Thursday, May 29, 2008

Positional Vertigo - Common and Treatable

One of the most common ailments I treat is Benign Positional Vertigo. The patient usually feels awful, off balance and with the room spinning for no reason. It can occur suddenly and dramatically when he gets out of bed and cause vomiting and unsteadiness when walking. The episodes can be continuous or in brief episodes that are worse as the head is moved. A good neurologic exam and absence of any one sided weakness or facial droop can cinch the diagnosis without expensive testing or scans. I look for nystagmus ( rapid involuntary movement of the eyeball) when I turn the patients head from side to side. Over time the nystagmus stops.

You would think that treatment for such a common and miserable condition would be taught in medical school. There are very effective office treatments called canalith repositioning procedure or Dix-Hallpike maneuver or Eply maneuver. Each has slight variation and involves a series of specific and timed positions for the head that restores the equilibrium in the inner ear with good effectiveness for the majority of patients.

Why don't more physicians know how to do this simple treatment? Many patients end up in the Emergency Department, yet the majority of ED physicians don't know how to do it. I thought the Ear-Nose and Throat (ENT) doctors would be the experts but after referring several patients, I realized they didn't do it. By default, I taught myself how to do it and have been helping patients leave the office symptom free ever since.

I was talking with a physician friend today about all of the simple, low tech things we can do for patients that have great benefit. They are the toolkit for primary care. They are not sexy and get little attention, no extra reimbursement and most physicians learn them themselves after years of practice...not in medical school.

The PET scans and MRIs and cardiac imaging studies get the attention and the big bucks but it is sometimes the simple, cheap methods that make life more pleasant.


Rich said...

Now vertigo is something I know about. I had it for about 9 months non stop. Two and a half months of vestibular physical therapy and some meds finally got me up and about.

All the testing didn't prove anything but ruled out a lot.

The Happy Hospitalist said...

Toni, at my hospital we have some physical therapists trained in these motions. Unfortunately, in my case, it's usually the 80 year olds who physically can't go through it. Oh well. said...

This can't work in fact, that is exactly what I consider. said...

Really worthwhile data, thank you for your post.

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Raymond Bouchayer said...

I had that years ago and even though my brother in law was an MD I had to take a scan of the brain ..very bad feeling and I hope it never comes again
Thank you for posting this Dr. Toni