Normally, only with head movement does
fluid within the inner ear also move informing the brain that a head-turn
occurred. However should a crystal called an otolith gets displaced into the
lateral or horizontal canal of the inner ear, BPPV dizziness occurs. Fluid movement
occurs due to the crystal rather than head turns causing the brain to think
movement has occurred even though none has happened. The Lempert or barbecue
maneuver is performed to treat this lateral canal BPPV by trying to get the
loose crystal out of the canal. This maneuver is started by turning the head
90 degrees while the body is laid back If BPPV is present, side to side eye
twitching called nystagmus will occur. After 30 to 60 seconds, the head is then
turned such that one is facing down. This position is again held for 30 to 60
seconds. The head is then further rotated another 90 degrees. When performing this
maneuver, another individual can help with these position changes. Finally the Lempert maneuver is
completed by moving the head and body back to the original starting position
before sitting back up. At this point the loose crystal should have come out of
the canal causing no further problems. So what’s going on with these position
changes? Essentially the head is moved in such a way to manipulate the crystal to
fall towards the canal opening. With each position changes, it takes about 30 to 60
seconds for the crystal to settle into the most dependent position in the canal.
If turns are made before the crystal has a chance to settle, the crystal may fall
back the wrong way and the maneuver will fail to work. It is also important
that each of the head positions are fully turned or else the crystal will
not settle to the correct position in the canal and the maneuver will fail.
Also if the position changes are done too slowly, the crystal may not settle
quickly enough from lack of momentum and the maneuver will fail.
Once the crystal falls out of the canal, the dizziness should resolve if due to
lateral canal BPPV.