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Unsteadiness in morning. Diagnosed with right ear nystagmus BPPV & undertaken epleys. Is this a normal part of the compensation of imbalance process?

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About 4 weeks ago I was diagnosed with right ear nystagmus BPPV and have now undertaken 4 Epleys (one by the ENT Specialist at the clinic and 3 at home) which appears to have finally removed the vertigo. I am left, however, with a sense and feeling of unsteadiness during the day which is worse in the morning when rising. Is this a normal part of the compensation of imbalance process?
Posted Fri, 18 May 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 50 minutes later
Hi,

Thank you for your query.

1. This may be a normal part of the compensation and imbalance process. BPPV (Benign Paroxysmal Positional Vertigo) is very common after the age of 60.

2. Patients recovering from BPPV also experience dullness. Some refer to it as 'brain fog', which improves and disappears within a few days.

3. Sometimes, a few particles may remain or enter other semicircular canals causing persistent unsteadiness. You may insist on an ENG (Electronystagmography) if your unsteadiness persists.

4. Sometimes, a few particles may remain stuck to the cupula of the semicircular canal. Ultrasound assisted Epley's may be used to dislodge these particles.

5. An Epley's maneuver can convert a posterior canal BPPV into an Anterior Canal BPPV which is more difficult to treat.

6. You may do Brandt-Daroff and Semont's exercises/maneuvers at home in addition.

7. I usually use a DizzyFix device, and then ENG aided Epley's if there is incomplete relief. You may have to sleep upright for two days after an Epley's (which is a difficult proposition). The Omniax System is like a computerized astronaut chair, which is used in resistant cases.

8. Cervical spondylosis and central causes (such as mild hypertension) can intervene, causing slow recovery.

I hope I have answered your query. If you have any further questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Unsteadiness in morning. Diagnosed with right ear nystagmus BPPV & undertaken epleys. Is this a normal part of the compensation of imbalance process? 50 minutes later
Dr Bhatti

Many thanks for your very helpful reply.

How long can the compensation process last?
XXXXXXX
 
 
Answered by Dr. Sumit Bhatti 26 minutes later
Hi XXXXXXX

Thank you for writing back.

If you are not better in a couple of weeks, I would advise a re-evaluation, preferably with an ENG (ElectroNystagmoGraphy). BPPV is known as 'Benign' as it usually subsides in a few months even without treatment. With the Epley's maneuver, recovery should be quick. There is no way of predicting another attack. Many patients have no recurrence.

Wish you a speedy recovery.

Regards.
Above answer was peer-reviewed by
 
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