DizzyFix: Teaches the Epley Maneuver for Vertigo on Your Smart Device

“I’m dizzy, doctor!” Those were the words of a female patient I saw in clinic this week. Upon further questioning, it was clear this patient had vertigo. The question was what type? Central or peripheral? Did this patient need imaging or just a good physical exam? Up to 10% of our patients in primary care will present with “dizziness” and sorting out a benign cause from something potentially catastrophic like a stroke is critically important. Luckily, a good patient history and physical exam can both make a solid diagnosis and, in some cases, treat the patient.

 

Primary care providers must know how to properly perform the Dix-Hallpike maneuver to help make a diagnosis of vertigo especially the most common form, benign paroxysmal positional vertigo (BPPV). BPPV is believed to be due to dislodged otoconia in the semicircular canals. These dislodged otoconia produce severe vertigo when patients suddenly move their heads. Due to the severity, nearly all patients will seek medical care. Luckily, the vast majority of vertigo cases seen in primary care are due to BPPV and this very disturbing condition (for the patient) can be effectively treated in nearly 90% of the cases by proper performance of the Epley Maneuver. This “modification” and “expansion” of the Dix-Hallpike maneuver is easy to perform but frequently patients do not receive it in the ER/urgent care/or even their primary care provider. For years I perform the maneuver in the office and then send the patient home with instructions/diagrams of how to perform it at home to ensure it goes away.

 

An enterprising ENT physician and inventor in Canada, Dr. Matthew Bromwich, created a unique solution to BPPV. He created an app called DizzyFix for providers to teach proper diagnosis and treatment of BPPV using the Dix-Hallpike and Epley Maneuvers, and the DizzyFix device that patients can place on any “ball cap” to guide them through the Epley Maneuver at home. He has published several small studies on both the app and device to support their use. Both use sensors and timers to ensure providers and patients rotate the head properly and hold each position for the required amount of time.

Evidence-based medicine

DizzyFix comes from the DizzyFix company who markets a DizzyFix device for home use by patients with BPPV. The app and device are designed by an ENT provider, Dr. Matthew Bromwich from Canada. The device sells for $150 CDN and is available on Amazon. There is some evidence for the device published in the medical literature and some for the app as well. Both help providers and patients perform the Epley maneuver that does have solid evidence. The app, unlike the device, is for providers to help ensure a proper diagnosis and initial treatment of BPPV. The app is based on solid literature for the proper diagnosis and treatment of BPPV with the Dix-Hallpike and Epley maneuvers. The detailed educational section of the app contains more than 60 medical references.

Who would benefit from this vertigo medical app?

Students, residents, mid-levels, primary care providers, emergency medicine, internal medicine, and hospitalist providers, or any provider who diagnoses and treats vertigo using Dix-Hallpike and Epley maneuvers.

Price

  • Free to download; $8.99 for full version via in-app purchase

 

Likes

  • High-quality videos demonstrating the proper performance of the Epley maneuver
  • Numerous educational sections on other vertigo diagnosis, evaluation, and treatment
  • Education section well-referenced

Dislikes

  •  App is expensive and videos about Epley available on YouTube
  • Use of app can be cumbersome per the included instructions
  • Not available for Android

 

Overall

DizzyFix is nearly the perfect solution for the evaluation and treatment of BPPV in the office setting. The app walks providers through the diagnosis and treatment of BPPV via the Dix-Hallpike maneuver for diagnosis and the Epley maneuver for treatment. The app is fairly easy to use and takes advantage of the iPhone’s sensors. The primary downside is the price for the in-app purchase. Basic videos of the maneuvers are available on the internet.

 

Overall Score

  • 4.5/5 stars

 

User Interface

  • 4.5/5 stars

Somewhat cumbersome to use per the instructions, but literally guides providers and patients through proper performance of the maneuvers using the phone’s sensors.

 

Multimedia Usage

  • 5/5 stars

App contains numerous high-quality videos on the performance of the Dix-Hallpike Maneuver and the Epley Maneuver plus evidence based information on vertigo with references.

Price

  •  4/5 stars

App is free to download, but full version requires $8.99 in-app purchase.

 

Real World Applicability

  •  4/5 stars

For medical providers unfamiliar with the Epley maneuver or those who want a refresher, DizzyFix provides an outstanding review of the procedure as well as the basics of vertigo and the diagnosis of BPPV. The app also can be prescribed to patients to encourage them to perform the maneuver at home if BPPV recurs or cannot be easily remedied in the office.

Device Used For Review: iPhone 8 running iOS 12.1

 

Available for download on iPhone and iPad. Not available for Android currently.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.