How to Diagnose Horizontal Canal BPPV (canalithiasis vs. cupulolithiasis)
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- เผยแพร่เมื่อ 29 มิ.ย. 2024
- Horizontal canal BPPV can be much more difficult to diagnose and treat than posterior canal BPPV, and it's also much less common (which is great!).
If you think you have horizontal canal BPPV, which is characterized by horizontal "nystagmus", your first step in getting rid of the vertigo is to figure out 2 things: what side is affected (left or right) and if you're dealing with particles floating in the canal (canalithiasis) or particles stuck to the cupula (cupulolithiasis).
This sounds confusing, I know, but I'll explain everything in this video!
In a future video, I'll explain the next step in the process of eliminating video, which is how to treat horizontal canal BPPV.
I hope this video helps you with your vertigo, or that it helps you treat a client if you're in the healthcare field.
Please leave a comment below, especially if you have a question that I can help with.
And don't forget to subscribe to my channel!
Thanks for watching!
- Luke Gordon, DPT
(Doctor of Physical Therapy/Owner of Gordon Physical Therapy)
www.gordonphysicaltherapy.com/
I am a vestibular mess and am one of those "unlucky" patients you reference in the video. I wouldn't wish vertigo on anyone. It has been a huge disrupter in my life. Thanks for sharing your expertise...knowing I am not alone is a comfort.
I'm sorry to hear that! Have you found any help as far as treatment and management? I hope so!
@@GordonPhysicalTherapy Working with a vestibular P/T -- a lot of trial and error to find where the crystals are stuck (something about the short arm)---I had four repositioning treatments yesterday but she isn't convinced that the crystals are back to where they should be. The last MAJOR vertigo episode I had like this was about 10 years ago with smaller episodes about 1x a year and have not slept on my right side in over 10 years and can no longer do yoga. 😞
Bless your heart. I'm dealing with BPPV now and have been doing yoga for decades. It would be tragic to me to have to quit. I'm sorry you have.@@michelebmooney6396
Ask your doctor for scopolamine dermal patches for dizzyness/nausea.
Thank you for this video.It was explained very well.
You are welcome! Thanks for watching!
very good..... you raised several crucial key points I was wondering about.
Glad it was helpful!
Extremely helpful as an audiology student, thanks so much for content like this!
You're welcome! Thank you for your comment :-)
Your video is perfect, clear.Thanks you
Thank you! Glad it helped!
Very helpful, thank you!
You're welcome!
Very very good man. This helped tremendously. I treat this in physical therapy and you really made this clear. Appreciate this .
My pleasure!
Love your video by the way!
Thank you!
This video was so helpful. Thank you so much for your videos
You're quite welcome! I'm happy to hear that these videos have helped you out!
Thank you for these videos. I ended up in the ER, stayed for 2 days. I appreciate that they ruled out life threatening concerns but no one ever mentioned or tested for BPPV at all. I've been researching as much as possible at home and am looking for a treatment provider in my area that has experience with BPPV. I'm not spinning any more but definitely want to be prepared if this happens again.
How r u feeling now? Are u ok did u had horizontal vertigo?
I hope you're feeling better now, Erika! Let me know!
This helps a lot! I’ve be trying to treat my posterior Vertigo, but I have a phobia of sending it into the horizontal canal. This has helped me feel so much better because at least I have a plan to figure it out!
That's great! I hope your treatment goes well! Keep me posted how it turns out :-)
@@GordonPhysicalTherapy Will do!!
Hey there Luke. Wish I was in your area. Thanks for the video. I think it would help your video greatly, especially since it gets technical pretty rapidly and the technical terms tend to CAUSE vertigo, if we were to add some specific video footage of a movement that you were talking about. Video like this really needs that. I'm not just trying to be theoretical, I'm sitting here trying to evaluate this because I spent three hours in ER this morning with this kind of stuff. Again I appreciate your video.
That's good insight, thank you. Did you see the second video where I demonstrate the treatment techniques? Or are you looking for video footage of the testing part?
@@GordonPhysicalTherapy No, I did not see the 2nd video at that time. I still haven't found it after only a few minutes looking. I'm sure I could if stayed with it. You obviously have a LOT of great videos, so please understand that I'm not being negative. They are just difficult to sort thru. In this case, since TH-cam is notorious for keeping relevant videos away from each other, it would have been helpful if you had placed a link to that other video in your comments area. Again, I appreciate your efforts here. The video I watched was useful.
I had a case of this when I was on vacation in Mexico. I rolled over in bed and the room started spinning. I became very ill, crying and vomiting. It would not go away unless I sat up straight in a chair. Every time I leaned my head or reclined, it came back, so I had to sleep sitting straight up, which was a nightmare. The resort doctor gave me antibiotics and other drugs for vomiting, but the vertigo did not go away. I was terrified. Sometimes it would come on when I was at work for 10 seconds or so-- also terrifying. Months later, someone told me about BPPV, and I went to an ENT. They were able to recreate it in the officen and it stopped with the Epley maneuver. The whole thing was very traumatic. I live in fear of it happening again. My heart goes out to anyone with vertigo.
Damn thank you sir i was not sure till i saw your video i have a horizontal vertigo on left side ... I did eply manauver i didn't got any vertigo ... But after watching your video im sure that it is horizontal vertigo thank u , now i can talk to my doctor about this
You're welcome! I hope you can get rid of your vertigo!
@@GordonPhysicalTherapy hello help me i think i don't have nastagmus.. so can i try sleeping on effected side as i only sleep on good side?
Thanks for doing these. If you do them again, I would have a script and make it as short as possible- also trying to get all in one video if possible.
Thank you for your input, Paul! It was a hard video for me to shorten, but I did my best!
I am not too sure what I have, doing the supine roll test doesnt induce any dizziness what so ever. Its only when I move my head really quickly to the right, say for instance I am driving and at an intersection I have to look right and left quickly (I am in the UK so have to look right first!), thats when the head start spinning and my eyes goes crazy. From your video ive learnt that my eyes beat to the left i.e. drifts to the left and resets back to the right repeatedly. I notice that it hardly ever triggers when I look left. It settles down after a few seconds or what I also found out recently is that moving my head quickly to the right again balances it out and stops the dizziness. I also find that the dizziness triggers much easier in the morning when I wake up, maybe cuz I am on my back the whole night and the crystals have settled in one place? as the day goes by it triggers less, but quick twist to the right almost always triggers it. Its gonna be nearly 2 months since ive had this and no idea whats wrong with me, the epley maneuver and the supine roll test doesnt do anything to me at all, maybe I am doing it incorrectly?
That's interesting that the rapid head movement is the only thing that will cause your symptoms... I'm going to have to do some research... Have you tried doing the VOR X1 Viewing exercises yet? That might be helpful.
Very good video and matches my diagnosis today. We did those tests today. When laying on my left side it was intense. My therapist diagnosed my right cupula had the crystals and did one treatment today.
I wonder if you have loose crystals on both sides, could you create a new problem fixing the initial problem?
Glad to hear you're working with a therapist who can help you treat this, Kelly! It's tricky when people have crystals loose on both sides... usually, we try to treat the more intense side first, wait a day or two, then treat the less intense side. With any luck, you only have one side involved. Keep me posted with how things go!
Hello. Thank you for some great videoes! When I'm laying in my bed on my back, and I roll over on my left shoulder and gets dizzy, is it then my left or right ear I'm having troubles with?
Hi Gordon! Thank u so much for your detailed explanations they are very helpful. Ive been doing Epley with NO results,i believe now i know why.I have Horizontal eye side to side movement on both sides! When doing the Supine roll test.Cant really tell which is worse,however my eye movement is going UPWARDS towards the ceiling on both sides! Been doing Gufonii maneuver,but not sure if im doing right or not? Because when i retest myself im still having Nystagmus movement on both sides.Im lying down on right side for 1 minute,then turning head upward 45 degree for 2 minutes.Then sitting back up.If this is right,how many times a day should i do this exercise? Do i go constantly until i get results? or give it a break.Try again next day? Also hear you talking about a "Bar B Que roll ,whats that?? One more thing,Is it normal too have fluid in the inner ear? Could this be the problem?Can these Crystals be removed or blocked from moving somehow with meds??Oh forgot to mention that I am stable if i Keep my head straight and upright,but if i bend over,or turn head too fast World turns upside down,and round,and round😂😔..Thanks for what you do! How long does this normally last? Going on 1 week so far.😔
Thank you for your questions, Chris! I'm happy to hear that you figured out you have horizontal nystagmus and upward/torsional. If you have upward beating horizontal nystagmus, you're doing the correct version of the Gufoni, so nice work there! Can you figure out which side is more intense? This should help you narrow down which ear/side you should be treating vs. treating both sides. If not, keep treating both sides, or consider only treating one side for 2-3 days and then reassessing. Here's something to consider: after each Gufoni treatment, I typically have clients rest for 5 minutes, and then we retest with the Supine Roll Test again. This allows us to figure out if we're making progress and also to see if the nystagmus has changed. For example, it could change to geotropic (downbeating) nystagmus, in which case you want to switch up your version of the Gufoni. Or, it could switch to upbeating/torsional nystagmus, in which case you'll want to switch to the Epley Maneuver. Do you see how confusing this can get? That's why I usually recommend enlisting the help of a PT who specializes in vertigo.
You also asked about the BBQ Roll. I don't really use this technique much and prefer the Gufoni. The BBQ Roll typically works with geotropic nystagmus and not ageotropic, and the Gufoni tends to work better for both. I hope this helps! Let me know what you think :-)
@@GordonPhysicalTherapy hey brother, thanks so much for your reply. I have noticed that my Nystagmus eye movement seemed to be worse on my left side when I do the supine roll test. Therefore, I have been laying over on my right side to do the Gufoni maneuver. For 1 minute, then I am looking in a 45° upward angle towards the ceiling for 2 minutes. I believe this is the right way. At least I think that it is. You're right, this does get confusing,But I have been doing the Gufoni for about 3 days now consistently and I have noticed a considerable difference in my horizontal canal vertigo it has almost disappeared completely! For the last 2 days I have not had hardly any vertigo symptoms except in the mornings. When I wake up that is when I noticed it the most,But the first thing I do is the gufoni maneuver and it seems to settle things down considerably. I was sort of confused about which side to lay on starting out with the Gufoni maneuver, but I believe that I may have figured it out. If I continue to have problems I will follow your advice of doing one side for 2 to 3 days, then switching over. I have noticed when I go back to do the supine roll test that my Nystagmus eye movement is almost gone on both sides. From the research I have done in medical journals of physiology, and Vestubular test studies, the barbecue roll and the Gufoni maneuvers are the two that are best for resolving the horizontal canal vertigo. However, Gufoni technique had a much higher success rate between the two. I can attest to that personally and totally agree with that assessment. Gufoni maneuver is definitely the way to go. Thank you once again for your help in this matter that was completely driving me crazy. The nauseating, and Dizziness I was feeling was just about to do me in. At times it was almost impossible to function normally. God bless you brother. Keep doing what you're doing. You're making a huge difference!
Can you have both horizontal and prosterior vertigo? I am normally prosterior and have a lot of problems looking up and down, bending down etc. but also when I sleep no matter which way I turn I will get vertigo with nystagmus. I do believe it’s my right ear. I’ve tried the eply manoeuvre and it either didn’t work or made things way worse. My yes tend to beat down and to the side
You can have both, yes, but it's usually one or the other. When you test your vertigo, are you doing the Supine Roll Test and the Dix-Halpike test, or just one of those?
Is there a possibility having astigmatism/ lazy right eye that I could experience the sensation but the direction of nystagmus/ torsion maybe hard to diagnose or even see movement?
That's an interesting question, and I think the answer is yes, that can certainly make the visual nystagmus harder to see. However, keep this in mind: when you do the Dix-Halpike test, even if you don't see the nystagmus but you still have the symptoms of vertigo, we still consider that positive for BPPV on that side (meaning you have BPPV on that side, and we'll treat that side). Does that help?
My eyes always move horizontally to the left. If I lay with my right ear down, the vertigo is more intense but my eyes move horizontally to the left. Once I lay with my left ear down, my eyes still twitch to the left but the vertigo is not as intense. Slightly confused here. I believe my left ear is the affected ear.
Thank you for all your videos and explanations! I am kind of desperate: I used to solve my BVVP with Epley manouver but this time is not like that and I am trying to figure out where the issue is… but with this dizziness feeling I cannot get fully concentrated and I have headache everytime I try to think 😂. I tried Yacovino manouver in a desperate state and it even got worse… So my question is… and sorry if it is a silly one… can I do Epley manouver (I use to have the right side affected) and then try the manouvers for the horizontal canal affected (canal and cupula)? Like: can I try all the manouvers or will this get it worse?? I am really desperated!! Thank you!!!
Good questions! Here's what I recommend: perform the Dix-Halpike test and the Supine Roll Test, and try to figure out what type of vertigo you have first (posterior canal vs. horizontal canal and right vs left). From there, select the appropriate treatment maneuver. Otherwise, if you just start doing all the various maneuvers, it's unlikely you'll get the right one. I hope that helps!
My episode of horizontal zystagmus w vertigo lasted 6 hours in the hospital. I say horizontal because my husband says that's what my eyes looked like but he says there was no downward or upward or other beat other than just horizontal. I'm guessing it has to have been geo or ageo and that he just couldn't tell or remember, rather than the possibility that someone doesn't have a particular beat, is that correct? I myself could not see a difference between when I turned my head to either side, the spinning seemed the same intensity. I also woke up with it so don't know how it started to tell if a certain movement up, down, left or right caused it. I'm nervous to do any testing that may set off the spinning again. I was like a vegetable for hours, well, one that vomits. 😊
Thank you so much for these videos.
Can you have your husband take a video of your eyes? That would be very helpful! The tricky thing with horizontal nystagmus is that when you do the "Supine Roll Test", you'll have nystagmus on BOTH sides. If you're eyes are beating down towards the ground (based on the fast phase), whichever side is more intense is the positive side (aka the side you want to treat). I hope that makes sense! If you can take a video, feel free to send it my way at Luke@GordonPhysicalTherapy.com
My vestibular physiotherapist told me I have capu. What I forgot to ask was, does this mean it will take more epleys and longer to get those crystals to stick?
So what are some reasons why you don't see nystagmus with horizontal canal bppv?
Also what's the reason that there is residual vertigo even after weeks? Are the debris still floating??
You usually do see horizontal nystagmus with horizontal canal BPPV. If there's still residual nystagmus weeks later, yes, it's probably still some debris in the cana.
perhaps a posterior canal diagnosis/treatment converts to horizontal nystagmus because the crystal moved to the horizontal canal
Yes, that can definitely happen! I've seen it several times.
Which is it if the vertigo is worse when lying on your back. Mine seems worse lying on my g on my back tha it does on either side?
You likely have posterior canal BPPV. I would try the Dix-Halpike test and see what you find.
Is it possible that the otoliths have stuck to cupula? That s what my doctor said I have after some manuvres he did to me.
Yes, it's possible. We call that "cupulolithiasis". The Gufoni Maneuver should typically work for this condition.
I saw a neurologist the other day and I was positive on both sides and the movement away from center was slow and the return was fast. Does this fit the ageotropic type? He directed me to see a VPT. I'm wondering if one can replicate this test without goggles on, and should it be tested sitting or lying down (or either one)? Thank you,
Yes, you can do this test without goggles. The eye movements with horizontal canal BPPV are usually very strong and easy to see. If you're laying on your right side and your eyes moving quick-phase towards the ground, that's geotropic. And if the fast phase is away from the ground, that's ageotropic. I hope that helps!
What about little to no nystagmus lasting about 2 minutes during dix hall pike? Is that likely a posterior cupulolithiasis? Patient became too nauseous, couldn't really keep testing.
I would guess you're dealing with the horizontal canal. Does the patient have any symptoms with the Supine Roll Test?
What if I get the vertigo just with the first step laying supine ,then vertigo again to the right and very intense. Did the gufoni not working
Make sure you're doing the Gufoni in the correct order and to the correct side (it can be confusing, even for me!). And make sure that you're dealing with horizontal nystagmus and not torsional.
HOR - if you mis diagnosis which side and perform hor manu, can you go back and perform hor man on the opposite side w/o harm?
Accurate diagnosis is key. If you get it wrong and then figure it out later, just do the correct maneuver as soon as you realize your mistake.
Hello sir today i went to 3rd new doctor they did dix hallpike ,a horizontal canal test and a 3rd one I forgot that there was only a little vertigo just 1 second and no nastagmus they seem all 3 test they said were negetive.. but after that test my head is feeling very heavy now .. they said they are gonna take my eng test what is that?
ENG testing is much more comprehensive and should give you much more specific information related to the function of your inner ear. It sounds like you're headed in the right direction. Let me know what the ENG results reveal when you get them back :-)
What would you say is most common diagnosis with vertigo/dizziness that occurs only when walking? When I’m still I’m fine. I’m not sure if it’s BPPV or PPPD. Been stuck like this for months now.
I would say the most common diagnosis for what you describe is "vestibular hypofunction", meaning that your vestibular system isn't functioning as well as it should and needs to be "strengthened". Does that help?
@@GordonPhysicalTherapyhow do you strengthen your vestibular system?
I know that Xanax stops or slows down the vestibular system, but what gets rid vaccine immune inflamatory response ?
I'm not sure about that type of inflammatory response... I'd probably recommend seeking out a naturopath who can help with some type of systemic detox program. I hope that helps!
@@GordonPhysicalTherapy Yes it does!!... I thought of that too, but homeopathic remedies are sometimes expensive, and I’m not sure who or what to trust. But yes I agree totally with your suggestions. I live in LA and this place is ripe with people who offer homeopathy remedies! It’s like nirvana for con artists looking to line their pockets with gold!
My left side beats down and my right side beats up. It’s always like that with my horizontal. So I treat the left?
Which side is more intense: when you're turned towards your left or turned towards your right?
Can vertigo give u severe headache? Hospital said I have vertigo and now it’s getting worst and I’m vomiting and can’t look at light
Vertigo and neck pain/headaches often go together. And sometimes the neck pain/headache is causing the vertigo.
What are the sympotom differences, like length of vertigo, etc
Horizontal vertigo is typically much longer in duration than posterior canal, especially with ageotropic (cupulolithiasis).
My husband is in the hospital right now and this sounds like what it is but he can’t even sit up. The hospital isn’t helping. What can we do?
Once he's out of the hospital, find a PT who specializes in vestibular rehab and treating BPPV. They should be able to help!
first comment, first like
Thanks!
I had an intense spinning vertigo when I turned my head over my shoulder to the right, then I had a panic attack the initial vertigo lasted about 2minutes. I then carried on as normal, but struggled with crowded places etc after a few weeks, I developed nystagmus when looking upwards, no balance at all my ride side effected mainly, the stairs were spinning etc. I did vrt, I've been trying go live as normal as possible after drs told me vestibular neuronitis- this was in March..it is now September and I still have dizziness every hour of the day, only relief is if I'm laid on my left side, some days more intense then others...does this sound like bppv? I want my life back 😔
Hi, Queeny. It's possible that you have BPPV. Did you work with an ENT doctor (Ear, Nose and Throat) or just your primary doc? Also, have you consulted with a PT trained in BPPV and vestibular disorders?
@@GordonPhysicalTherapy hi no I haven't seen anybody, my original onset left me with severe anxiety and I refused any medical treatment. So I have just been doing vrt from you tube videos. The waiting lists for PT treatment in the UK are very long.
@@GordonPhysicalTherapy thank you for replying also
@@queeny4624 hello bro how are you feeling now?
@@barewaliaboy249 hey sis! Lol I'm not a bro 😆 I'm still feeling terrible yesterday was a bad day so I did the epley Maneuver twice before sleep and woke up feeling 70% better I'd day, are you suffering?
I Think it is hard to say if my eyes are beating Down to the Ground or away from the Ground.
Try to determine the "fast phase" of your eye movements: whichever side your eyes are beating towards faster. I hope that helps!
Hello sir 1 question in mineres dieses do we have vertigo if we roll to effected side just like bbpv???
No, not typically. Meniere's Disease doesn't typically include positional vertigo, at least not the same way BPPV does.
@@GordonPhysicalTherapy ok thank you
@@GordonPhysicalTherapy and how about in fluid buildup in inner ear?
Hi I have vestibular problem I need help any exercise that can help me pls.
Hi, Gigi. The first step is figuring out the cause of your vertigo. Have you had any luck with that yet or been able to get help?
Can't we do all three canals manuver...all we need is to get rid from vertigo😦
You want to narrow down the specific canal and then pick the appropriate maneuver.
May I suggest that you make clear the terms horizontal and vertical nystagmus are used with reference to the patients head; otherwise it’s easy to confuse horizontal nystagmus as “vertical “ with the patients head turned . From the observers perspective it is vertical Maybe instead of horizontal , say from “ear to ear “
Very good suggestion! Thank you :-)
Eyes went back and forth very fast left to right for some minutes. This was years ago but have feeling like on a ship an trying to walk straight every since!? 🤷🏼♀️
If your eyes are no longer going back and forth (nystagmus) with positional testing, and you still feel like you're walking on a ship, you might just need to do some vestibular exercises. Have you looked into those yet?
@@GordonPhysicalTherapy Not yet, but family dr knows it’s bothered me for years. I reg get ear wax removed but no effect on balance. I’ll ask about exercises that may help. I’ve had topple over falls when it first started but careful with bending forward to much now. Almost had retina detached but it stopped in right eye. On gabapentin for sciatica from pinched nerve. Only had the rapid eye movement happen the one time. 👍🏻
Heyy hiii...i feel my head is moving towards the ground when eyes are closed...is it geotropic nystagmus??
You'll want to have someone look at your eyes (or record a video of them) to see which direction they're moving. The "fast phase" of the eye movement is the direction they're moving.
Mine move side to side. I have more vertigo to my.left
Is it possible to have BPPV without nystagmus?
Yes it is! With positional tests, like the Dix-Halpike, you can still have symptoms of vertigo without visible nystagmus, and this is still considered a positive test (meaning you have vertigo coming from that canal you're testing).
@@GordonPhysicalTherapy Thank you 🙏 so much. I’ve been given exercises to do, but I still get a little dizzy from doing them. The half somersault makes me really nauseous, and I’m not sure why.
Its practically impossible to tell which side is more intense. Both sides look bad, and if you turn the patient a few times to have a closer look, they will throw up on you. I just do the barbeque to one side 720 degree then back to other side 720 degree. Doesnt matter which side.
That's an interesting approach. I haven't had too much trouble telling which side is more intense, although sometimes that's because the vertigo started in the posterior canal, so I already basically know which side the vertigo is coming from. Do you prefer the BBQ roll to the Gufoni? If so, why?
@@GordonPhysicalTherapy thanks for the reply. I was at Emory 20 years ago and had the privilege of working with Drs Ron Tusa and Susan Herdman and that's what I was taught.
Also can geographic turn into apogeo?
Yes, this could happen. Geo vs. apogeotropic nystagmus just tells you what part of the horizontal canal the crystals are located in (near the cupola or in the canal).
Thoughts on the Zuma maneuver?
I'm not too familiar with it, but it looks very similar to the Gufoni.
What if both sides affected
With horizontal canal BPPV, it will appear that both sides test positive. You pick the more intense side to treat. After that, if both sides really are positive, you'd treat the second side a day or 2 after treating the first one.
@@GordonPhysicalTherapy
Thank you...
Can it be cured only with an exercise?
Or need medicine ?
My sister is 32 years old and she has suffered from meniere disease for years and she always complains to me that I had to bought her Dr Madida herbs I saw on TH-cam and she is telling me last month that she is cured completely and don’t long have the symptoms like vertigo or dizziness, feeling of fullness in the ear or ringing, hearing loss, imbalance, motion sickness, nausea, or nystagmus
That's great that the herbs helped!
My sister is 32 years old and she has suffered from meniere disease for years and she always complains to me that I had to bought her Dr Madida herbs I saw on TH-cam and she is telling me last month that she is cured completely and don’t long have the symptoms like vertigo or dizziness😵💫, feeling of fullness in the ear or ringing, hearing loss, imbalance, motion sickness, nausea, or nystagmus.
Good to know. I have no experience with those herbs...
quite confusing as the terms seemed to be mixed up.
When I roll over and tand up is the worst
That could be horizontal canal BPPV, or it could be posterior canal. Make sure to check both!
You use the word "torsional" when talking about nystagmus but you never really tell us what it means. It would be fantastic if you were to show us a video of each type of nystagmus.
Here's a video of it but they don't classify it very clearly. Maybe you could comment on it.
( th-cam.com/video/QjXxBB_o7mM/w-d-xo.html )
In this video, there is no torsional nystagmus, only side-side nystagmus. Torsional looks like twisting/turning.