Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo-A Critical Review

Abstract

Benign paroxysmal positional vertigo (BPPV) defined by Dix and Hallpike is one of the most common disorders causing vertigo and fortunately, is a very simple disorder to manage. BPPV is more prevalent in adults and in women. Canalithiasis describes free-floating particles within a SCC. Cupulolithiasis describes particles attached to the cupula. BPPV can be caused either by canalithiasis or by cupulolithiasis, and can affect any of the three SCCs. BPPV mostly develops in the posterior semicircular canal. The main symptom of BPPV is vertigo induced by a change in head position with respect to gravity. The Dix-Hallpike test is the most commonly used test to confirm the diagnosis of posterior canal BPPV. Treatment options for posterior canal BPPV are Epley's maneuver, Liberatory maneuver and Brandt-Daroff exercises. Objective of this review is to find out which intervention is most effective in relieving symptoms. There are evidences that suggest performance of any of the three maneuvers can be expected to give good results in the management of posterior canal BPPV than placebo. The Epley's maneuver is a safe, effective treatment for posterior canal BPPV with confirmed evidence level A. Epley's maneuver is also comparable to the Semont maneuver which is difficult to perform for elderly for posterior canal BPPV. Both (Epley's maneuver and Semont maneuver) are more effective than Brandt-Daroff exercises in the short term but evidence suggests that Brandt-Daroff exercises should be incorporated in the long term as a preventative measure or to promote functional recovery.