Deep Head Hanging Maneuver to Treat BPPV Vertigo

Normally only with head movement does fluid within the inner ear also move informing the brain that a head turn occurred However should a crystal called an otolith gets displaced into the superior or anterior canal of the inner ear BPPV dizziness occurs Fluid Movement occurs due to the crystal rather than head turns causing the brain to think movement has occurred even though none has happened The deep head hanging maneuver is performed to treat the superior canal BPPV by trying to get the loose crystal out of the canal This maneuver started by laying down and extending the head as far back as possible. If BPPV is present, vertical eye twitching called nystagmus will occur. This position is held for 30 to 60 seconds. The head is then bent forward chin to sternum and is again held for 30 to 60 seconds. When performing this maneuver, another individual can help with these position changes. Finally, the deep head hanging maneuver is completed by sitting back up at this point. The loose crystal should have come out of the canal causing no further problems. So what’s going on with these position changes? Essentially the head is moved in such a way to manipulate the crystal to fall towards the canal opening. With each position changes, it takes about 30 to 60 seconds for the crystal to settle into the most dependent position in the canal. If turns are made before the crystal has a chance to settle, the crystal may fall back the wrong way and the maneuver will fail to work. It is also important that each of the head positions are precisely performed or else the crystal will not settle into the correct position in the canal and the maneuver may fail. Also, if the position changes are done too slowly, the crystal may not settle quickly enough from lack of momentum and the maneuver will fail. Once the crystal falls out of the canal, the dizziness should resolve if due to superior canal BPPV.


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