Treatments for Benign Paroxysmal Positional Vertigo (BPPV)

The purpose of this study was to determine the relative short- and long-term efficacy of several physical treatment paradigms commonly employed for the treatment of benign paroxysmal positional vertigo (BPPV), including the canalith repositioning (Epley) maneuver, the liberatory (Semont) maneuver, the Brandt-Daroff exercises and nonspecific vestibular habituation exercises. These procedures involve exercises and head manipulations. Vertigo intensity and frequency, the presence/absence of slow-phase eye movements, the degree of dizziness handicap and acts of daily living (ADL) were assessed. The study also ascertained the effects of co-morbid conditions on the response to treatment. While BPPV is a common and significant public health problem that has been recognized for several decades, this is the first systematic study of the relative treatment efficacy of different physical treatment modalities for this disorder.

The subject sat in a chair; the head was passively tilted downward, turned away from the involved side, turned back to center, upward, away from the involved side, twice, slowly.

Standard passive motion of the head: Dix-Hallpike maneuver, turn head to opposite side, roll over, sit up.

Head shaking exercises in pitch, roll, yaw and circumduction. Titrating from 2 repetitions per exercise to 20 repetitions per exercise, as tolerated.

Inclusion Criteria: Patients may be eligible for this study if they: Are at least 21 years old. Have a diagnosis of unilateral posterior semicircular canal BPPV according to established clinical test criteria. Have functional to normal range of motion of the neck and the back. Exclusion Criteria: Patients will not be eligible for this study if they: Have a history of prior ear surgery or prior treatment for BPPV. Have an orthopedic or connective tissue disorder that impairs functional neck or trunk range of motion. Have a significant neurological disorder or spinal cord damage. Are on vestibular suppressant medications. Have Meniere's disease or acoustic neuromas.

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Cohen HS, Kimball KT. Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. Am J Otolaryngol. 2004 Jan-Feb;25(1):33-7. doi: 10.1016/j.amjoto.2003.09.010.

Cohen HS, Kimball KT. Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol. 2005 Sep;26(5):1034-40. doi: 10.1097/01.mao.0000185044.31276.59.