Vestibular Rehabilitation Therapy

The Vestibular System has to do with our sense of balance and is for maintaining equilibrium. Vestibular Rehabilitation Therapy (VRT) is a special form of Physical Therapy designed to decrease dizzy symptoms and improve balance. This is accomplished by stimulating the brain to adjust to abnormalities of the vestibular system.

What is involved with Vestibular Rehabilitation Therapy (VRT)?

• Exercises to help your eyes remain steady during head movements
• Exercises to help you tolerate head movement or position changes which cause dizziness Exercises to help your balance and walking to decrease your risk of falls
• Correcting your posture and help strengthen weak muscles to improve balance Education for prevention, maintenance and self-care of symptoms after discharge

What should I expect with VRT?

• An initial evaluation will be performed to get a baseline of your symptoms and function and will last approximately 45 minutes to one hour.
• You will be seen once a week (twice weekly for more severe problems) for 45 minutes. Treatment can last 4-12 weeks depending on the severity of the problem.
• You will be prescribed a specific Home Exercise Program (HEP) for you based on the results of the evaluation and your improvement over time. The HEP is designed to help your brain adapt to your vestibular system problem. It is important to consistently and regularly perform the exercises at home, in between appointments.
• Some exercises may initially make your symptoms worse, but symptoms will steadily improve as you perform them consistently.
• Many different factors contribute to your final level of recovery including: initial severity and type of injury to the vestibular system, consistency with performing the exercises at home, medical and physical condition prior to this problem, level of anxiety or depression, and headaches.
• Medications such as meclizine, Antivert, phenergan, or valium can slow your recovery by preventing your brain from adjusting to your vestibular system abnormality. Please consult your doctor regarding weaning off of these medications as soon as you can.
• Once VRT is complete, it will be important to continue with the HEP designed for you. Relapse of symptoms, known as “decompensation”, can occur in times of stress, fatigue or illness. By performing the exercises regularly, you can avoid this. 

Hearing Aids Aren't Enough

Hearing Aids Aren’t Enough without Good Communication Habits

If you’ve taken the first step toward better hearing by investing in hearing aids, you deserve to be congratulated. But your satisfaction is not guaranteed by a simple purchase.  You have a responsibility to develop good communication habits designed to maximize the benefits you receive from wearing hearing aids.

To achieve the desired results, remember hearing is not passive.  To understand and communicate effectively, you must learn to be a good listener and to control your environment to help compensate for your hearing loss…even while wearing hearing aids. To maximize the benefit you receive from your hearing aids:

·       Commit to wearing your hearing aids! If you’ve ever worn contact lenses, you know it takes some time to get used to wearing them.  The same is true with hearing aids.  You must become accustomed to how they feel your ear and to hearing sounds you may not have heard for a very long time.  For example, if it’s been awhile since you’ve heard a bird sing or a clock ticking, you may initially find these sounds irritating. But give it some time.  Your brain will adjust to hearing these sounds and soon they will become normal. Do not stop wearing your hearing aids during this adjustment period.  Be patient and focus on the commitment you have made to your hearing health.

·       Show off your hearing aids. Don’t  hide them. It is your responsibility to inform those with whom you communicate that you have difficulty hearing and are wearing hearing aids. Become a partner with the person to whom you are speaking.  Give them guidance to allow you to communicate effectively. You must face the listener when you talk, tell him or her to speak louder or move the conversation to another room if the environment is too noisy.

·       Control your environment.  If you know you are going to be in a situation where background noise will interfere with your ability to communicate effectively, formulate a plan to minimize it.  For example, arrive at a restaurant early so you can choose seating away from the source of background noise.  Prepare in advance by looking online for restaurants that post their menus. By familiarizing yourself with the menu ahead of time, you will eliminate your need to ask the waiter or waitress to repeat menu choices.

·       Make eye contact.  You will discover communication improves when you can evaluate and interpret body language and facial expressions.

·       Practice your listening skills.  You can do this by listening to the radio or an audio book. There is even an auditory rehabilitative software program you can buy for your computer that will allow you to practice listening in background noise.

·       Be patient and “keep your eyes on the prize.” In time, listening with hearing aids will become second nature and you will be rewarded with the joy of hearing all the sounds of life.

Maintaining Balance Throughout Life

Working on balance isn’t just for “old folks”

There is a lot of emphasis these days on cardiovascular fitness and strength training, to help us age well.  However, just as important is our balance.  Just as our strength and endurance decline with age, our balance can as well, especially if we are not challenging it.

Balance involves not only the strength of our leg and trunk muscles and flexibility, but also 3 sensory systems.  Our vision helps us with balance by telling us where we are in relation to other objects.  If I see a door frame is vertical, I know I’m vertical.  The sensation of proprioception in our feet and legs tells us if we’re leaning one way or the other, or what kind of surface we’re on, such as thick carpet for a firm floor, or if we have weight more on one aspect of our foot than the other.  The inner ear system, known as the vestibular system gives us information on where we are in space, and if we are moving, turning, tilting or changing speed.  During every activity we do, our brain takes input from each system, integrates the information and forms the needed response to move in a specific environment.  For example, when we walk in the dark, either outside at night or when turning out a light and walking across a room to go to bed, we can’t use our vision as much to help us balance.  Our brains have to know how to use the vestibular system and the sensation and proprioception in our feet and legs to walk safely.  If we walk on uneven surfaces, the brain has a harder time using the sensation in our feet for information, we have to rely more on our vision and vestibular system.  A more complex task is walking on uneven surfaces at night when both vision and sensation inputs are not 100%.  Our brain then has to rely the most on information from the vestibular system.

If we’re not challenging our balance as we age, it can decline, just like muscle strength and flexibility.  If our brain never has to use the vestibular system, it will in a sense “forget” how to use it when it needs to.  Our proprioception can decline with age so we may rely too heavily on vision for balance and ignore the other systems.  Once people start to feel a little off balance or even fall, they lose confidence in doing the things they enjoy and may limit themselves or stop the activity altogether.  This can lead to further imbalance or debilitation if they end up limiting a lot of activities.  Obviously, that can lead to further medical issues and decreased quality of life.

Just like strengthening our muscles, there are exercises and activities we can do to “strengthen” the balance system.  A lot of fitness centers and social centers are incorporating balance into their exercise classes and/or offering classes specifically to help with balance.  Tai Chi is a popular exercise which has been proven through research to help with balance.  Activities to help improve balance can include standing with your eyes closed,  standing with one foot in front of the other or on one leg, using a chair beside you to hold on to for safety if needed.  These activities can help your balance now, to help keep you active as you age.

Physical Therapists who are trained in Vestibular Rehabilitation are also good resources for improving balance.  If you or a loved one is beginning to feel off balance with their normal activities, or beginning to fall, seek help from a therapist trained in this area.  They can design an exercise program specifically for your needs based on the difficulties you are having with balance.  Often, only a few visits are needed to make some significant progress balance to prevent falls as people age.

Maximize the Benefits of Hearing Aids

Follow these Guidelines to Maximize the Benefits You Receive from your Hearing Aids

Your hearing aids may be the most technologically advanced devices you own, but technology alone cannot guarantee long-term satisfaction.  To maximize the benefits you receive from wearing hearing aids, it is important to follow these hearing health and maintenance guidelines.

Maintaining Your Hearing Health

1.     We recommend you have an audiogram every two years. By comparing the results of a new audiogram with an older one, we can determine if your hearing loss has worsened.  If it has, your hearing aids can be reprogrammed to compensate for the additional loss.

2.     Wear your hearing aids daily to allow your brain time to relearn sounds you may have been missing.

3.     Do not miss a regularly-scheduled check up.  We need your consistent feedback to keep your hearing aids performing as they should, as well as the opportunity to clean them or to replace plastic tubing.

4.     Do not wear someone else’s hearing aids.  They have not been programmed for your listening lifestyle.

Taking Care of Your Hearing Devices

1.     Clean your earmolds daily with an audiowipe (an FDA approved antimicrobial cleaning wipe) to remove any buildup of earwax.

2.     Hearing aids should not be submerged in water so be sure to remove them before taking a shower or going swimming.

3.     Do not expose your hearing aids to hair spray.

4.     Do not expose your hearing aids to radiation from x-rays, so remove them when going through security at the airport or while at the dentist office.

5.     Do not try to repair your own hearing aid.

6.     Do not use alcohol or cleaning fluid on any parts.

7.     Regularly check the plastic tubing on your hearing aid. Remove debris per the instructions provided by your Audiologist.

Battery Care

1.     Replace batteries routinely. Battery life is determined by the type of hearing aid and how long it is worn each day.  The average battery life is 7-10 days.

2.     Memorize the battery size your hearing aid requires.  It is also helpful to know the tab color of the package your batteries come in, as battery sizes are color-coded across all brands. A #10 battery can be identified by a yellow tab; a #13 battery by an orange tab; a #312 by a brown tab; a #675 by a blue tab and a #5 by a red tab.

3.     Extend battery life by turning off your hearing aids at bedtime.  Keep the battery compartment door open to allow any moisture that has accumulated inside to evaporate.

4.     Store batteries at room temperature.

5.     Do not carry loose batteries in your pocket or purse. Contact with metal objects like coins or keys can short-circuit the battery.

6.     When newly purchased, hearing aid batteries are sealed with a tab to ensure freshness.  Do not remove this tab until you are ready to use the battery.  Once the tab is removed, allow the battery to charge for 30-60 seconds prior to placing it into the hearing aid.

Vestibular Neuritis and Labyrinthitis

Vestibular Neuritis and Labyrinthitis are often attributed to a viral infection affecting the vestibular (balance) nerve, as many affected with these conditions report a preceding illness. The vestibular nerve carries information from the inner ear to the brain about head movement and when one of the two vestibular nerves are affected, this creates an imbalance, and vertigo (false sense of motion or “spinning” sensation) occurs. If hearing loss occurs along with vertigo, we use the term Labyrinthitis.

Symptoms
Vestibular neuritis and labyrinthitis (vestibular neuritis with hearing loss) usually cause the sudden onset of vertigo, disequilibrium or imbalance, and nausea or vomiting. Initially, dizziness or vertigo is constant and may last a few hours to a few days. After several days, vertigo will disappear, but dizziness remains. After weeks to months, dizziness is only noted with certain activities, such as turning the head.

Diagnosis
The ears, brain and eyes work closely together to maintain balance. Head movement or other stimulation of the inner ear sends signals to the muscles of the eyes via the brain. Our ability to diagnose Vestibular Neuritis/Labyrinthitis is enhanced by infrared video goggles that easily visualize and record eye movements. The Videonystagmogram (VNG) is a series of tests that look for signs of vestibular system dysfunction by measuring nystagmus (an involuntary movement of the eyes). Additional testing includes Rotary Chair in which the eyes movements are evaluated while sitting in a chair that rotates at various speeds. The vestibular evoked myogenic potential (VEMP) provides information about the lower portion of the vestibular (balance) nerve, which is not evaluated by the VNG and rotary chair. With vestibular neuritis, we will be able to see what is called a right- or left-beating nystagmus with a caloric (air blown in the ears) weakness, a VOR asymmetry on RotaryChair and an abnormal VEMP if the inferior portion of the vestibular nerve is involved. An audiogram (hearing test) will tell us if you have suffered from vestibular neuritis or labyrinthitis.

Treatment
Acutely, vestibular neuritis or labyrinthitis is usually treated with vestibular suppressant medications, such as Antivert (meclizine), Ativan (lorazepam), Phenergan (promethazine), Compazine (prochlorperazine), or Valium (diazepam), in addition to prednisone. The vestibular suppressant medications are not meant to be a long-term solution to controlling the dizziness and should only be used for 3-7 days. Long-term, such medications will inhibit recovery. Recovery from vestibular neuritis/labyrinthitis occurs by the brain adapting to the vestibular imbalance in a process known as central (brain) compensation. Some will recover on their own over time, but for the majority of those affected, Vestibular Rehabilitation Therapy (VRT) is necessary. VRT is a specialized form of physical therapy that helps dizziness and balance disorders. In the hands of a physical therapist (PT) with specialized training in this area, it is highly effective in alleviating any remaining dizzy symptoms from vestibular neuritis/labyrinthitis. 

Hearing Aid Technology Today

“They’re NOT Your Mother’s Hearing Aids!”

The recent advances in hearing aid technology mean those living with hearing loss can enjoy numerous benefits that were previously impossible.  Some of the newest advances include:

Size:  Today’s hearing aids are extremely discrete, often smaller than a watch battery! Even behind-the- ear hearing aids are smaller than ever before while some in-the-canal style hearing aids are 100% invisible. 

Digital technology:  Advanced technology means a more accurate simulation of the way the ear works.  That means sounds are more natural to the hearing aid user.

 Automatic adjustments:  Hearing aids can automatically adjust to rapidly changing listening environments, eliminating the need for manual operation by the hearing aid user.

Adaptive Dual Microphones:  Communication clarity is made possible by microphones that focus on the sound source while reducing or eliminating irritating and distracting background noise.

 Open fit technology:  That stuffed up or “talking in the barrel” feeling has been eliminated by slim design hearing aids that leave your ear canal open or unoccluded. Comfort and clarity of speech are the result.

 Feedback management technology:  That irritating whistle that let’s everyone know you are wearing hearing aids is gone!  Feedback management technology allows the hearing aid to recognize feedback and squelch it before it ever occurs.

Cell phone and Bluetooth compatibility:  Changes by the FCC means that you can easily find out if a cell phone is hearing aid compatible (HAC).  Just look for the HAC label.  No label means the phone is not compatible. Cell phones that work well with hearing aids have a microphone (M) rating of M3 or M4.   Hearing aids are rated from M1 to M4.  The higher rating means you experience less noise and have a better connection. The rating for the telecoil is from T1 to T4. A higher rating means you will be able to hear better in the telecoil mode. A combined rating of 6 is considered excellent, a combined rating of 5 is considered normal and a combined rating of 4 is considered usable.   

Is it Really Meniere's?

Meniere’s Syndrome - Frequently Misdiagnosed

Meniere’s syndrome is a disorder of the inner ear affecting balance and hearing.  The inner ear has fluid-filled chambers and canals. These chambers and canals, sending information from your inner ear to your brain, help interpret your body's position and maintain your balance.  Meniere's occurs when a part of this system, called the endolymphatic sac, becomes swollen. This sac helps filter and remove fluid in the semicircular canals.  An attack of Meniere’s usually appears without warning and the severity of each episode varies.  It generally affects only one ear, but may affect both in at least 20% of patients.

Symptoms

The symptoms of Meniere’s include recurrent vertigo (spinning sensation) spells usually lasting 20 minutes to several hours, hearing loss, low-pitched tinnitus and a sense of fullness or pressure in the involved ear.  Symptoms are generally worse with head movements.  The hearing loss is in the low frequency range.  In the early disease process the hearing may recover between attacks but eventually will lead to some degree of permanent hearing loss.  The tinnitus usually sounds like a low-pitched roar.

Treatment

There is no known cure for Meniere’s disease.  Some lifestyle changes and medications can generally relieve symptoms.  Reducing salt (sodium) in the diet and the use of water-pills (diuretics) may relieve vertigo symptoms.  Other factors that may influence Meniere’s attacks and should be avoided if possible include alcohol use, fatigue, smoking and stress.  If symptoms are not adequately controlled by reduced salt intake and/or diuretic medication, there are several surgical procedures that may be effective in controlling symptoms.  The latest advances in surgical procedures include minimally invasive surgical techniques, including the injection of steroids or gentamicin (an antibiotic which is toxic to the inner ear) across the ear drum.

Warning

Unfortunately, Meniere’s is a condition that is over-diagnosed, meaning that many are diagnosed with it but they don’t really have it.  If you or someone you know has been diagnosed with Meniere’s and do not have hearing loss and/or are under the age of 40, consider obtaining a second opinion, as most who are improperly diagnosed with Meniere’s are suffering from vestibular migraines.

Hearing Aids Improve Lives

Dramatic lifestyle improvement found in patients who start using hearing aids

Many scientific studies in the past have confirmed the negative impacts associated with hearing loss: depression, anxiety and social isolation. However not many studies have shown the positive impacts created by a hearing solution.  A new study released in September 2011 conducted by the Better Hearing Institute (BHI), shows overwhelming data about how much of a difference hearing aids/devices can make.

The study surveyed more than 2,000 hearing loss patients who use devices to enhance the sense of sound. Of the sample group, 82 percent of patients would recommend hearing aids/devices to their friends and 70 percent reported improved ability to communicate. The data also shows more than four out of five people who use a device to hear better are satisfied with their solution.

“This survey clearly reveals how dramatically people’s lives can improve with the use of hearing aids/devices,” BHI Executive Director Sergei Kochkin, PhD said. "In this comprehensive study of more than 2,000 hearing device users we looked at 14 specific quality-of-life issues and found today’s hearing devices are a tremendous asset to people with even mild hearing loss who want to remain active and socially engaged throughout their lives.”

The study also concluded up to a third of patients saw improvements in their romance, sense of humor, mental, emotional and physical health. Further, roughly 40 percent noted improvements in their sense of safety, self-confidence, feelings about self, sense of independence and work relationships.

These results are the most significant of their kind because they show a clear potential solution to many of the draining feelings patients with hearing loss suffer. Many of the results are attributed to changing technology allowing hearing devices to be much smaller and present less of a societal stigma about wearing devices in day-to-day life. Newly introduced devices are so small they are nearly invisible. The new devices are also more intelligent and offer many improvements over older generation models. BHI’s Kochkin says, the first step to preserving your future enjoyment in life is to make an appointment with a hearing health professional and get your hearing checked.

Source:  http://www.betterhearing.org/press/news/Customer_satisfaction_hearing_aids_pr08292011.cfm

Internet Hearing Aid Purchase a Bad Idea

Internet Hearing Aids

Familiar with the phrase "You get what you pay for"?  Internet hearing aids are certainly no exception.

With the widespread use of the internet and the ability to find just about anything online, many people are looking for solutions to their hearing loss without consulting a trained hearing professional.

This trend is more than just a bad idea.  Serious medical conditions, such as a brain tumor, might be missed, without an appropriate, professional audio-logic evaluation.

Hearing aids bought on the internet often provide little improvement in hearing.  Face-to-face verification of proper hearing aid settings and counseling about additional options is vital for patient satisfaction with their purchase and compliance with proper hearing aid/device use.  What's more, the warranty of internet hearing aids may be only one year, while most major hearing aid/device manufacturers offer a 2-3 year warranty.

Those who pursue internet sales for their hearing solutions will be spending money, hundreds or even thousands of dollars, for no real benefit, while still suffering the wide ranging negative social and health impacts of hearing loss.  Untreated hearing loss can lead to psychological conditions such as feelings of isolation, depression, anxiety and frustration.

Hearing aids/devices should be programmed to the individual’s specific hearing loss requirements in order to provide proper benefit and satisfaction, which requires a complete in-person hearing assessment in a sound booth.  Instruction in proper use of the hearing devices and hearing aid maintenance is an essential part of hearing aid/device education and care.

In order to fit hearing aids using sophisticated computer programs, appropriate in-person follow-up and counseling is paramount.  This is not possible when consumers purchase one-size-fits-all hearing aids over the Internet.

Hearing Loss and Dementia

Untreated Hearing loss Linked to Increased Likelihood of Dementia

A study examining the link between dementia onset and hearing loss showed a concerning connection. Published by the Archives of Neurology, The U.S. National Institute on Aging  study showed more than 35 percent of dementia risk in patients older than 60 was linked to hearing loss.

The cognitive and hearing tests were given over a four-year period and monitored more than 600 patients for signs of dementia. At the conclusion of the study, 58 patients were diagnosed with dementia. The researchers then cross-referenced their data and found risk for a degenerative cognitive disorder increased with moderate to severe hearing loss. They reported for every additional loss of 10 decibels of hearing capacity the risk for Alzheimer’s jumped 20 percent.

The study suggests several theories for this correlation but insists more research is needed to find the exact relationship.  “Hearing loss might result from damage to nerve cells," Dr. Richard B. Lipton said. "That means damage to the hearing organ and inner ear structure called the cochlea, and the hair cells that pick up the pattern of vibration the sound produces in the ear. And if there's damage to the neurons that mediate hearing, that may be a kind of marker for similar damage to nerve cells involved in memory and higher cognition.”

Lipton also suggests social isolation accompanying hearing loss could lead to less cognitive engagement – a vital interaction to protect against dementia:  “And that would mean that the loss of cognitive stimulation could itself contribute to the risk for Alzheimer's," Lipton said.

Regardless, this new study shows dementia and Alzheimer’s has less to do with chronological age and is encouraging researchers to focus on biological age and the overall health and lifestyle of patients who show early signs of cognitive decline. Your first step to battling Alzheimer’s should be to schedule a hearing test.

http://www.betterhearing.org/press/news/Alzheimers_Hearing_Loss_Link_021411.cfm

Migraine-associated Dizziness

The most common cause of dizziness overall is migraine. The most recent research data indicate that approximately 60-80% of all patients reporting dizziness, in particular without hearing loss, have migraine-associated dizziness.

Migraine-associated dizziness is one of the most under recognized conditions in medicine today. It can occur at any age and dizzy symptoms may occur before, during and/or after migraine pain, or may occur without headache pain at all. Therefore, some people who have had a history of migraines but no longer have the headache pain of migraine, may still have dizziness from the same underlying cause. One very common story that we hear is that someone used to have migraines years or even decades ago, but no longer has headaches at all, and is now experiencing dizziness, attacks of vertigo and/or disequilibrium. Approximately 90% of those who claim to have “sinus” headaches are actually suffering from migraine, in particular if they notice headache and/ or dizzy symptoms associated with change in weather or other identifiable triggers.

Common symptoms of migraine-associated dizziness:

• Sense of lightheadedness and imbalance, typically worse in the morning Sensation of floating and that the head and eyes are not moving together
• Visual motion or activities that require visual stimulation can be particularly bothersome
• Light and/or noise sensitivity may be present
• Looking for items at the grocery store or being in large, open buildings is often difficult
• Feeling dizzy or off balance with walking, bending over or with quick head turns

Diagnosis of migraine-associated dizziness is usually made after ruling out other causes of dizziness such as BPPV, Meniere’s disease, or vestibular neuritis.

Treatment for this common cause of dizziness requires elimination of any trigger factors that might be exacerbating migraine symptoms, such as dietary triggers, skipping meals, stress, inadequate sleep, use of nicotine, etc. Often, medications that prevent migraines are prescribed. Physical Therapy/Vestibular Rehabilitation Therapy can help with balance issues and motion sensitivity once the headaches are under control. 

BPPV (Benign Paroxysmal Positional Vertigo)

Do you suffer from vertigo (a sense of motion or spinning) when lying back in bed, rolling over in bed, arising from bed, looking up or down?  If so, you have have a treatable condition called BPPV (Benign Paroxysmal Positional Vertigo).

Vertigo implies a false sense of motion, often described as a “spinning” sensation.  In BPPV, vertigo is due to debris that has collected within a certain part of the inner ear.  Small crystals of calcium carbonate, known as “otoconia”, “canaliths”, “crystals”,”rocks” or “stones”, have broken off from a part of the inner ear called the utricle and migrated into another part of the inner ear know as the semi-circular canal.  There are 3 semi-circular canals in each ear that may be affected.  Determining which semicircular canal is affected will direct your treatment.  

Symptoms

The symptoms of BPPV generally include a brief sense of vertigo when lying back in bed, rolling over in bed, arising from a lying position, bending forward, or looking up.  Vertigo is usually precipitated by a change of head position and typically lasts 10-15 seconds.  You may, however, feel nauseated or imbalanced for a longer period of time.  An intermittent pattern is common with BPPV. It may be present for a few weeks, then stop, then return.  It should be noted that many other disorders of the vestibular (balance) system have similar symptoms.  This is why testing is critical to determine the exact cause of your dizziness or vertigo.

Diagnosis

Diagnosis of BPPV is made based on your history of symptoms and observation of your eye movements while placing your head into positions that may trigger dizziness.  One position, known as the Hallpike position, involves moving from a sitting position to a lying position with your head turned to either side and observing your eye movements.  Other tests for different semi-circular canal involvement include lying with your head in various alternate positions.  Our ability to diagnose BPPV is enhanced by you wearing video goggles fitted with infrared cameras so that your eye movements may be more easily visualized and recorded.  

VIEW VIDEO OF BPPV

Treatment

Depending on the semi-circular canal involved, specific “canalith repositioning maneuvers” have been developed to cure BPPV and are named after the doctors who discovered the technique.  These “canalith repositioning maneuvers” are intended to remove “crystals” out of the semi-circular canal, back to where they originated, the utricle.  Each maneuver takes less than 10 minutes to complete.

The Epley maneuver was invented by Dr. John Epley and is used to treat BPPV of the posterior semi-circular canal. This maneuver involves first lying back into the position that triggers vertigo, then sequential movements of the head are made that remove the “crystals” from the semicircular canal. 

The Lempert roll is used to treat BPPV of the horizontal semi-circular canal.  It involves lying back on the bed, and turning the head and body in a slow 270 degree turn.  

These maneuvers are effective in over 90% of patients with BPPV.   If your vertigo has not resolved after your first visit, additional appointments may be necessary to repeat the maneuver.  The recurrence rate for BPPV after these maneuvers is about 15 percent per year.  In some persons, the positional vertigo can be eliminated but a sense of imbalance persists.  In these cases, a course of vestibular rehabilitation may improve your sense of balance.