YouTube: A new prescription for vertigo?

For those with the inner ear disorder, benign paroxysmal positional vertigo (BPPV), life is marked by periods of sudden dizziness and the sensation of spinning.  While there is a common therapy to combat the symptoms of BPPV, the maneuver is often underutilized or unknown by patients.

But now, new research has revealed another resource for those looking for relief from this form of vertigo: YouTube.

Scientists from the University of Michigan Health System in Ann Arbor have discovered that patients can learn how to relieve their vertigo symptoms by watching informational videos on YouTube.  The videos demonstrate what is known as the Epley maneuver, a certain kind of exercise shown to be highly effective in combating dizziness associated with BPPV.

“[BPPV] thankfully has a highly effective treatment called the Epley maneuver which has been proven effective in medical trials and there are guideline statements in support of it,” study author Dr. Kevin Kerber, a neurologist at UMHS and a member of the American Academy of Neurology, told  “Yet when we look at what’s going on in routine care, it looks like the test and the treatment for BPPV are substantially underused."

BPPV is caused when small particles of calcium break free and float around inside fluid-filled tubes in the inner ear.  These tubes, called semicircular canals, are very sensitive to the fluid’s movement, allowing the brain to know when your body changes position and to help maintain balance.  But when particles disturb the fluid’s movement, the brain receives confusing signals about how the body is positioned, creating the spinning sensation.

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    The Epley maneuver helps relieve the dizziness and spinning symptoms by moving the calcium particles out of the sensitive semicircular canals and into another inner chamber of the ear, where they don’t cause symptoms.  According to Kerber, the exercise simply involves lying down and rolling your head in such way so that the particles fall out.

    However, Kerber noted that physicians and patients seem to be unaware of the technique or are underutilizing it.  This gave him and his colleagues the idea to look for other informational avenues, ultimately leading them to YouTube.

    “One of the questions is, ‘How can you get information out to patients and providers about these treatments?’” Kerber said.  “We found there are many videos out there that are readily available with basic search terms.  If you just type in vertigo, these come up quickly.  They seem to be commonly watched videos based on hits, and most of them are accurate demonstrations of the maneuver.”

    The researchers rated the videos on their accuracy as well as reviewed comments posted by viewers about whether or not they had success with the exercise.  The team found that the video with the most hits was a clip developed by the American Academy of Neurology from 2008.  Kerber said conveniently most of the videos they reviewed were accurate and informative for patients.

    “It wasn’t uncommon to find a post about a patient reporting their symptoms had got substantially better,” Kerber said.  “Some comments said something like, ‘I went to three doctors nothing helped, found this video, rolled myself over and now I’m cured.’”

    “But there were also comments from patients that said, ‘I’ve tried this and it’s not helping,’” Kerber noted of the downsides. According to Kerber, there are technical issues with the maneuver’s head positioning that could detract from the its effectiveness if not performed just right.  He also noted people without BPPV could be trying the Epley maneuver to relieve dizziness caused by something else.

    “Can we get the right patients to this site and can they also do it?” Kerber said. “The problem is there will be four hundred comments, but three million hits.  So there’s potential for massive bias on whether they’re helping or not.”

    Despite this possibility, Kerber is confident that YouTube videos can be an important informational resource for not only patients, but also their physicians.

    “I’m a doctor and I use these web sites to teach medical students, so I think there is a potential to help providers,” Kerber said.  “For a provider who doesn’t see this very often but knows about it, they can go directly to a site and get a refresher.”

    “But also there’s an opportunity to get directly to patients,” Kerber added. “They’re looking more and more stuff up on the Internet.  So can a patient self diagnose and relieve their symptoms on their own?”

    Kerber and his team are furthering their research by testing video interventions on patients to see if they can improve their outcomes.