Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day
CPT4 code
Name of the Procedure:
Canalith Repositioning Procedure(s) (eg, Epley Maneuver, Semont Maneuver)
Summary
The Canalith Repositioning Procedures, including the Epley and Semont maneuvers, are non-invasive techniques used to treat vertigo. These maneuvers involve specific head and body movements to reposition tiny calcium particles in the inner ear that can cause dizziness.
Purpose
These procedures address Benign Paroxysmal Positional Vertigo (BPPV), a condition caused by displaced calcium particles (canaliths) in the inner ear. The goal is to move these particles to a part of the ear where they won't cause dizziness, thereby relieving vertigo symptoms.
Indications
Patients experiencing:
- Sudden onset vertigo triggered by positional changes (e.g., turning over in bed, looking up or down).
- Diagnosed with Benign Paroxysmal Positional Vertigo (BPPV).
- No underlying conditions that contraindicate the procedure (e.g., severe neck or spine issues).
Preparation
- No fasting or extensive preparation is typically required.
- Patients should avoid eating a heavy meal right before the procedure.
- A brief medical history and possibly some diagnostic tests (like the Dix-Hallpike test) to confirm BPPV.
Procedure Description
Epley Maneuver:
- Start sitting up with legs extended.
- Turn the head 45 degrees to the side of the affected ear.
- Rapidly lie back with the head hanging slightly over the edge of the bed.
- After 30 seconds, turn the head 90 degrees in the opposite direction without lifting it.
- Turn the body in the same direction so the patient is lying on their side.
- Slowly return to sitting position.
Semont Maneuver:
- Start sitting up on the bed.
- Quickly lie down on one side with the head turned 45 degrees towards the ceiling.
- Hold this position, then rapidly move to the other side, face turned 45 degrees downward.
- Slowly return to a sitting position.
Tools: None required. Anesthesia: None; the procedure is performed fully awake.
Duration
Typically, each maneuver takes about 15 minutes.
Setting
Usually performed in an outpatient clinic or a physician's office.
Personnel
The procedure is usually conducted by an audiologist, physical therapist, or a doctor experienced in treating BPPV.
Risks and Complications
- Rare instances of neck or back strain.
- Temporary increase in symptoms (dizziness, nausea).
- Very rare but possible dislodging of particles to a different area causing persistent vertigo.
Benefits
- Immediate to short-term relief from vertigo symptoms.
- Non-invasive with no need for medication or surgery.
- Can significantly improve quality of life by reducing dizziness.
Recovery
- Patients may experience mild dizziness following the procedure.
- Advised to avoid lying flat for a few days and sleep using plenty of pillows.
- Follow-up appointment to assess effectiveness and repeat the maneuver if necessary.
Alternatives
- Medications like vestibular suppressants (less effective long-term).
- Balance therapy exercises.
- Surgical intervention in severe, persistent cases (rare).
Patient Experience
- Mild discomfort due to head movements.
- Temporary nausea or dizziness during and immediately after the procedure.
- Most patients find the maneuver tolerable and benefit from reduced symptoms shortly after.