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A 52-year-old male experienced an acute onset of vertigo immediately following a Valsalva maneuver when he was performing a bench press. His primary physician referred him to outpatient physical therapy because his symptoms have been persistent for more than 3 weeks despite taking meclizine (a common drug for vertigo) for the past 5 days. He has been purposefully limiting his cervical range of motion because he reports that movement of his head up and to the right causes his vertigo. He is still able to work as a mechanical engineer, which involves working at a desk and computer to view drawings. However, he has been taking frequent rest breaks throughout the day. He has also limited his driving because he experiences symptoms when he turns his head to change lanes. Currently, his coworker transports him to and from work. The patient is married and has three school-aged children and lives in a two-story home. His spouse is becoming quite frustrated at his limited assistance with caring for the children and household chores since the onset of his vertigo.


What is his rehabilitation prognosis?


What are the most appropriate physical therapy interventions?


What are the examination priorities?


What are the most appropriate examination tests?


  • AMPULLA: Widened portion of semicircular canal (SCC) that is near the utricle and contains the sensory hair cells
  • BONY LABYRINTH: Bony shell filled with perilymphatic fluid, which is similar in composition to cerebrospinal fluid (high sodium, low potassium); includes the three semicircular canals, the cochlea, and the vestibule
  • CANALITH REPOSITIONING PROCEDURE/EPLEY MANEUVER: Clinical technique used in treating the canalithiasis form of benign paroxysmal positional vertigo
  • CANALITHIASIS: Type of benign paroxysmal positional vertigo in which otoconia are floating free in the semicircular canals
  • CRISTA AMPULLARIS: Sensory structure (including hair cells) that senses angular movement within the semicircular canals
  • CUPULA: Bulbous, gelatinous mass that surrounds hair cells of cristae within semicircular canals
  • DIX-HALLPIKE MANEUVER: Clinical test for diagnosing benign paroxysmal positional vertigo in the anterior and/or posterior semicircular canals
  • MEMBRANOUS LABYRINTH: Structure filled with endolymph that is suspended within the bony labyrinth by fluid and connective tissue; contains membranous portion of the three semicircular canals, utricle, and saccule
  • NYSTAGMUS: Involuntary back-and-forth or cyclical eye movements; movements may be rotary, horizontal, or vertical
  • OTOCONIA (OTOLITHS): Calcium carbonate crystals in utricle and saccule that cause stimulation of the hair cells when the otoconia are stimulated by linear acceleration
  • SACCULE: Otolith structure in inner ear that detects vertical translation motion of head
  • SEMICIRCULAR CANALS: Three fluid-filled loops in the inner ear that measure angular acceleration; includes anterior (superior), posterior (inferior), and horizontal (lateral) canals
  • UTRICLE: Otolith structure in inner ear that detects horizontal translation and tilt of head
  • VERTIGO: Illusion of movement; a sense of spinning


  1. Describe basic vestibular anatomy.

  2. Describe benign paroxysmal positional vertigo (BPPV) ...

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