Single Treatment Approaches to Benign paroxysmal Positional Vertigo, Is It Enough?

Abstract

Bening paroxysmal positional vertigo (B.P.P.V) is one of the most common vestibular disorders.During the last years, it has been attributed to cupulolithiasis or canalithiasis of the posterior semicircular canal.This randomized study was done to determine the effectiveness of two different physical therapy approaches and to determine if a single treatment approaches is enough.In this prospective study 80 patients received either a single treatment based on the hypothesis that the vertigo and nystagmus of (B.P.P.V) are due to debris adhering to the cupula of posterior semicircular canal (cupulolithiasis), Semont maneuver, or a single treatment based on the hypothesis that the debris is free floating in the long arm of the posterior semicircular canal (canalithiasis), Epley maneuver.Treatment outcome was classified as asymptomatic, improved and no change. Analysis of the results of this study revealed that at the end of the first session , out of 80 patients, 60(75%) were asymptomatic ; 14(18%) improved ;6(7%) showed no change. Follow– up showed that 8 patients developed recurrence. After a second session to 22 patients (8 recurrences, 10 improved, 4 had no change) ,17 became asymptomatic.This means that at the end of the seconed session ,69 (86%) of 80 patients became asymptomatic ; 9(11%) of 80 patients improved ; 2(3%) of 80 patients showed no change. In conclusion , this study shows that 1) The success rate of Semont’s maneuver was up to 80%, so it is much better than Epley maneuver 70% after the first session. 2)Recurrent cases are best treated with second session.