Repeated vs single physical maneuver in benign paroxysmal positional vertigo

Area of Science:

• Neurology
• Otolaryngology
• Vestibular System Disorders

Background:

• Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder.
• The posterior canal is the most frequently affected canal in BPPV.
• Particle repositioning maneuvers (PRM) are standard treatments for BPPV.

Purpose of the Study:

• To compare the effectiveness of a single session of repeated PRM versus a single PRM for treating idiopathic BPPV.
• To assess the impact of post-treatment restrictions (neck collar and head upright position) on treatment outcomes.
• To evaluate the side effects and patient convenience associated with different treatment protocols.

Main Methods:

• 125 patients with idiopathic BPPV were divided into three groups.
• Group I (n=50): single session of repeated PRM.
• Group IIb (n=50): single PRM.
• Group IIa (n=25): single PRM followed by 48 hours of neck collar use and head upright position.

Main Results:

• Success rates at 1 week were 92% for repeated PRM (Group I), 80% for single PRM (Group IIb), and 84% for single PRM with restrictions (Group IIa).
• Transient nausea and disequilibrium were equally reported and well-tolerated across all groups.
• Patients in Group IIa found the post-treatment restrictions highly inconvenient.

Conclusions:

• A single session of repeated PRM demonstrates superior clinical effectiveness compared to a single maneuver for BPPV.
• Post-treatment restrictions following PRM are inconvenient for patients and do not appear to improve outcomes.
• Abandoning post-treatment restrictions is recommended to enhance patient convenience and adherence.