Abstract
Abstract Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. The canalith repositioning procedure (CRP) is known to be an effective therapy for the treatment of BPPV. However, because of its various movements of the head and body, it is impossible to perform in BPPV patients with orthopedic impairments or in the elderly. The rolling-over maneuver (ROM) involves easy movements, with only a small load. This therapy is suitable for most BPPV patients, especially for those without an indication for CRP. Hence, we propose that ROM is as effective as CRP for the treatment of BPPV. In this study, we compared among the ROM, Epley, and Brandt-Daroff maneuvers in the management of patients with posterior semicircular canal-type BPPV. The study included 60 patients with BPPV who were randomized and divided into the following three groups: (i) those treated by Epley maneuver as CRP; (ii) those treated by ROM; and (iii) those treated by the Brandt-Daroff maneuver. The findings of this study demonstrated that the success rate was the best in patients who were treated with Epley maneuver (90%), then in patients treated with ROM (85%) followed by those treated with the Brandt-Daroff maneuver (80%). The recurrence rate after management was high in patients treated with the Brandt-Daroff maneuver (31.25%), with no statistically significant difference. We recommend either Epley maneuver in the office or ROM at home, according to the general condition of the patient.
Highlights
Introduction and rationaleBenign paroxysmal positional vertigo (BPPV) is considered to be the most common peripheral vestibular disorder, in the elderly
It is known that BPPV develops in stages: first, the otoconia detach from the utricular matrix, and they enter into a semicircular canal when the head assumes a critical position
Patients and methods The study was conducted in the Vestibular Unit, ENT Department, Ain Shams University, and included 60 patients with the diagnosis of posterior semicircular canal BPPV
Summary
Introduction and rationaleBenign paroxysmal positional vertigo (BPPV) is considered to be the most common peripheral vestibular disorder, in the elderly. By the age of 70 years, about 30% of all elderly individuals have experienced BPPV at least once [1] This condition is characterized by brief attacks of rotatory vertigo and concomitant positioning rotatory-linear nystagmus, which are elicited by rapid changes in the head position relative to gravity. Schuknecht and Ruby [4] hypothesized that heavy debris settles on the cupula (cupulolithiasis) of the canal, transforming it from a transducer of angular acceleration to a transducer of linear acceleration It is generally accepted, that the debris floats freely within the endolymph of the canal (canalolithiasis).The debris – possibly particles detached from the otoliths – congeals to form a free-floating clot (plug). Most patients with BPPV (90.2%) have involvement of the posterior semicircular canal, and in most patients physical therapy is effective [3,4,5]
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