|Head roll to the right||Head roll to the left|
Before performing any form of positioning maneuver, it is important to ascertain whether the patient has current or past injuries of the neck or spine.
If neurological symptoms occur during the execution of positioning maneuvers, discontinue the procedure immediately and refer for a neurological evaluation. These symptoms might include, blurred vision, numbness, weakness of the arms or legs or confusion.
It is important to remember that the consistency of fluid inside the vestibular system is relatively viscous; therefore, you should allow sufficient time within each of the positions for the otoconia to achieve maximum displacement. This condition may also be responsible for a delayed onset of nystagmus.
It is most helpful to utilize Frenzel lenses or VNG when performing positional maneuvers. This reduces the ability of the patient to fixate during the procedure in an attempt to reduce the nystagmus This will also allow the examiner to see even very slight horizontal nystagmus.
It is common for the patient to tell you during the intake interview which ear is affected and will describe accurately the symptoms of BPPV. Use this information to determine which ear is likely the affected. ALWAYS test both ears - even if the patient complains of only one side being affected.
Patients are often very sensitive to horizontal canal BPPV, resulting in severe dizziness and If the patient reacts violently during the roll test, immediately turn the patient to the opposite side and perform a Lempert 360º roll.
Nystagmus is worse on the affected side and beats toward the ground. Best treated with the Lempert 360º roll. Acceptable alternative treatments are the Gufoni maneuver and forced prolonged positioning.
Nystagmus is worse on the unaffected side and beats away from the ground. Best treated by first converting the nystagmus to geotropic and then performing the Lempert 360º roll. Acceptable alternative treatments are head thrust, Gufoni maneuver, Vannucchi-Asprella and forced prolonged positioning.