3-21
cause is a displaced otolith (debris) in a vestibular organ. Symptoms will usually respond to antihistamines.
Returning the head to neutral position may be instantly curative.
If the patient has dizziness only when walking or standing, he does not have true vertigo.
Plan:
Treatment
BPV/BPPV:
Basic/Primitive: Curative maneuvers (Valsalva, Epley maneuver)
Epley maneuver: The goal is to herd debris in the vestibular canals away from the hair cells that directly
influence balance.
- Rotate posterior canal backward close to its planar orientation. This directs foreign material out of
the canal. - Change the angular displacement of the head by about 90° with each position change.
- Rapidly perform the changes in head positions and maintain each position until nystagmus has
disappeared, indicating cessation of endolymph flow. If no nystagmus is visible, the latency and
duration of nystagmus observed during Dix-Hallpike testing may serve as a guideline. - Guide head movements from behind and execute each change in position within one second; maintain
each position for at least 30 seconds. - If vertigo is severe, pre-medicate patient with a vestibular sedative, such as prochlorperazine or
dimenhydrinate, 30-60 minutes before performing the maneuver.
Perform the Epley maneuver:
a. Have the patient sit upright with head turned 45° to the affected side.
b. Have the patient lie down with head dependent (as in Dix-Hallpike maneuver).
c. Rotate the head 90° with chin upwards and maintain dependent position.
d. Ask patient to roll onto side while holding head in this position.
e. Rotate the head so that it is facing obliquely downward, with nose 45° below horizontal.
f. Raise patient to a sitting position while maintaining head rotation.
g. Simultaneously rotate the head to central position and move it 45° forward (return to normal
position).
Alternate: Antihistamines: meclizine (Antivert) 25 mg po q 6 hrs as needed.
Advanced: Valium 10 mg po q 6 hrs as needed.
Meniere’s Disease:
Basic: Valium 10-15mg po q 4 hrs
Alternate: Valium 5-10 mg IV or IM every 10-15 minutes prn to max of 30 mg
Purulent Otitis Media
Basic: Amoxil 250 mg tid x 7 days
Alternate: Augmentin 250 mg tid or 500 mg bid x 7 days
Serous Otitis Media
Basic: Over-the-counter antihistamines and decongestants
Labyrinthitis
Basic: Reassurance and support
Patient Education
General: The symptoms of labyrinthitis will probably resolve in less than a week but may persist for up to
a month. Serous otitis media is probably secondary to eustachian tube dysfunction from allergy, barotrauma