Residual Dizziness after Successful Repositioning Maneuvers for Idiopathic Benign Paroxysmal Positional Vertigo Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo Treatment of Horizontal Canal Benign Paroxysmal Positional Vertigo: A New Rehabilitation Technique Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo. Effect of Repositioning Maneuver Type and Postmaneuver Restrictions on Vertigo and Dizziness in Benign Positional Paroxysmal Vertigo Comparative study of the efficacy of the canalith repositioning procedure versus the vertigo treatment and rehabilitation chair Particle Repositioning Maneuver Versus Brandt-Daroff Exercise for Treatment of Unilateral Idiopathic BPPV of the Posterior Semicircular Canal: A Randomized Prospective Clinical Trial With Short- and Long-Term Outcome
Objective : To establish a possible causal factor for residual dizziness ( RD ) after successful repositioning maneuvers in patients with benign paroxysmal positional vertigo ( BPPV ) . Material s and Method : Ninety consecutive patients with idiopathic BPPV were treated with repositioning maneuvers , and the rate of RD was assessed as well as clinical data .  Posturography and assessment of anxiety levels were performed on patients reporting RD . Results were compared with a control group of BPPV patients of the sample after repositioning maneuvers and without RD . Results : Twenty-eight subjects ( 31.1 % ) reported RD on the second day after successful repositioning maneuvers . The mean duration of RD was 11.6 ± 3.9 days . Patients with RD presented a higher duration of BPPV ( 14.1 vs. 10.9 days , p = 0.01 ) . A correlation was demonstrated between the duration of BPPV and duration of RD ( p < 0.01 ) . Subjects with RD presented increased body sways , above all in eyes-closed conditions . Conclusion : RD is mainly correlated with duration of vertigo in BPPV patients . Anxiety was demonstrated to play a role in increased body sways Background : Canalith repositioning procedure ( CRP ) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo ( BPPV ) . We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV . Methods : Nine hundred sixty-five patients ( 481 men and 484 women , from 18 to 87 years of age ) were enrolled in this prospect i ve study during 1995–2010 . Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver ( either Dix-Hallpike or Roll test ) . Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months . Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement , and horizontal canal involvement , respectively . Short-term follow-up was obtained 48 h and 7 days after initial treatment , whereas long-term follow-up was obtained at repeated 6-month intervals . Results : Symptoms subsided immediately in 819 patients ( 85 % ) by the first CRP . Only 19 patients ( 2 % ) required CRP more than 3 times . Patients ’ mean follow-up was 74 months ; symptom recurrence was noted in 139 patients . A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy ( p < 0.001 ) . Conclusions : This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV , especially for younger patients without a history of head trauma or vestibular neuropathy . Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls The aim of this study was to evaluate the effectiveness of a new technical variant applied to the Gufoni 's manoeuvre , in the treatment of horizontal canal benign paroxysmal positional vertigo ( HSC-BPPV ) . 87 patients with BPPV of HSC ( 55 women and 32 men ) , aged between 21 and 80 years , were r and omized either to modified Gufoni 's manoeuvre or to the Gufoni 's manoeuvre .  93 % of patients treated with modified Gufoni 's manoeuvre was cured after the first treatment session , of which only 2 % had a conversion into PSC-BPPV , while the Gufoni 's manoeuvre led to a symptoms resolution in 88 % of cases , of which 16 % had a conversion into PSC-BPPV . Therefore , the modified Gufoni 's manoeuvre shows the same effectiveness in the resolution of symptoms of Gufoni 's manoeuvre , but it appears more effective than the latter to reduce the percentage of conversion of the HSC-BPPV into PSC-BPPV ( χ 2 = 6.13 , P = 0.047 ) UNLABELLED Benign paroxysmal positional vertigo ( BPPV ) may compromise the balance of elderly subjects . OBJECTIVE To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance . METHOD This is a prospect i ve clinical study . Patients diagnosed with BPPV ( Dix-Hallpike test ) were su bmi tted to the Timed Up & Go ( TUG ) test , the Clinical Test of Sensory Interaction and Balance ( CTSIB ) , and lower limb testing before and after they were repositioned using the modified Epley maneuver . RESULTS Most subjects were females , and the group 's mean age was 70.10 years ( SD = 7.00 ) . All patients had canalithiasis of the posterior canal . The following symptoms improved after the maneuver : postural instability ( p = 0.006 ) , nausea and vomiting ( p = 0.021 ) , and tinnitus ( p = 0.003 ) . Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver ( p < 0.001 ) . Patients performed better on the CTSIB after the Epley maneuver  on condition 2 ( p < 0.003 ) , condition 3 ( p < 0.001 ) , condition 4 ( p < 0.001 ) , condition 5 ( p < 0.001 ) , and condition 6 ( p < 0.001 ) . CONCLUSION Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver The need for Class I and II studies on the efficacy of Semont ’s liberatory maneuver ( SLM ) in the treatment of posterior canal benign paroxysmal positional vertigo ( PC-BPPV ) motivated the present double-blind r and omized trial on the short-term efficacy of SLM . A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study . Patients were r and omly assigned to treatment by SLM ( n = 174 ) or sham treatment ( n = 168 ) . Subjects were followed up twice ( 1 and 24 h ) with the Dix – Hallpike maneuver by blinded examiners . At the 1 and 24 h follow-up , 79.3 and 86.8 % , respectively , of patients undergoing SLM had recovered from vertigo , compared to none of the patients undergoing the sham maneuver ( p < 0.0001 ) . Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery ( 87.1 vs. 55.7 % ; p < 0.0001 ) . To the best of our knowledge , this is the first Class I study on the efficacy of SLM . SLM proved highly effective with respect to the sham maneuver ( p < 0.0001 ) . Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment . The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level OBJECTIVE In the present study , we calculated the success rate of the modified Epley maneuver and determined the effectiveness of post-maneuver positional restriction in terms of the prevention of early and late recurrence . METHODS The present study was conducted on 78 patients who had unilateral benign paroxysmal positional vertigo ( BPPV ) of the posterior semicircular canal ( SCC ) and who were treated in the Otorhinolaryngology Department of Susehri State Hospital . The Dix-Hallpike test was performed on all patients . After the involved canal was identified using this test , we guided patients through the modified Epley repositioning maneuver . A maximum of two maneuvers were performed in the same session . The patients were r and omly divided into two groups . One group was not advised any positional restriction , while the second group was advised positional restriction for 10 days after the procedure . Recurrences during 1 - 90 days after the treatment were noted as early recurrences , while those that occurred after 90 days were noted as late recurrences . RESULTS In the restriction group ( n=39 ) ,  repositioning  was successful after a single maneuver in 32 ( 82.05 % ) patients and after two maneuvers in 5 ( 12.8 % ) patients .  Repositioning failed in two ( 5.1 % ) patients . In the non-restriction group ( n=39 ) ,  repositioning  was successful after a single maneuver in 31 ( 79.4 % ) patients and after two maneuvers in 6 ( 15.3 % ) patients .  Repositioning failed in two ( 5.1 % ) patients . Thus , the success rate was 94.8 % in each group . Early recurrence occurred in 3 ( 8.1 % ) of 37 patients in the restriction group and 2 ( 5.4 % ) of 37 patients in the non-restriction group ( p>0.05 ) . Late recurrence occurred in 5 ( 13.5 % ) of 37 patients in both the restriction and non-restriction groups ( p>0.05 ) . CONCLUSION Postural restriction after a canalith repositioning procedure does not improve procedural success or decrease early and late recurrence rates . However , the number of patients was too small to detect a difference between both treatment groups Introduction . To compare the efficiency of Epley ( Ep ) and Sémont-Toupet ( ST ) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale ( VAS ) in benign positional paroxysmal vertigo ( BPPV ) . Material and Methods . 226 consecutive adult patients with posterior canal BPPV were included . Patients were r and omized into 2 different maneuver sequence groups ( n = 113 ) : 2 ST then 1 Ep or 2 Ep then 1 ST . Each group of sequence was r and omized into 2 subgroups : with or without postmaneuver restrictions . Vertigo and dizziness were assessed from days 0 to 5 by VAS . Results . There was no difference between vertigo scores between Ep and ST groups . Dizziness scores were higher in Ep group during the first 3 days but became similar to those of ST group at days 4 and 5 . ST maneuvers induced liberatory signs more frequently than Ep ( 58 % versus 42 % resp . , P < 0.01 , Fisher 's test ) . After repositioning maneuvers , VAS scores decreased similarly in patients with and without liberatory signs . Postmaneuver restrictions did not influence VAS scores . Conclusion . Even if ST showed a higher rate of liberatory signs than Ep in this series , VAS scores were not influenced by these signs Abstract Conclusion : Vertigo treatment and rehabilitation chair ( TRV ) may be suggested as the first choice for patients with posterior canal benign paroxysmal positional vertigo ( p-BPPV ) . Objective : To investigate the short- and long-term treatment efficacy of the canalith repositioning procedure ( CRP ) versus TRV for patients with p-BPPV . Methods : A total of 165 patients with unilateral p-BPPV were assigned to either the CRP group or the TRV group . Patients were assessed at 1 week , 4 weeks , 3 months , and 6 months after their first treatment . The numbers of treatment sessions required for successful repositioning in both groups at 4 weeks , 3 months , and 6 months were recorded . Results : Treatment efficacy of patients in the TRV group was significantly better than that of patients in the CRP group 1 week after the first treatment . The number of treatment sessions needed for successful repositioning was significantly lower in the TRV group than in the CRP group at 4 weeks and 3 months after the first treatment Objective To compare the outcome and probability of recurrence in a series of patients with unilateral idiopathic benign paroxysmal positional vertigo of the posterior canal ( PC-BPPV ) that were r and omly treated by Br and t-Daroff exercise ( B-D exercise ) or by particle repositioning maneuver ( PRM ) .  Study Design R and omized prospect i ve clinical trial . Setting Tertiary referral center . Patients Patients were included in this study if they complained of vertigo and had been diagnosed as having unilateral idiopathic PC-BPPV for at least 1 week before Dix-Hallpike maneuver ( DHM ) , remained for 30 days in the r and omly assigned treatment , and had at least 48 months ’ follow-up . Intervention Forty-one patients were treated with a single PRM and 40 patients by B-D exercise . Main Outcome Measure Resolution of benign paroxysmal positional nystagmus on the DHM . The probability of recurrence was also studied . Results At Day 7 , DHM was negative in 80.5 % of the PRM-treated patients and in 25 % of those treated by B-D exercise ( p < 0.001 ) . At Month 1 , the differences between both treatment groups remained statistically significant ( 92.7 % in PRM versus 42.5 % in the B-D exercise had a negative DHM ; p < 0.001 ) . The variable that influenced that DHM became negative was the PRM ( RR = 4.8 ; 95 % confidence interval , 2.5–9.2 ; p < 0.001 ) . The number of recurrences in PRM and B-D exercise were 0.56 ± 0.8 and 0.48 ± 0.8 , respectively ( p = 0.48 ) . The recurrence rate at 48 months was 35.5 % ( 15/41 ) in B-D exercise and 36.6 % ( 9/31 ) in the PRM group ( p = 0.62 ) . Although the time interval until the first recurrence was similar ( p = 0.44 ) , patients included in the PRM group showed a significantly longer time interval between the first and second recurrence ( p = 0.04 ) . Conclusion PRM is more effective treatment and as safe as B-D exercise in the short term for unilateral and idiopathic PC-BPPV , and although it does not reduce the probability of recurrence in the 4-year follow-up period compared with B-D exercise , it may delay the second recurrence ’s onset in those patients who had already experienced a single recurrence . Our study supports the use of PRM as the treatment of choice in unilateral and idiopathic PC-BPPV , although exercise may be also considered as an alternative treatment in selected cases
Introduction Benign paroxysmal positional vertigo ( BPPV ) is the most common cause of vertigo , and it is characterized by episodes of vertigo roundabout when the head is moved .
Objective To investigate the long-term effectiveness of  vestibular rehabilitation ( VR )  in patients with BPPV and the rate of recurrence of symptoms .