Simple exercises may alleviate the symptoms of vertigo

Vertigo. For most people, the word summons images of Jimmy Stewart dangling from high places in Alfred Hitchcock’s classic thriller by the same name. It means something else, however, to hundreds of thousands of people who experience the strange, dizzying affliction.

The most common cause of vertigo, known as benign paroxysmal positional vertigo, usually can be treated with one visit to the doctor. Because the problem is caused by loose crystal particles floating in the inner ear canal, doctors usually maneuver the head and upper body so that the particles fall out.

Sometimes, however, the vertigo persists or reoccurs, and repeated treatments become necessary.

But researchers in Germany have found that many sufferers can treat their vertigo at home, without another visit to the doctor. A few simple head-turning exercises appear to be able to relieve the stomach-churning sensation of spinning and whirling that occurs when the head is suddenly turned.

Patients who can treat themselves feel more confident if it recurs “because they have learned how to manage their vertigo independently,” says principal investigator Dr. Andrea Radtke, a neurologist at Charite Campus Virchow Clinic in Berlin.

The study, which was published in last week’s issue of Neurology, involved 70 people, all of whom were about 60 years old. (Vertigo occurs nearly twice as often in women and in people older than 50.)

The group was split in half, with each group performing one of two treatments. Both techniques took less than two minutes and involved head and neck movements while sitting on a bed. Patients performed the movements three times a day until the vertigo stopped for at least 24 hours.

After one week, 95% of people who did the “modified Epley” procedure had no more symptoms. The exercise, developed by Portland, Ore., physician John Epley, requires patients to lie on their backs and tilt their heads to one side for 30 seconds, then to the other side for 30 seconds. They then turn their bodies on that same side without moving their head, holding that position for 30 more seconds before sitting up.

At the end of the study, 58% of people who performed the “modified Semont” maneuver reported no more symptoms. That maneuver requires patients to sit up and then drop quickly to one side, holding their ear against the bed for 30 seconds, and then sit up and drop quickly to the other side, with their ear down for 30 more seconds.

Dr. Joseph Furman, an otolaryngology and neurology specialist at the University of Pittsburgh, says the study is important “because it validates the concept of home therapy for a common disorder.”

The goal of both exercises was to transport the trapped particles through the ear canal and make them fall out, Radtke says.

“Patients should be instructed to learn how to perform the maneuver correctly because incorrect performance could impair its efficacy,” Radtke says. She recommends watching a short video attached to the study on the Internet or following illustrated instructions. Most patients are able to follow the instructions independently, she says.

A video showing the maneuver is available on the Neurology journal website, www.neurology.org. Go to the July 13 issue, then to the “Brief Communications” section. Look for the study beginning “Self-treatment,” and click on “videos.”