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BPPV - Meniere's Disease - Acoustic Neuroma - Cawthorne Exercises


Benign Paroxysmal Positional Vertigo (BPPV)

Definition and Cause- BPPV is caused by a dysfunction of the inner ear and is a very common form of dizziness. In BPPV, abnormal electrical signals are generated in the inner ear and these are sent to the brain. These signals result in the illusion of body movement when body movement is not actually occurring.  Crystal deposits in the inner ear generate these confusing signals and are identified as the cause of BPPV.
Symptoms- Patients complain of brief episodes of spinning lasting 15-60 seconds. Sudden changes in body position, like rolling sideways in bed or head movement up and to the side will elicit an attack. Each episode of BPPV may be accompanied by nausea or vomiting, but patients do not complain of hearing loss, tinnitus, ear pressure or headaches.
     The onset of BPPV may follow head trauma or an inner ear viral infection. However, in most patients, BPPV develops for unknown reasons. BPPV resolves spontaneously in some individuals, but with persistent symptoms the patient may benefit from treatment.
      BPPV is diagnosed by your local otolaryngologist. The Dix-Hallpike maneuver is done in the office setting and confirms the diagnosis. It consists of a series of movements in the office followed by re-positioning techniques to improve and treat symptoms.
Treatment-Treatment of BPPV includes the repositioning maneuver performed in the clinic setting along with important follow-up instructions. Success with treatment is common, but recurrence may necessitate a second maneuver with careful follow-up.

Meniere’s Disease

Definition- Meniere’s disease is one of the most common causes of dizziness originating from the inner ear. The actual cause is unknown but specialists believe it results from an abnormality in the fluids of the inner ear. Typically symptoms develop between the second and fifth decades of life, men and women being affecting equally.
Symptoms- The symptoms of Meniere’s disease include episodic vertigo (spinning sensation), hearing loss, tinnitus or ear ringing, and a full sensation in the affected ear.  The spinning vertigo is usually the most troublesome symptom in Meniere’s disease. This can last anywhere from 20 minutes to two or more hours. During these episodes patients are usually unable to complete their daily tasks at work or home.
Diagnosis- See your local ENT physician if you have any of the above mentioned symptoms. Your otolaryngologist will usually recommend a hearing test along with some balance testing.
Treatment- Treatment attempts to decrease or diminish the symptoms and attacks of Meniere’s disease. These may include a low salt diet and/or diuretics or water pills. Anti-nausea medications may be prescribed during attacks to help alleviate symptoms.

Lifestyle modifications to attempt to reduce the frequency of Meniere’s episodes:

  • Avoid alcohol, caffeine, smoking, and stress
  • Eat a well-balanced diet
  • Get plenty of rest and remain physically active

Acoustic Neuroma

Definition- An Acoustic Neuroma is a slow-growing, benign tumor that occurs along the hearing and balance nerves. This tumor is not a cancer or a malignant tumor and normally does not spread to distant parts of the body. Because of its location, near the brain, it should be removed and assessed surgically.
Signs and Symptoms- Patients will usually begin with symptoms of unilateral hearing loss followed by progressive dizziness and ear ringing occurring in approximately 70% of those with the tumor.
Diagnosis- If you have any of the above symptoms see your otolaryngologist right away. Hearing and balance tests will probable be recommended along with an MRI of the brain in the area that contains the hearing nerves.
Treatment-Treatment is surgical and requires complete removal of the tumor.

Cawthorne Exercises

In bed with NO head movement, eyes only

  1. Look up, then down
  2. Look side to side
  3. Repeat 1 and 2 while focusing on your finger moving from 3 feet to 1 foot away from the face

In bed

  1. Bend head forward and back
  2. Turn head from side to side
  3. Repeat 1 and 2 with eyes closed


  1. Bend head forward and back
  2. Turn head from side to side
  3. Repeat 1 and 2 with eyes closed
  4. Shrug shoulders and rotate upper body
  5. Bend forward to pick up an object
  6. Rotate head and shoulders, first slowly, then quickly; eyes open, then closed
  7. Rotate head, shoulders and trunk; eyes open, then closed


  1. Bend head forward and back
  2. Turn head from side to side
  3. Repeat 1 and 2 with eyes closed
  4. Rotate head and shoulders slowly, then quickly; eyes open, then closed
  5. Stand from sitting; eyes open, then closed
  6. Throw a ball from hand to hand at eye level
  7. Throw a ball from hand to hand above eye level
  8. Go from sitting to standing, turn around, then sit again
  9. Rotate head, shoulders and trunk; eyes open, then closed


  1. Across room; eyes open, then closed
  2. Up and down slope; eyes open, then closed
  3. Stand on one foot; eyes open, then closed
  4. One foot in front of the other; eyes open, then closed
  5. Participate in a game involving stooping or stretching, such as bowling or Shuffleboard.

*Be sure to do these exercises in order. They should be done 2-3 times per day, 5-10 times each. Start slowly, gradually increasing the speed. Contact us for questions.



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