BPPV: Controlled Trials, Contraindications, Post-manoeuvre Instructions, Complications, Imbalance

Abstract

Four single-blinded, randomized controlled trials have shown that patients with benign paroxysmal positional vertigo (BPPV) respond to canalith repositioning treatment (CRT) 67–89% compared to a spontaneous remission rate of 0–48% to sham or no treatment. Non-blinded controlled trials have shown the liberatory manoeuvre also to be effective in treating BPPV. Caution is advisable in assessing and treating BPPV in individuals with significant neck disease. In these patients, a simple two-step assessment can be carried out to determine if CRT can be performed. In the past, it was recommended that patients stay upright for at least 24hours after CRT. Recent studies have shown this to be unnecessary. The patient may only need to be upright for 20 minutes. Patients should be encouraged to treat themselves at home the following morning. This not only helps to increase remission, but it also allows patients to treat themselves if there is a recurrence in the future. BPPV not only causes transient vertigo, but it also causes imbalance which also responds to CRT. Some patients have other causes for imbalance besides BPPV, so all patients with persistent imbalance should be re-evaluated 1–2 weeks after CRT.

• vertigo
• spells
• dizzy
• treatment