus detectable? I've read that nystagmus can be fatigued when one does a lot of exercises for vertigo like the Brandt-Daroff manouvre.
Testing for fatigueability is no longer recommended. Sometimes it is necessary to repeat positional testing (both the Dix-Hallpike test and the supine roll test) even on different days in order to reliably rule out a form of BPPV. Also, it is possible to have BPPV where the patient has no nystagmus, but has the appropriate symptoms. This is called subjective BPPV, and in my experience it is rare. If you feel the patient has subjective BPPV, it is appropriate to perform the Epley maneuver. Hope this helps.
Well doctor i am sorry to bother you i have been diagnosed with horizontal bppv 2 years ago i get 90% okay but still discomfort ... 5 months i have diagnosed with posterior bppv .. so the problem now i feel a discomfort while moving my head .. 2 days i done eply maneuvers i felt okay but while walking and turing my head left feels dizzy a little and when i sleep on left side too .. every time i do eply maneuver the symptoms decreased almost vanished but when i do bbq maneuver i felt better to but the moving my head up and down felt dizzy so I returned to eply maneuver the symptoms was very strong again and now i am lost sorry for this long chat
hello, my dr called this the Appiani maneuver on me for hc bppv. is it likely the same thing as what you did with the lying on side for 1 minute, then nose down 2 minutes, then upright?
Kind of you to reply. I've seem to have gotten it in my right ears upper canal, and also now the left ear horizontal. I've been fighting this for several years, just now finally with a doctor that understands the moves. I'm terrified I will have this constantly the rest of my life. It's completely ruining me. I'm only 41, single, trying to work hard, hope for a family some day. I just need inspiration and positive doctors right now.
I just reviewed the original articles by Appiani. For both geotropic and apogeotropic horizontal canal, he refers to what he is doing as "Gufoni's new maneuver". Pretty clear that should be the name.
I have stopped using the BBQ roll. I find the Gufoni maneuver easier and quicker to perform, even in frail or large individuals. See my new video to see how. ruclips.net/video/VRjRTnIw9YE/видео.html
hey anyone, preferably the doc, please reasure something for me. so if the right ear is the bad one, you do the bbq roll to the left though. then vice versa?
Well I hope I were on the same page lol. So if laying on my right side makes me dizzy, I roll to the left. If laying on my left makes me the most dizzy, I roll to my right correct? Sorry to ask twice, but you mentioned if your understanding me correctly. I will have to look up that other maneuver. Do you think if I keep this up, since it clears it up each time, that it will eventual stop? Is their a reason mine clears up, then is right back in a day, then clears up 2 days, then right back? Some ppl say the crystals, calcium or whatnot, should go back and absorb back into the body, they say it could be too much calcium, not enough, or vit D deficiency. Others say no they don't dissolve, they just go stick in the right spot. It would sure help if in today's science some could figure that out for sure............ide like to know. Side note, you need to know that if ppl come to you on here, it's because their quality of life is going or been down hill and they are hitting depression through this awful situation. You taking the time to answer as best you can and help us for free is a blessing to us and you need to know how much we all appreciate that. This is so very real for us and me myself, it's ruining my life. My work just approached me as well wondering what the heck is going on. 11 years at this place, I don't want to mess this up. So thanks so much anytime you help out. Jason.
I hope you have seen my video "How to do the Epley Maneuver" because it shows you how to cure the most common cause of BPPV. Have a look and let me know if you have questions after that.
i use to spin to the left, for a few months then i would spnd to th right.....now i either spin backwards or forwards with eyes going up and down when i get up or lay down. which maneuver should i do? i also cant move my head to left or right when laying down and have a very stiff neck.....what do you recommend?
Have you seen my video "How to do the Epley maneuver"? It would be best to see a health care professional in real life. A physiotherapist who does vestibular rehab, MD with an interest in vertigo.
Peter Johns yea i was seeing one for awhile...sometimes left side was treated then sometimes we treated the right and it helped, then they quit seeing me and showed me how to do it at home and it helped somee. but now that im spinning front or back i dont know how to do that because he never treated that before...i am waiting for him to call me back today, dont really have the money to see anybody right now...... we dont have much drs to choose from in our area
why is it that every time i see a video of a diagnosis a woman is used as the model. are women more prone to getting diseases? i don't mean to be sexist just an honest question.
Thanks for the video! I am an Otolaryngologist from the Philippines. Have received a 60/M patient today with recurrent vertigo; on Dix - Hallpike was negative. Performed the supine roll test and he had geotropic nystagmus when head was turned to right. Was curious though, there was no nystagmus when her was head turned to left. I wanted to do the BBQ maneuver but she wouldn't consent anymore, so I advised them if they could try it at home. Will try the Gufoni maneuver. I've also read in our textbook that a significant fraction of PC BPPV is converted to Lateral Canal BPPV upon performing Epley, the reverse of what happened in your video. Glad your patient recovered :) Thank you for all your Dizziness videos, really helpful!
Thanks for your kind words. Yes, I have seen PC convert to HC, but not very often. For patients not willing to undergo a maneuver, this recent paper suggests you can cure 71% of geotropic HC BPPV by having them lie on their good ear for 1 hour. www.frontiersin.org/articles/10.3389/fneur.2023.1153491/full
Thank you for this! I was able to do these maneuvers at home (after finally figuring out which canal was affected) and I can move around again. I’m a physician and had never really learned about anything other than PC BPPV, so this was incredibly helpful.
Great to hear you're feeling better. Horizontal canal BPPV is one of the most undiagnosed conditions that cause vertigo. We have to teach people that just doing a Dix-Hallpike test and seeing nystagmus is not enough.
Poor lady! Its a terrible affliction. Im glad to hear she was doing better. It definitely sucks! Its difficult to watch when i know how that feels. Just glad shes better now.
Detected and cured my first horizontal canal BPPV today, all thanks to your amazingly informative videos!
Great to hear! More and more studies show that if you know how to look for it, HC BPPV is about a third of the BPPV that comes in to ED (and probably in any situation where the patient seeks and receives treatment early.
Thanks Peter. Very helpful video as it showed initial failure to clear and conversion into post canalithiasis. It gives me confidence as a clinician to treat such cases. Thanks a bunch
These videos have been SUPER helpful! Thanks!
Hope the dear lady was referred to derm for that very suspicious lesion on her nose!
Looks like basal to me
I had 4 bouts of vertigo. Each one landed me in the er of the hospital. When the vertigo bout happened, I threw up violently. I had not thrown up for 40 years. When the first bout of vertigo happened, I was shocked as I did not know what was happening. I thought heart attack, stroke or brain hemorrhaging. I was really scared. I am 78 years old and never experienced anything like this before. I have no idea what brought this on. After the 4 visits to the hospital( which by the way, I was not in the hospital for the last40 years, also.) I ran across the head exercises that you have shown and explained. I have not had a vertigo episode for the last 7 months. It would be a great thing if I never have another one in my life. Thank you for your insight.
Thanks! Good question. The downward ear, on the side where the apogeotropic nystagmus is less intense, is considered to be the affected year.
For instance in the model demonstration, the affected ear is the left one, so the apogeotropic nystagmus would be less intense when the head is turned to the left, and more intense when the head is turned to the right.
Thank you so mucho. Yes, my dr made me a videonistagmography and it turnos positional in the left and menier in the right. I inheritage that from mom and my grandmother. Thank you
Very useful and informative video. Thank you so much for posting.
this case is exactly what happened to me yesterday. now I'm dizzy laying straight back. was too sick to keep going. going back Tuesday to try and get it resolved. great video.
my right side was the affected side, they tried the bbq roll. I threw up several times. after the roll, my right side seemed better but I was dizzy straight on my back and they decided not to try anymore cause I was sick. . I hope they can resolve it Tuesday.
I just love this video. Many thanks...
Thank you so much for a very informative video! I have trouble understanding nystagmus through textbooks and this real life nystagmus of a patient really helped ! :)
+tissue522 You're welcome!
after a concussion I still knew i had something wrong... after doing the test and 2 of these maneuvers per my findings, This worked great.... I now can do the test with out spinning and nearly hurling...
John Krenn That's good to hear!
excellent demonstration dr peters, the old lady also seems to be having a lesion on the tip of her nose (basal cell ca?)
Thank you for posting this information, I suffer from horizontal bppv. And I'm really scared to do the exercises at home.
I need to ask you. Do you feel vértigo when you put your ear I. Your bed, in flat?
@Raheen Shampaine I've dealt with it off and on for a few years
@@monicaguti1 I feel it when I kay flat on my back, or move too fast
@@cassiandadavis9566 same as me. I use dramamine or gravol, here in my country Costa Rica, I inyected myself TODAY. I AM better. I take betahistine 16 MG every day for the rest of my life. I cant complaine, I go downtown on a bus, by choice BECAUSE I LIKE the view. 10 years I stay at my house without going anywhere. I did gentamicine in my right ears 8 years ago in a private hospital just to kill the semicircular canal. 1 Year in bed with recovey excesices. A living hell. I AM 55 and got this since 18 years old. My father was a doctor, so he took me to Saint vincents hospital in LA, for test and scans, and so on. But in those years there were no thing to do. Until 2008. Then I saw Internet that the first astronauta,,, allan shepard had has menier. That confort me and I went to Florida to the hall of fame in 2011. As a promise for my bravery recoveres. Jojothank you for answer my question, take CARE and take dramamine and betaserc
Very good explanation
Thanks! Nomenclature in vertigo is difficult, and I'm not sure I have it completely correct, but in an editorial by Dr. Kerber in Neurology, he mentions "the Gufoni maneuver for the geotropic form" as well as "a Gufoni maneuver adapted for the apogeotropic varient". So it's good enough for Dr. Kerber and Neurology, it's good enough for me!
Thanks, very nice and useful video
My physical therapist diagnosed me with this today - it’s been 11 months since I was hit by a car while walking. I’m truly hoping this is finally the answer to why I’m unbalanced/dizzy. Though I am anxious because the first maneuver didn’t work and I was instructed to do it from home a couple times a day till my next appointment. Didn’t know I could develop regular BPPV 😬😬😬😬😬
Thank you so much Respected Sir i was wondering how to differentiate between these you solved this ❤
I think this video is even better. ruclips.net/video/VRjRTnIw9YE/видео.html
Thanks for this informative video. I've had 6 days now of BPPV on BOTH sides (left and right ear) only brought on by ear to shoulder head movement in an upright position, and lying flat and turning my head to the left side and right side. I can't see a doctor until another week, so what manoeuvres would you recommend as it seems to be both ears with me? I take full responsibility for trying this at home and only asking for your expert opinion. Thanks, Roxana
i have cerebral palsy mild case never had dizziness until 14yrs ago i am 54 years of age it started 14 yrs ago it subsided after therapy and on its own , it has come and gone after eply manuevers , now it has started again severly after laying flat day befoe doing vng test what luck the results are not solid , they are confused because during the halpike test i remained with nystagmus waiting for doctors final word on what i should do , what do u think
I had the scariest vertigo episodes yesterday. It would be triggered by laying down, rolling over or sitting up, it would spin virgiously for a few seconds before settling down and i also felt slightly nauseous. My symptoms matched BPPV, though I never went to the doctor. Had the epley maneuver done on me and the vertigo disappeared after that, although I don't think my eyes twitched or we were just too amateur to tell. Could it have been BPPV after all or should i go to the doctor?
I get a little confused as to which is the affected ear. Am I correct in thinking that the affected ear will always be the side to which the fast beating component is going towards when turned towards the most affected side? This would follow for both geotrophic and ageotrophic.
Kevin Baughman That would be another way to think about it. But instead say "most intense response" side. "Affected side" is a term used to describe the ear that has the otolith problem.
Hello, thank you for the good video ! i have a question, can i apply the the test or maneuver for normal people ? Just for practice!
yes, there is no problem.
Does the direction in which your surroundings are spinning (if you're the patient) say something about which canal is affected (horizontal, superior, posterior)?
Or the type of movement that starts the spinning (turning head left to right, turning up and down, bringing the ear to the shoulder)?
Wondering how to self-diagnose when you need the stop the spinning fast (because you need to be able to work the next day), and have no time to wait for an appointment with a PT.
Or should you just try the epley first (on the correct ear of course), and if that fails after 3 tries, try the Gufoni/BBQ roll?
It would probably be easier to video your own nystagmus and then apply the appropriate treatment based on the nystagmus. I think this would be difficult for a lay person to do. However, my brother (with no medical training) did diagnose himself with geotropic BPPV and cure himself with the appropriate Gufoni maneuver. So it is possible.
Thanks for your reply. That's an idea. I'll start studying the material then, so I'll have the knowledge ready if a new attack comes. So far I've only had posterior canal bppv (easy to tell), and the Epley was always succesful.
I have this and it's easy to do the normal bppv test. Just sit up turn your head looking over your left shoulder and lie down with it in that position. If it is the left ear you will get vertigo and feel your eyes going tick, tick, tick. Use your phone to video the eyes if possible as it might help if you need it for a doctor to determine the more unusual type. If the left side doesn't reproduce vertigo, it's not your left ear. So try the right side. When you determine which side, do the "Epley maneuver." Unfortunately, it can take a few days to fully clear even if done properly. This video discusses a more unusual type which is horizontal. If Epley doesn't work, then suspect the horizontal kind and do the fix for that if the test is positive. If none of them are positive, you need to be evaluated for other ear problems, brain or CNS disorders. I almost always get it in the spring. Wish they would figure out why and prevent it.
I'm not sure but ,if anyone else wants to uncover cure vertigo with water try Magonsi Fast Vertigo Expert (do a google search ) ? Ive heard some great things about it and my brother in law got amazing success with it.
I'm not sure but ,if anyone else wants to uncover how to help vertigo try Magonsi Fast Vertigo Expert (Have a quick look on google cant remember the place now ) ? Ive heard some amazing things about it and my buddy got great results with it.
Hey Dr. Johns, Is there a reason why you did the lempert roll first vs. the gufoni? I have an elderly gentleman that I'm not sure he could perform the lempert roll....
Thanks for the question. No, there was no particular reason why we did the Lempert roll first. And the Gufoni maneuver was definitely easier to perform in this elderly lady.
great video - on the BBQ roll step 5 ( or the 2nd last maneuver on side of body), what could be the cause that the nystagmus movement continuing without settling down? For other steps, the nystagmus is short lived except for step 5. This is for a suspected left ear horizontal bppv. thanks
I don't know the answer to that question, sorry.
Otoconia,not otoliths..... :). Thanks for sharing. Very nice of the patient to cooperate.
www.ncbi.nlm.nih.gov/pubmed/10431888
Well, a smarter man than me, (Dr. Robert Baloh) refers to them as otoliths.
Admittedly, nomenclature in vertigo is one of the reasons that makes vertigo not an easy subject to understand.
+Peter Johns Totally agree!!
It appeared to me that the woman's nystagmus (1st time) was beating upward and away from the floor. Isn't that Apogeotropic BPPV?
No, it was beating towards the ground.
Yes the more intense side was when she faced the left, and the video shows her eyes moving away from the floor. I thought the same thing as you and was wondering why @peterjohns didnt mention that.
I've had it for 4 years I still have it
Hope it is better now?
Yous are the God doctor
Hi there. If a Dix-Hallpike is performed on a patient with horizontal BPPV, you highlight that the test would be negative, or it would produce atypical findings. What might be seen in terms of nystagmus? And would any harm be caused if you went on to try and treat it with an Eply (apart from it just not being successful)? Thank you.
Good question! You could see exactly what you would see in a supine roll test. That is, horizontal nystagmus either geotropic or apogeotropic on both sides. You would not see the typical vertical nystagmus with rotatory component towards the downward ear, on one side only, which is the typical positive Dix-Hallpike for posterior canal BPPV. No harm would be done.
Very helpful answer, thanks Peter.
i need help do you know if there's a dr. in houston tx that can do those maneuvers I have being with vertigo for 6 days and I can't carry my newborn cause I'm afraid I'll drop her please help me
+martha estrada If you google vestibular rehab and Houston, you should be able to find someone who can help you. Good luck.
For the treatment of geotropic HC BPPV, you mention using the Gufoni maneuver- should it be the Appiani (or are you using the terms interchangeably)? Versus treatment of apogeotropic HC BPPV with the true "Gufoni" maneuver (Which is confusing since he apparently developed both tests)? Thanks for the great video here!
Thanks Peter for a great video! 2 questions: 1. Do you ever try the BBQ roll for horizontal BPPV with apogeotropic nystagmus?
2. In the demo of the Gufoni maneuver, you mention turning the head 45deg toward the table but demonstrate 90deg. Is the amount of rotation critical with this procedure? Thanks!
1. I have not tried it, no.
2. I meant to turn it 45, I might have gone beyond that. I don't know how critical it is, but that's how it is described, 45 degrees.
is it normal that after maneuvers you still feel little dizzy in few days or weeks?
It can happen, yes.
@@PeterJohns thank you for your answer sir.. uhmm can i do my maneuver over and over when i feel dizzy?
@@xXx-cm3co If you really have BPPV, it can help. If you don't have BPPV, it will just make you feel vertigo for no benefit.
@@PeterJohns or maybe you are treating wrong canal? if no progress ..am i right sir?
That would be unusual, and not at all typical of BPPV.
hello dr, I've been battling vertigo for months now. it was a constant imbalance/light headedness issue, then all of a sudden I woke up in the middle of the night and everything was spinning. Dr diagnosed it as horizontal. after a couple days doing her exercise, room has stopped spinning. My head still doesn't feel right. How long do I keep doing the exercise? thank you.
I'd check with your doctor.
I'm in your situation now. How are you doing?
❤❤❤very good, thanks a lot❤❤❤
Thanks a lot , in geotropic lat bppv the can we determine the side from the strongest symptoms on that side??
As severity of nystagmus s sometimes hard to measure..thanks in advance.
Yes, in geotropic HC BPPV, when the patient has their affected ear down, they experience more vertigo and nystagmus than the other side. If you're not sure, I'd do the Gufoni for the side you think is the affected ear, and after 15 minutes, do the supine roll test again. Sometimes on re-testing the affected ear becomes more apparent.
@@PeterJohns well appreciate your idea... Thank you...
I am confused about ageotropic nystagmus
Where is the affected side
+Marwa1981 Ahamed As in the comment above, the affected ear in apogeotropic horizontal canal BPPV is the downward ear on the side which has the least intense response to the supine roll test. For example, if I had a patient with left ear apogeotropic horizontal canal BPPV, and I turned the patients head to the left, I would see horizontal nystagmus away from the ground (apogeotropic). If I then turned the patients head back to neutral and then to the right, I would again see apogeotropic nystagmus, but I should observe that the nystagmus is somewhat more intense when turned to the right then when I had turned the head to the left. Therefore the affected ear (the one with the misplaced otolith) is the left ear.
@@PeterJohns shouldn't the affected be the right side, but in the anterior part of the horizontal canal. Just the treatment is like for the posterior part of the left ear...
@@Arachnoidarachnoid Watch my more recent video. ruclips.net/video/VRjRTnIw9YE/видео.html
What about a patient that gets vertigo on right side Dix-Hallpike but no nystagmus?
I think you're asking about what is termed subjective BPPV. If the patient has one side negative, and then the other side has latency, and the appropriate duration of vertigo, yet no nystagmus, I would try an Epley maneuver on that side. If the patient's Dix-Hallpike is negative when tested 10 minutes after the Epley, this would qualify as a cure in subjective BPPV.
What's the diagnosis if there is torsional nystagmus in supine roll test but no nystagmus during epley?
Hard to say. Sorry.
Is there a different approach to the BBQ roll with patients who present with ageotropic HC of either ear?
I actually don't use the BBQ roll at all. I use the Gufoni for both geo and apogeo with great success. See the video described as "new and more concise" above.
I wish you were at every ER. Can someone create goggles using a VR headset & cell phone. Connect it to program that can analyze the nystagmus if you tell it (supine or dix halpike). It could determine geotrophic, ageo, torsional. Then it tells you what maneuver to do to clear it. If we can create a rocket to fly up and down to space, this is do able. I would buy it. Lost over 10 days of work through various episodes. Blessings
I'm sooo lucky I have just been diagnosed with this I have to do the BBQ Role
Where is the BBQ role centres
Can you tell me where you purchased your inner ear model (shown around 1 min 50 sec mark?) Thanks!
The box it came in says "Chang Bioscience Castro Valley CA" Hope this helps.
store.changbioscience.com/smd101.html
Hi
Is is normal that, you can have this with interval of months or even years?
And are the chances of felling the dizznes enhanced by alkohol/the hangover the day after?
they have not done all the manuevers like u have shown looking up and down causes lightheadedness presently
Sorry, I'm unable to comment.
Thanks sir,If you have more video for BBQ Or Gufoni manouver.
Yes, click on "videos", my horizontal canal video explains the Gufoni maneuver.
what kind of vertigo do I have if I have motion sickness while walking I feel like I'm off balance
Hard to say. You should see a health care professional.
Ask for a videonistagmography this will tells you WHAT do you have. With an otorinolaryngologist
did she see a dermatologist afterwards? It's a loco typico for skin cancer...
is it correct that if nystagmus is not present, meaning it is not bppv in any form possible?
If you could rephrase your question I will try and answer it.
I am sorry, my english is not adequate I guess. I will try again. Can bppv be present even if there is no nystagmus detectable? I've read that nystagmus can be fatigued when one does a lot of exercises for vertigo like the Brandt-Daroff manouvre.
Testing for fatigueability is no longer recommended. Sometimes it is necessary to repeat positional testing (both the Dix-Hallpike test and the supine roll test) even on different days in order to reliably rule out a form of BPPV. Also, it is possible to have BPPV where the patient has no nystagmus, but has the appropriate symptoms. This is called subjective BPPV, and in my experience it is rare. If you feel the patient has subjective BPPV, it is appropriate to perform the Epley maneuver. Hope this helps.
So this was treating Horizontal -> Posterior Canalithiasis correct?
First geotrophic horizontal canal BPPV, which converted to a posterior canal BPPV.
Thank you!
Hey doctor.. did you do the three maneuvers after each other in the same visit or let a day between them ?!
Same emergency visit!
Well doctor i am sorry to bother you i have been diagnosed with horizontal bppv 2 years ago i get 90% okay but still discomfort ... 5 months i have diagnosed with posterior bppv .. so the problem now i feel a discomfort while moving my head .. 2 days i done eply maneuvers i felt okay but while walking and turing my head left feels dizzy a little and when i sleep on left side too .. every time i do eply maneuver the symptoms decreased almost vanished but when i do bbq maneuver i felt better to but the moving my head up and down felt dizzy so I returned to eply maneuver the symptoms was very strong again and now i am lost sorry for this long chat
I really need your help doctor
@@mohamedayman4938 Sorry, I can't help you. Hope you feel better soon.
@@mohamedayman4938 I'm very sorry.
hello, my dr called this the Appiani maneuver on me for hc bppv. is it likely the same thing as what you did with the lying on side for 1 minute, then nose down 2 minutes, then upright?
yes, nomenclature in vertigo is a problem.
Kind of you to reply. I've seem to have gotten it in my right ears upper canal, and also now the left ear horizontal. I've been fighting this for several years, just now finally with a doctor that understands the moves. I'm terrified I will have this constantly the rest of my life. It's completely ruining me. I'm only 41, single, trying to work hard, hope for a family some day. I just need inspiration and positive doctors right now.
I just reviewed the original articles by Appiani. For both geotropic and apogeotropic horizontal canal, he refers to what he is doing as "Gufoni's new maneuver". Pretty clear that should be the name.
@@jasons8798 hi Jayson how are you now... Is it horizondal semicircular canal issue.. What treatment work for you.. Heard its not very easy to cure.
Hello have you ever seen or heard of children with Vertigo?
I know that children can get various types of vertigo, but pediatrics is not part of my medical practice, so I have no personal experience.
How can I treat the apogeotropic with BBQ manu.
I have stopped using the BBQ roll. I find the Gufoni maneuver easier and quicker to perform, even in frail or large individuals. See my new video to see how. ruclips.net/video/VRjRTnIw9YE/видео.html
You must be watching a very select number of videos.
hey anyone, preferably the doc, please reasure something for me. so if the right ear is the bad one, you do the bbq roll to the left though. then vice versa?
also, when to do the 270 roll versus 360?
Anyone?
Yes to question one (if I understand what you're asking.).
Some people do 270, some the full 360. I actually prefer the Gufoni maneuver.
Well I hope I were on the same page lol. So if laying on my right side makes me dizzy, I roll to the left. If laying on my left makes me the most dizzy, I roll to my right correct?
Sorry to ask twice, but you mentioned if your understanding me correctly.
I will have to look up that other maneuver.
Do you think if I keep this up, since it clears it up each time, that it will eventual stop?
Is their a reason mine clears up, then is right back in a day, then clears up 2 days, then right back?
Some ppl say the crystals, calcium or whatnot, should go back and absorb back into the body, they say it could be too much calcium, not enough, or vit D deficiency. Others say no they don't dissolve, they just go stick in the right spot. It would sure help if in today's science some could figure that out for sure............ide like to know.
Side note, you need to know that if ppl come to you on here, it's because their quality of life is going or been down hill and they are hitting depression through this awful situation. You taking the time to answer as best you can and help us for free is a blessing to us and you need to know how much we all appreciate that. This is so very real for us and me myself, it's ruining my life. My work just approached me as well wondering what the heck is going on. 11 years at this place, I don't want to mess this up.
So thanks so much anytime you help out.
Jason.
I hope you have seen my video "How to do the Epley Maneuver" because it shows you how to cure the most common cause of BPPV. Have a look and let me know if you have questions after that.
i use to spin to the left, for a few months then i would spnd to th right.....now i either spin backwards or forwards with eyes going up and down when i get up or lay down. which maneuver should i do?
i also cant move my head to left or right when laying down and have a very stiff neck.....what do you recommend?
Have you seen my video "How to do the Epley maneuver"?
It would be best to see a health care professional in real life. A physiotherapist who does vestibular rehab, MD with an interest in vertigo.
Peter Johns yea i was seeing one for awhile...sometimes left side was treated then sometimes we treated the right and it helped, then they quit seeing me and showed me how to do it at home and it helped somee. but now that im spinning front or back i dont know how to do that because he never treated that before...i am waiting for him to call me back today, dont really have the money to see anybody right now...... we dont have much drs to choose from in our area
Brad Ellender are you saying side to side eye movement is horizontal canal and up and down is post?
Generally, yes.
I mean, like you only have it one day a year.
Yes, BPPV can last months.
Alcohol will make vertigo feel worse.
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No.
why is it that every time i see a video of a diagnosis a woman is used as the model. are women more prone to getting diseases? i don't mean to be sexist just an honest question.
Thanks for the video! I am an Otolaryngologist from the Philippines. Have received a 60/M patient today with recurrent vertigo; on Dix - Hallpike was negative. Performed the supine roll test and he had geotropic nystagmus when head was turned to right. Was curious though, there was no nystagmus when her was head turned to left. I wanted to do the BBQ maneuver but she wouldn't consent anymore, so I advised them if they could try it at home. Will try the Gufoni maneuver. I've also read in our textbook that a significant fraction of PC BPPV is converted to Lateral Canal BPPV upon performing Epley, the reverse of what happened in your video. Glad your patient recovered :) Thank you for all your Dizziness videos, really helpful!
Thanks for your kind words. Yes, I have seen PC convert to HC, but not very often. For patients not willing to undergo a maneuver, this recent paper suggests you can cure 71% of geotropic HC BPPV by having them lie on their good ear for 1 hour. www.frontiersin.org/articles/10.3389/fneur.2023.1153491/full
@@PeterJohns Wow, thank you for the information! :)
Thank you a lot for this simple demonstration
Have you seen my other video about HC BPPV? It's shorter, and even better in my opinion. ruclips.net/video/VRjRTnIw9YE/видео.html
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