Positioning devices for BPPV treatment

Timothy C. Hain, MD •Page last modified: August 18, 2024

Omniax device – -for treatment of BPPV TRV chair – newer version of similar device.

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Although roughly 98% of all patients can be cured of their BPPV with physical maneuvers, delivered without the need of anything more than a padded mat table and an expert clinician, there are occasional times when this just doesn’t seem to work . There are also situations where the maneuver simply cannot be accomplished through a combination of moving the head on trunk and body in space on a flat table. This sometimes occurs in persons with neck fusions, such as due to ankylosing spondylitis. These patients may then be presented with the options of:

• Live with it
• Have surgery to plug canal.
• Have repositioning maneuver done with a device that avoids the need to turn the head on neck.

Most people chose to live with it, but occasionally people choose to travel to one of a few institutions around the world where their head and body can be positioned with the help of a device.

In regards to devices, the main possibilities are:

• Stryker frame (an orthopedic positioning device). This device was used at the Mayo Clinic (Rochester)
• Epley Omniax device (see figure above)
  • To our knowledge, there are 4 of these devices in the US (including Portland where it was developed). There is at least one elsewhere (in Australia).
• Pittsburgh head-over-heels device (Furman et al, 1998).
• TRV chair (several installations world-wide, now FDA approved). The TRV chair has no motors, but is basically a gimballed device. This presumably makes it easier to maintain.
• China medical “three-dimensional motion swivel chair”

The Epley Omniax was an early device, but it is no longer available as the company that made it (Vesticon) went out of business. We have been told that keeping this device operational was difficult. Too many moving parts ?

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The TRV chair is more recent, and has less moving parts. Presumably it will have more staying power. It has no motors at all, and it is powered by the treating provider. This seems a bit more sensible.

The “China Medical” device, seems presently to be limited to use in China. According to Lou et al, 2020, “The BPPV diagnosis and treatment system is manufactured by China Medical，is currently one of the most advanced BPPV diagnosis and repositioning equipment in the world. It consists of three parts: hardware system, software system and background workstation. The hardware system consists of a fully automatic three-dimensional motion swivel chair and a film acquisition device for wirelessly recording eye…”It sounds as if they repeated the mistakes of the Epley Omniax. In other words, a very complicated device with both a lot of moving parts as well as electronic interfaces and computers. Very cool I suppose.

Evidence

We are presently not sure whether or not these devices are more effective than conventional methods, and we are also not sure whether or not they pose any unusual risks. With regards to the latter, it would seem to us that prolonged, or upside-down positioning procedures might run some risk of complications including glaucoma, “canal jamming”, and perhaps movement of loose otoconia into the endolymphatic duct. It will take experience to be sure. What has been written so far seems to support their use.

There have been a few publications. Searching for “Omniax” in Pubmed brings up very little, and it takes sleuthing to find articles that talk about these devices.

Furman et al (1998) wrote about their device, which is a “heels over head” device. They wrote ” Our results indicate that 1) heels-over-head rotation is an extremely efficacious procedure for treating patients with BPV and 2) the pattern of nystagmus during repositioning is consistent with the theory that free- floating debris is highly likely to account for BPV. ”

Omniax

Power et al (2018) wrote about their “Early experience” with the Omniax. By Early, presumably they mean that it was early to Australia, as the Omniax chair was first reported on in 2002. They reported on 2016 patients between 2014 and 2016, without any controls. It is difficult to compare this data to conventional treatment.

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Nakayama and Epley reported on their results in a conference abstract.

West et al (2016) reported on a combination of classical manual maneuvers, the Epley Omniax, and the TRV chair. This was a small study. They commented that ” The EO and the TRV are highly valuable assets in diagnosis and management of BPPV of particularly complex and refractory cases. However, further validation is anticipated through controlled clinical trials. “

Li and Epley (2006) reported on use of a “360-degree maneuver” using a “multiaxial positioning device. Perhaps an Omniax ? They reported that “Subjective improvement scores, tolerability, objective nystagmus observations, and complications were recorded. RESULTS: Subjective improvement rates were 90% after one treatment; 97% were symptom-free and nystagmus-free after a maximum of three treatment sessions. Eighty-seven percent found the procedure quite tolerable from an ergonomic standpoint. “

TRV chair

There is little written regarding the TRV chair. West et al (2016) (see above) did comment favorably about it. The TRV chair is used in several sites in Europe.

Positioning aids

Dizzyfx device on a hat

There are also educational devices to assist persons in treating their BPPV maneuvers. For example, the “DizzyFX” device, is sold for $150. This is a “cap” that has a model of the inner ear attached.

We suggest that this is a bad idea.

• There are much less expensive methods of doing this – -for example, free (i.e. just look at illustrations of the maneuver online), or find a reputable video on Youtube.
• If you are independently wealthy and have $150 to spend on these things, and lots of time to experiment with your dizziness, why don’t you just see an expert ? These self-help devices omit the diagnostic part – without an examination, you might be treating the wrong ear or part of the ear.

References

• Furman, J. M., S. P. Cass, et al. (1998). “Treatment of benign positional vertigo using heels-over-head rotation.” Ann Otol Rhinol Laryngol 107(12): 1046-53.
• Lechner, C., et al. (2014). “Causes and characteristics of horizontal positional nystagmus.” J Neurol 261(5): 1009-1017.
• Li, J. C. and J. Epley (2006). “The 360-degree maneuver for treatment of benign positional vertigo.” Otol Neurotol 27(1): 71-77.
• Lou, Y., et al. (2020). “Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo.” Am J Otolaryngol 41(3): 102412.
• Nakayama, M. and J. M. Epley (2005). “BPPV and variants: improved treatment results with automated, nystagmus-based repositioning.” Otolaryngol Head Neck Surg 133(1): 107-112. [This is an abstract of a conference proceeding, not peer reviewed research]
• Power, L., et al. (2018). “Early experience with a multi-axial, whole body positioning system in the treatment of Benign Paroxysmal Positional Vertigo (BPPV).” J Clin Neurosci.
• West, N., et al. (2016). “Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome.” Eur Arch Otorhinolaryngol 273(3): 573-580.

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