Epley manoeuvre for BPPV
The Epley manoeuvre is used to treat the commonest type of BPPV, where the chalk crystals are free-floating in the posterior ear canal. The Epley manoeuvre begins by making the patient dizzy with the appropriate Hallpike Test. The patient is then rolled over (in stages, pausing for about half a minute in each position) onto the opposite side (nose towards the floor), before being sat up again. This manoeuvre floats the chalk crystals round the affected canal and out of the far end, back to where they belong. Once there, they may reattach themselves, or possibly dissolve. They may however remain free-floating and liable to fall back into one of the semi-circular canals. Up to a third of patients may suffer one or more further bouts of BPPV at some time in their lives. This is not a major problem: the manoeuvre can be repeated as and when necessary, and in some cases, patients (or their relatives) can even be taught to do it themselves.
The manoeuvre is safe and can be carried out on anyone without severe neck or back problems, which would not necessarily prevent treatment but would need to be carefully assessed beforehand. Following treatment, a small number of patients will feel a bit dizzy and off-balance, occasionally for a day or two. This is rare. Patients who are liable to vomit when dizzy should take appropriate medication prior to treatment. This manoeuvre has offered instant relief of symptoms in nine out of ten patients; however some may need two or more treatments. Overall the Epley Manoeuvre has seen 95% of cases to be symptom free after the manoeuvre.
Managing hearing loss
Hearing aids are important for all people with hearing loss, whether it is in one ear (unilateral) or both ears (bilateral). There are specific hearing problems for people with Meniere’s but most can be helped by the range of aids available. Visit your audiology department/hearing therapist for advice on your own personal condition.
If your hearing does not recover following an attack, you may notice difficulties following conversations in demanding listening environments, like a busy restaurant, or when listening from a distance. Depending on the extent or severity of your hearing loss, you may also find it challenging to tell which direction sounds are coming from. These difficulties can, in turn, affect an individual’s mental well-being, causing anxiety or worry; and social well-being, triggering withdrawal from social activities that are too demanding.
What can you do about it
Your audiologist will be able to advise you on available hearing aids that are suitable for your hearing loss. Sometimes a conventional hearing aid can help. However, if the extent of hearing loss on the affected side is quite severe, you may have to be fitted with a device that ‘re-routes’ sounds to your better-hearing ear.
CROS Hearing System
The most commonly used device is the Contralateral Routing of Signals (CROS) hearing system by Phonak, Oticon or Signia. It is made up of two parts: a wireless microphone which is mounted onto the poor-hearing ear and is paired to a hearing aid that is worn on the better-hearing ear. Your audiologist can programme this on the basis of your hearing test results, and can advise you on how best to use it. Background noise can affect how well the CROS aid performs, so you may find that you have to position yourself in a space that reduces the interference. Using other communication strategies also helps.
Bone Anchored Hearing Aid (BAHA)
An alternative ‘re-routing’ device is the Bone Anchored Hearing Aid (BAHA), which transmits signals from the poor-hearing ear to the better-hearing ear via bone vibration. There are two different types of BAHA devices: a percutaneous device by Oticon MedicalTM or CochlearTM Baha® where a titanium fixture, the abutment, is placed on the skull bone behind the ear; and a transcutaneous device, known as the Baha® Attract where a magnet is placed under the skin. This treatment requires an audiological assessment and a trial of the device in your own environment, by wearing it on a headband, for a period of 2-4 weeks. If it is found to be beneficial during the trial period, it can be implanted by an Ear Nose and Throat (ENT) surgeon. Similarly, to the CROS hearing system, careful positioning in the listening environment and communication strategies should be used for most benefit.
A new adhesive bone conduction device, the ADHEAR by MedEl is also available and has been reported to be a viable option for unilateral hearing loss.
Middle Ear or Cochlear Implant
Less commonly available treatments for severe-to-profound unilateral hearing loss restore the hearing in the poor-hearing ear by surgically inserting a hearing device, such as a middle ear implant or a cochlear implant. They help by stimulating the poor-hearing ear directly, and some studies have shown that these treatments can help with locating of sounds and hearing in noisy environments.
However, there is still uncertainty with regards to which treatment choices are best for one-sided hearing loss. This is due to the lack of consistency in the way that treatments are tested and results reported by clinicians and scientists. Scientists are working hard to improve consistency, so it is easier to compare and combine the evidence to make an informed decision.
You won’t know if a device will help you unless you try it. So, speak to your audiologist or ENT consultant at the first opportunity.
Information kindly provided by Roulla Katiri, CROSSSD Study.
The Meniere's Society can not recommend a particular manufacturer, product or device. Please speak with your medical professional to find the most suitable hearing aid to suit you.
The Meniett device is a portable, battery operated machine which creates a low pressure wave transmitted to the ear by an ear piece. In order to use the device, the patient must have a grommet fitted in the ear. The ear piece of the machine is placed in the ear canal by the user and the Meniett is switched on. A low pressure wave is created which is transmitted to the ear by the ear piece. The grommet allows the air pressure wave through to the middle ear where it can act on the inner ear via the round window membrane. The machine raises the pressure in the ear to 1.2kPa and then oscillates the pressure. Each pressure cycle takes about one minute followed by a 40 second pause. Availability of the Meniett device on the NHS is limited.
Often the perception of tinnitus can be diminished by providing information, understanding and low-level sound enrichment. Various white noise generators, which help mask the tinnitus, as well as retraining and counselling are available. This management would be provided by an audiologist or hearing therapist with specific skills.
For more information, visit British Tinnitus Association (external site).