Particle repositioning maneuver: effective treatment for benign paroxysmal positional vertigo

To assess short-term and long-term outcomes of the particle repositioning maneuver (PRM).

This is a prospective study of 68 cases of benign paroxysmal positional vertigo (BPPV) in 65 consecutive patients.

Initially, 57 (83.8%) cases had no evidence of residual symptoms, 10 (14.7%) had a partial improvement, and only 1 (1.5%) failed treatment. In the long-term (18.7 month mean follow-up period), 43 (67.2%) cases had no history of recurrence, and 22 (34.4%) cases had recurrences, of which 14 (21.9%) experienced only mild symptoms, and 8 (12.5%) were no better than before the PRM. Of the eight who were no better, five had repeat PRMs that successfully relieved their symptoms. The final overall outcome was that 59 (95.2%) patients had either mild symptoms or no symptoms, and 3 (4.8%) patients were treatment failures. Factors that did not seem to be predictive of outcome were secondary nystagmus, gender, and duration of symptoms. In both the short and long terms, the self-limited form of BPPV was found to have the best outcome, the episodic type had an intermediate outcome, and the prolonged type had the worst outcome.

We postulate that outcomes are best in those cases where free-floating canaliths are the mechanism of disease, which includes patients with self-limited BPPV. Patients with episodic or prolonged BPPV may have varying degrees of underlying cupulolithiasis that cannot be entirely corrected with PRM alone.