In physiotherapy, tests are first carried out to provoke dizziness to see how severely the patient is affected, how quickly and what symptoms occur. If the test is positive, the change of position is followed by a rapid flickering of the eyes. In order to observe this, the patient should keep the eyes open during the test if possible.
Therapy
The therapy of positional vertigo is conventional. It is often sufficient to perform only a certain movement, which is supposed to transport the small particles out of the archway. These are various so-called positioning or release maneuvers.
These maneuvers can be performed by the patient himself at home. For the sake of simplicity, the maneuvers are explained on the right ear. If the other side is affected – just turn everything over once.
For the so-called Epley maneuver, the patient sits upright on the treatment bench (or on the bed at home). Behind him lies a small cushion, which should be at the level of the thoracic spine when leaning back. From this position, the head is now turned by about 45° to the right.
The rotation is held and the upper body is now quickly laid on the back so that the thoracic spine is resting on the pillow. The lower position causes a slight hyperextension of the cervical spine and head. Maintain the rotation of the head even in the supine position.
Here, the dizziness may already be occurring. The patient remains in this position until the dizziness has subsided, but at least for 30 seconds. Then the head is rotated by about 90° to the left side without lifting it from the support.
Again, the patient waits 30 seconds, or until the dizziness has subsided. Now the head and body are turned 90° to the left again, the body is turned to the side and the head lies on the left forehead. After another 30 seconds in this position, the head will quickly sit up over the side.
The exercise can be performed several times a day or, if not immediately successful, 2-3 times in a row. Another “liberation” exercise is the Semont maneuver. Again from an upright position on the long side of a bed or treatment bench, the head is turned 45° to the left.
While maintaining the head rotation, the entire body is tilted once quickly to the right side/shoulder. The viewing direction now points to the upper left in the direction of the ceiling. Again, stay in this position for about 30 seconds until the dizziness has subsided.
Then the body is quickly tilted 180° to the left side/shoulder (the gaze now points to the lower left) and remains in this position for another 30 seconds before slowly sitting up over the side. If the dizziness occurs in everyday life, especially when turning the head, the barbecue maneuver is used. From the supine position, the patient turns to the right side and remains there until the dizziness has subsided completely.
Afterwards, the patient turns quickly to the left side and remains there until the dizziness has subsided completely. The patient then turns back to the right side, stays there and returns to the supine position. Another maneuver for the same symptomatology in the head rotation is the Gufoni maneuver.
From an upright position, the head is turned again by about 45° to the right. With the head turned, the body is quickly laid down on the left side. Direction of gaze points to the ceiling at the top right.
After 10 seconds the head is turned quickly to the left – viewing direction towards the floor. A relatively severe dizziness may occur here. The dizziness will remain until it has subsided completely. Then the patient slowly straightens up on his or her side – the rotation of the head is maintained until no more dizziness is felt in the seat.
