BPPV: The 15 minute Wait

After doing the half somersault, the Epley maneuver, or any of the other maneuvers for BPPV on yourself, I recommend that you wait 15 minutes before doing another maneuver.  Providers generally don’t wait long between maneuvers, so why should you do this, and what do you do while you’re waiting? 

Every time you do a maneuver, there is a good chance that you will have moved some or all of the particles out of the ear that were causing your BPPV symptoms.  The last thing you want to do is accidentally move them all back in.  That’s the reason for the 15 minute wait.  It also lets your stomach quiet down from the nausea maneuvers can cause. 

Any time your head is upside down, it is possible for loose particles to move into the canals.  If you’ve just removed clumps of particles from the canals, they are probably hanging out right next to the canal openings.  If you immediately invert your head, they can fall right back in.  By keeping your head fully upright for 15 minutes after a maneuver, particularly if you walk around and move a bit, those particles get further away from the openings and are less likely to re-enter. 

The absolute worst thing to do is the Dix Hallpike maneuver, which is the first part of the Epley, Brandt-Daroff and Semont maneuvers.  This position puts the canal perfectly under the location of the removed particles, so it’s very common for them to re-enter.  They can also fall into the horizontal canal in this position.  Waiting 15 minutes reduces this risk. 

So why do providers do maneuvers back-to-back?  We have the advantage that we can watch your eyes for nystagmus.  If you show a reversal in the direction, or horizontal nystagmus, we will sit you back up immediately to stop the particles from going deep into the canals.  You can see this yourself, too—the direction of spinning changes—but usually you’re too distracted by the dizziness to move quickly enough.  In this case it’s better to avoid making this mistake. 

While you wait for 15 minutes, you should keep your head fully upright, but you can recline your body on a sofa or bed as long as your head is propped fully up.  After the spinning declines, try moving your head up and down a bit and see if the dizziness is still there.  If it is, you haven’t finished removing all the particles and will need to do another maneuver.