Dear Dr. Johns thanks for another very clear and informative video. Some collegues of mine prefer using the Semont manouver to treat BPPV. Seems some kind of quick fix to me, and I don´t remeber you mentioning it in your previous videos, I guess the Epley manouver is more effective? What do you think about it?
There are a few differences between them, but not enough for front line providers to learn both techniques. Since the Epley maneuver has only 3 positions (other than sitting upright) and 2 of the 3 positions are positions you must learn for the Dix-Hallpike test, I prefer to teach the Epley maneuver, as I think it will be more easily remembered. Also for larger patients, the Semont maneuver would be more difficult in my opinion. Of course, if someone has been using the Semont maneuver with success, I would not argue for learning the Epley maneuver. Thanks for the questions!
Dr. Johns, a have a question. I've seen some videos showing a technic of Epley maneuver, and there was a piece of advice about finishing that. Namely at the end of the maneuver a patient should bring a chin closer to a chest in the sitting position and sits this way about 30 seconds. Does it make sense?
Yes, I've seen that as well. I think theoretically it would increase the chance the otolith would make it's way back to the utricle without falling back in the posterior or horizontal canal. I generally don't do it or teach it, as I try and keep things as simple as possible. But I am certainly not against it.
No you do not. I only wanted to make it clear that the nystagmus in posterior canal BPPV can look different depending on which way the patient gazes. As long the clinical presentation and Dix-Hallpike test is typical of BPPV, seeing vertical upwards or torsional towards the downward ear (or a combination of both) are all diagnostic for posterior canal BPPV.
You are doing a great service to the medical community Dr Johns.
Please keep it up.
God bless you
Thank you very much. This is material that requires very frequent reinforcement for most of us.
Gorgeous as usual! Especially slow motion of nystagmus
Thank you Dr Peter!
Thanks!
Thank you doctor
Dear Dr. Johns thanks for another very clear and informative video. Some collegues of mine prefer using the Semont manouver to treat BPPV. Seems some kind of quick fix to me, and I don´t remeber you mentioning it in your previous videos, I guess the Epley manouver is more effective? What do you think about it?
There are a few differences between them, but not enough for front line providers to learn both techniques. Since the Epley maneuver has only 3 positions (other than sitting upright) and 2 of the 3 positions are positions you must learn for the Dix-Hallpike test, I prefer to teach the Epley maneuver, as I think it will be more easily remembered. Also for larger patients, the Semont maneuver would be more difficult in my opinion. Of course, if someone has been using the Semont maneuver with success, I would not argue for learning the Epley maneuver. Thanks for the questions!
Dr. Johns, a have a question. I've seen some videos showing a technic of Epley maneuver, and there was a piece of advice about finishing that. Namely at the end of the maneuver a patient should bring a chin closer to a chest in the sitting position and sits this way about 30 seconds. Does it make sense?
Yes, I've seen that as well. I think theoretically it would increase the chance the otolith would make it's way back to the utricle without falling back in the posterior or horizontal canal. I generally don't do it or teach it, as I try and keep things as simple as possible. But I am certainly not against it.
Do you need to ask the patient to look to the R or L while extension on neck?
No you do not. I only wanted to make it clear that the nystagmus in posterior canal BPPV can look different depending on which way the patient gazes. As long the clinical presentation and Dix-Hallpike test is typical of BPPV, seeing vertical upwards or torsional towards the downward ear (or a combination of both) are all diagnostic for posterior canal BPPV.