Re: recurrent BPPV in older female
As you know BPPV is a common problem affecting 10% of people over 60. What a lot of people don't realize is that is it also a chronic problem. The calcium crystals (otoconia) that cause BPPV are normal parts of the inner ear. Only in the disease state do they come loose and float around like snow in a snow globe. The Eply maneuver or variants of it do, in most cases, move the crystals from the posterior canal and back into the saccule. However, these crystals are not gone. Much like shaking a snow globe, movements over the next week weeks to months causes these crystals to find their way back into the posterior canal. Why do some people get highly recurrent BPPV? This is not well known but a good theory has to do with the number of particles which are loose. You can imagine, to extend the metaphor, that a snow globe with only a few snow flakes will take a while for them to all land in one spot - eventually it might happen by chance, but it will take time. However, if there are millions of them the chance that a single spot will be covered is higher. So to with BPPV, if you have a lot of loose crystals, you will get more recurrent episodes.
So what to do. Certainly some people have the patient come back every two weeks for a repeat maneuver. You have demonstrated that the treatment is effective but just not prolonged. You can teach the patient to do the maneuver themselves, and some patients can manage that. Also ear surgery is an option to occlude the posterior semi-circular canal. There is also a new product out which helps patients to perform their own Epley maneuver correctly. This device enables people with recurrent BPPV to treat their own symptoms at home. It is FDA cleared and requires a prescription with a diagnosis of BPPV. One nice thing for the sake of your patient is that they wouldn't require any medications, they can just repeat the maneuver at home.
Last edited by moderator2; 06-26-2009 at 05:59 AM.
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