Canalith repositioning variations for benign paroxysmal positional vertigo

Abstract

OBJECTIVE: To determine if variations in common treatments for benign paroxysmal positional vertigo (BPPV) affected efficacy.

STUDY DESIGN: Prospective, pseudo-randomized study.

SETTING: Outpatient practice in a tertiary care facility.

SUBJECTS AND METHODS: Patients (n = 118) with unilateral BPPV of the posterior canal, including 13 patients with BPPV of the lateral canal, were tested at a tertiary care center on one of five interventions: canalith repositioning maneuver (CRP), CRP plus home exercise, modified CRP, CRP for patients with involvement of two semicircular canals, and self-CRP home exercise. Self-CRP was also compared to previously published data on efficacy of the Brandt Daroff exercise. Main outcome measures were vertigo intensity and frequency, presence/absence of Dix-Hallpike responses, Vestibular Disorders Activities of Daily Living Scale (VADL), and computerized dynamic posturography.

RESULTS: Vertigo intensity and frequency and Dix-Hallpike responses decreased significantly, and posturography and VADL improved significantly from pre-to post tests. No other significant changes were found. The groups did not differ significantly. Vertigo intensity and frequency were not strongly related at pretest but were related at post-test. Length of illness and age did not influence the results.

CONCLUSION: However the head is moved, as long as it is moved rapidly enough and through the correct planes in space, repositioning treatments are likely to be effective. Therefore, clinicians have a range of choices in selecting the treatment best suited for each patient's unique needs.

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References

von Brevern

Radtke

Lezius

Epidemiology of benign paroxysmal positional vertigo. A population based study. J Neurol Neurosurg Psychiatr 2007; 78:710–5.

Brandt

Daroff

RB.

Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1980; 106:484–5.

Epley

JM.

The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992; 107:399–404.

Semont

Freyss

Vitte

Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988; 42:290–3.

Massoud

Ireland

DJ.

Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 1996; 25:121–5.

Parnes

Price-Jones

RG.

Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993; 102:325–31.

Welling

Barnes

DE.

Particle repositioning maneuver for benign paroxysmal positional vertigo. Laryngoscope 1994; 104:946–9.

Yimtae

Srirompotong

A randomized trial of the canalith repositioning procedure. Laryngoscope 2003; 113:828–32.

Harvey

Hain

Adamiec

LC.

Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. Laryngoscope 1994; 104:1206–12.

10.

Radtke

Neuhauser

von Brevern

A modified Epley's procedure self-treatment of benign paroxysmal positional vertigo. Neurology 1999; 53:1358–60.

11.

Tanimoto

Doi

Katata

Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal. Neurology 2005; 65:1299–300.

12.

Rajguru

Ifediba

Rabbitt

RD.

Three-dimensional biomechanical model of benign paroxysmal positional vertigo. Ann Biomed Eng 2004; 32:831–46.

13.

Brandt

Steddin

Daroff

RB.

Therapy for benign paroxysmal positioning vertigo, revisited. Neurology 1994; 44:796–800.

14.

Faldon

Bronstein

AM.

Head accelerations during particle repositioning manoeuvres. Audiol Neurotol 2008; 13:345–56.

15.

Cohen

Kimball

KT.

Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol 2005; 26:1034–40.

16.

Coats AC. Electronystagmography In: Bradford

, editor. Physiological Measures of the Audio-Vestibular System. New York: Academic Press; 1975. p. 37–85.

17.

Radtke

von Brevern

Tiel-Wilck

Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology 2004; 63:150–2.

18.

Cohen

Kimball

KT.

Development of the Vestibular Disorders Activities of Daily Living Scale. Arch Otolaryngol Head Neck Surg 2000; 126:881–7.

19.

Cohen

Kimball

Adams

AD.

Application of the Vestibular Disorders Activities of Daily Living scale. Laryngoscope 2000; 110:1204–9.

20.

Snijders

Bosker

Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling. Thousand Oaks, CA: Sage Publications; 1999.

21.

Froehling

Bowen

Mohr

The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clin Proc 2000; 75:695–700.

22.

Lynn

Pool

Rose

Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg 1995; 113:712–20.

23.

Helminski

Janssen

Hain

TC.

Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo. Otol Neurotol 2008; 29:976–81.

24.

Helminski

Janssen

Kotaspouikis

Strategies to prevent recurrence of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2005; 131:344–8.

25.

Cohen

Jerabek

Efficacy of treatments for posterior canal benign paroxysmal positional vertigo. Laryngoscope 1999; 109:584–90.

26.

Schuknecht

HF.

Cupulolithiasis. Arch Otolaryngol Head Neck Surg 1969; 90:765–78.

27.

Cohen

Kimball

KT.

Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. Am J Otolaryngol 2004; 25:33–7.

28.

Asawavichianginda

Isipradit

Snidvongs

Canalith repositioning for benign paroxysmal positional vertigo: a randomized, controlled trial. Ear Nose Throat J 2000; 79:732–7.

29.

Hain

Helminski

Reis

Vibration does not improve results of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg 2000; 126:617–22.

30.

Casqueiro

Ayala

Monedero

No more postural restrictions in posterior canal benign paroxysmal positional vertigo. Otol Neurotol 2008; 29:706–9.