Efficacy of canalith repositioning maneuvers for benign paroxysmal positional vertigo

Abstract

Summary Objective Vertigo is a common clinical problem, particularly in older people. Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. It may be dangerous, especially in older individuals, because unsteadiness associated with BPPV can lead to falls. We aimed to investigate therapeutic effects of canalith repositioning maneuvers in patient with BPPV. Design Prospective study. Setting Patients complaining of vertigo referred to our Physical Medicine Outpatient Clinic for vestibular rehabilitation. Subjects 26 patients (14 male, 12 female) were studied; mean age was 52.5 ± 6.5 year (range 35–65), and mean symptom duration was 9.5 ± 20 months (range 0.25–96). Methods Detailed clinical examination, tests, and imaging studies were performed to exclude other possible diseases that may cause vertigo. Previous falls from the onset of symptoms were recorded. The Dix–Hallpike test for posterior and anterior semicircular canals (SCC) BPPV, and the supine roll test for horizontal SCC BPPV were performed. In all patients, the Epley maneuver (canalith repositioning maneuver, CRM) was performed initially. The Semont (liberatory) maneuver was performed in those patients who showed no signs of improvement with the Epley maneuver. Patients were followed up during 3 months. Results All patients were diagnosed as having posterior SCC BPPV. Eight patients described immediate relief of their vertigo following the first maneuver. Ten days later 16 patients (61.5%) showed complete relief from vertigo. The Epley maneuver was repeated in five patients who showed moderate improvement with the first maneuver. Five patients with little or no improvement following the Epley maneuver undertook the Semont maneuver (liberatory maneuver): complete relief from vertigo was found in two. Patients were followed up during 3 months. No recurrence was observed in any patients during the study period. After 3 months, six patients still had the symptoms of BPPV but to a lesser degree. Conclusion Our results indicate that BPPV can be diagnosed easily and treated using a simple maneuver. On the basis of patient history and the Dix–Hallpike test it seems to be unnecessary to perform other diagnostic examinations routinely before trying CRM. Diagnosis and appropriate therapy is important for the prevention of further complications.