Epley Omniax Chair
Precise and Professional
The Omniax, available at our Las Vegas location, was designed to precisely align the semicircular canal being treated to be parallel with gravitational pull of the earth allowing maximum force to reposition the particles (calcium crystals) quickly and efficiently. Traditional table maneuvers can only approximate the canal to gravity relationship and can be off sometime up to 20-30 degrees due to cervical disease, fear, obesity of patient, and restricted mobility of the lumbar spine. This reduces the effectiveness of the table maneuver leaving sediment in the canal, continued vegetative symptoms and unnecessary additional treatments.
Convenient and Accurate
The Omniax is set-up for the concept of "minimal stimulus" which is the idea of a treatment causing the least amount of sensory input to the brain. This reduces vegetative symptoms (nausea, vomiting) common with the table treatment of BPPV due to imprecise positioning. The patient is sitting in the upright position with customized lumbar support versus supine and even prone with the rolling and turning techniques of the standard Epley table maneuver. This comfortable positioning allows the treatment to be less psychologically and physically overwhelming and allows a straightforward treatment for the patient.
Custom Assessment Capabilities
The Omniax is an all encompassing vestibular testing system for your patient. It allows the clinician to assess non-BPPV and BPPV forms of positional vestibular vertigo. Not only can it assess and treat BPPV, it can also identify otolithic dysfunction with off-axis rotational testing but also peripheral and/or central disorders with video-nystagmography (VNG) testing.
Focused Treatment Paradigms
The Omniax has customized protocols for anterior, posterior, and horizontal canal BPPV using nystagmus-based evaluation. This allows the assessment and treatment of canalithiasis and cupulolithiasis to be simple, effective, and fast. It also has a "free-style" application for customized treatment of BPPV variants (multiple canal involvement), abnormal anatomical conditions, and large patients.
Omniax PDF Documentation
Dr. John M. Epley, M.D.
Dr. John Epley is widely known in the field of otology and neurotology. He is respected for his innovative approaches to the diagnosis and treatment of vestibular disorders, having devised new surgical techniques and patented several medical inventions. By and large, his contributions to the field have resulted in less invasive, less risky and more effective management of vestibular disorders. He is most noted for his "Canalith Theory" as the cause of Benign Paroxysmal Positional Vertigo (BPPV), and for development of the "Epley Maneuvers" (Canalith Repositioning Maneuvers) for its treatment. This treatment and the supporting concepts are regarded as one of the most significant breakthroughs in the vestibular field in the past century.
"Epley's landmark report of a successful cure for the typical form of BPPV demands that we approach BPPV much differently, and he deserves full credit for enabling the paradigm shift toward the more aggressive treatment of BPPV advocated today." - Annals New York Academy of Sciences, 2001
In 2002, he won the highest international award for contributions to his field of neurotology, which is given every other year by the Barany Society of Sweden. Also in 2002, the American Academy of Otolaryngology made the Epley maneuvers the official standard of care for BPPV by adding them to professional guidelines for the nation's 9,000 otolaryngologists. Other academies related to neurology, physical therapy and audiology also added Canalith Repostioning maneuvers to their guidelines in recent years.
Dr. Epley attended medical school at the Oregon Health Sciences University, interned at the University of Miami Medical School in Florida, served three years with the Strategic Air Command at Vandenberg Air Force Base in California and completed a four-year residency in otolaryngology at Stanford Medical Center in California. He is certified by the American Board of Otolaryngology and is a member of several societies, including the American Neurotology Society, the American Otology Society and the International Barany Society.
Balance Disorders Defined
Definitions: "Dizziness" is a vague term that applies most commonly to the feeling of spinning, disequilibrium, lightheadedness and sickness similar to that experienced with carnival rides, sea-travel, inebriation or acute labyrinthitis. However, it also can also apply to a loss of consciousness (fainting), such as may occur with prolonged standing on a hot day, or low blood pressure. The former form is referred to as ""true vertigo," and the latter as "syncope."
"Vertigo" is a false sense of movement. "Imbalance" is a decrease in the ability to control upright posture. These symptoms are usually caused by disorders of the "balance system", referred to medically as the "vestibular system." Thus, the terms "balance disorder" and "vestibular disorder" are more or less synonymous.
Origination: Most symptoms of vertigo and/or imbalance are caused by abnormalities of the vestibular sensors in the inner ear. Less frequently involved are the neural-pathways leading from the ears to the brain (central nervous system),.
Symptoms: When trauma or disease damages the body's balance system it causes symptoms of nausea, spinning, imbalance, vertigo and lightheadedness.
Balance system: The three semicircular canals and otolithic organs of the inner ear are mechanical transducers that sense angular and linear acceleration respectively. Thus, the semicircular canals send information to our eyes that orient them during head rotations (the vestibulo-ocular reflex) (VOR), and the otolithic organs control balance (the vestibulo-spinal reflex) (VSR).
Diagnosis and treatment: Only through observational tests that monitor the VOR through reflexive eye movements (nystagmus), and the VSR through abnormalities in balance control, as well as aberrations in the associated perceptions of these reflexes, has any progress been made in diagnosis and treatment. Unlike most conditions, the physiological measure of damage or disease– for example, electrical and sound activity for heart disease, imaging for brain tumors - is elusive and often difficult to pinpoint. Modern electronic and technology is providing greater insight into the vestibular system. However, these measures and their inter-relationships in the 3-D realm of space are extremely complex, and, in many cases, only with the help of the computer can this data be interpreted and applied to the diagnosis, localization and treatment of these conditions.
The Market: Significant and Growing Prevalence of Balance Disorders
Prevalence: Balance disorders are one of the most common complaints in health care in the U.S. They are the third most common complaint to primary care and emergency rooms and the number one complaint in the growing elderly population. They are also the second most common reason for Medicare hospital admissions with an average of 4.3 days per stay.
About half of all adults will experience balance problems during their lifetime. While some cases are minor or resolve without treatment, up to five percent of adults under age 65 are currently identified as experiencing chronic problems. And each year 3.2 percent of visits to primary care physicians are for new vertigo cases. In 1994, there were 11 million physician visits for dizziness recorded.
In the elderly population, there are currently 12.5 million Americans, or about 30 percent, identified as suffering from vertigo that significantly interferes with their lives. This translates into five million to eight million annual visits to physicians. As baby boomers age and life expectancy increases, total number of balance problems will increase.
While these numbers indicate a large market potential, they probably significantly underestimate the problem since no population studies yet exist. Until the last decade, few understood or recognized balance disorders. Much of what still passes for inevitable aging – unsteadiness, lack of mobility, dementia – is often related to a balance problem. Despite the expensive and sometimes debilitating results of untreated balance problems, they are one of the most under-diagnosed and misdiagnosed conditions in medicine today.
Implications for Misdiagnosis and Under-treatment
Costly and unnecessary expense: Without practical and affordable technology to diagnose and treat balance disorders, the diagnosis and treatment are often costly, lengthy and disappointing. The least expensive and most common treatment by primary care providers, a Meclizine prescription, while relieving some symptoms, actually increases the risk of falls and injuries by reducing the body's ability to compensate for the vertigo and by slowing reaction time, a leading cause of falls.
Patients are also often caught in an expensive cycle of referral, run through a series of expensive and low-yielding tests, such as an MRI., or even sent to a psychiatrist. If they receive proper care, they have seen an average of three or four specialists and gone months or years untreated.
The treatment just for injuries from falls costs our healthcare system over $20 billion each year. At least half of these falls and associated costs are related to preventable vestibular problems. Since many of those injured become chronic patients, there are additional costs for those who require nursing home care (40 % of those injured) and equipment such as wheel chairs and walkers.
Beyond costs to the healthcare system, chronic vertigo is a significant cost for disability and workers compensation insurers.
Decline in quality of life: Because balance disorders run the gambit of minor to debilitating, and can sometimes be misinterpreted as malingering or psychological problems, treatment is often delayed. Patients are likely scared and confused about what is happening to them. They may have a constant malaise and reduced cognitive ability. Some can no longer enjoy simple everyday pleasures such as reading, watching TV or going out to dinner or to movies. Besides depression and a rapid decline in their overall health, there are also social costs such as divorce, job loss, poverty, and isolation from family and friends.
Epidemic of Elderly Fallers: Those with balance problems are prone to falling and often need assistance with simple daily living and will self-limit their activity out of fear of falling and injuring themselves. Falls are often misperceived as an inevitable part of aging. They are the leading cause of injury for senior citizens and the leading cause of accidental death for those over age 85 .
The Problem: Unmet Technology Needs
The Inner Ear, One of the Last Frontiers of Medicine
"Dizziness is one of the most challenging problems in medicine. It is difficult to define, impossible to measure, a challenge to diagnose, and troublesome to treat... Most of those with chronic symptoms are not relieved by medical treatment." - Annals of Internal Medicine, 2001
Despite being an expensive and debilitating problem, balance disorders are one of the most misdiagnosed and under-treated areas of medicine today. Until the last couple decades, few understood their origination and attributed symptoms to other health problems.
Even as understanding has increased, the balance disorder patient has remained an intimidating prospect for most physicians. Balance disorders are difficult, time consuming, and consequently, a low profit margin area of medicine.
It has only been in the last few decades, in large part due to Dr. Epley's work on vertigo and the development of the Epley Maneuvers, that any progress been made in understanding the balance system in the inner ear and the closely linked area of the brain. However, while the Maneuvers are considered the "standard of care" (Annals of Internal Medicine, May 2001), without practical technology that encourages widespread and standardized deployment, diagnosis is often more of a "best guess" with a "stab in the dark" series of expensive tests.
Treatment may incorrectly consist of tranquilizers, doing nothing and hope it will go away, psychological counseling, and telling the patient, "learn to live with it." Until CRP, vestibular nerve section surgery that cut off the balance center from the brain was the treatment of choice.
The Epley Omniax Chair is only available at the Werner Institute of Balance and Dizziness, Inc. (Summerlin). It is covered by most insurance companies and is the new standard of care in the assessment and treatment of positional vertigo associated with BPPV disorders. Omniax is not the Epley table maneuver – it is a precise repositioning procedure for all BPPV disorders and diagnostic evaluation system. Please call (702) 880-1515 for a referral of your patient with positional vestibular vertigo.