From the Guidelines
The primary treatment for Benign Paroxysmal Positional Vertigo (BPPV) should be a canalith repositioning procedure (CRP), such as the Epley maneuver, as initial therapy, due to its strong recommendation based on systematic reviews of RCTs and a preponderance of benefit over harm 1. This procedure involves moving the head through specific positions to relocate displaced calcium carbonate crystals from the semicircular canals back to the utricle where they belong. Some key points to consider in the treatment of BPPV include:
- The Epley maneuver can be performed by a healthcare provider or taught to patients for home treatment, and typically provides immediate relief in about 80% of cases.
- Other effective repositioning techniques include the Semont maneuver, Half-Somersault maneuver (Foster maneuver), and Brandt-Daroff exercises.
- Medications generally play a limited role in BPPV treatment but may include vestibular suppressants like meclizine (25mg every 4-6 hours as needed) or diazepam (2-5mg as needed) for short-term symptom management during severe episodes, as noted in the context of BPPV diagnosis and treatment 1.
- Most patients require only 1-3 repositioning sessions for complete resolution, though some may need repeated treatments. The effectiveness of these maneuvers stems from their ability to use gravity to move the displaced otoconia (ear crystals) out of the semicircular canals where they inappropriately trigger vertigo symptoms during certain head movements. It is also important to note that BPPV can go away on its own within weeks if left untreated, but seeking professional help is recommended, especially for seniors or those with a history of falls, to reduce the risk of injury and to resolve symptoms quickly 1.
From the Research
Treatment Options for BPPV
The treatment for Benign Paroxysmal Positional Vertigo (BPPV) primarily involves repositioning maneuvers, which are highly effective, inexpensive, and easy to apply 2. These maneuvers aim to relocate the calcium particles (otoconia) in the inner ear that cause the vertigo.
Repositioning Maneuvers
- Epley maneuver: Used for posterior canal BPPV, this maneuver has been shown to be effective in treating BPPV, with a high success rate 3, 4.
- Semont maneuver: Also used for posterior canal BPPV, this maneuver is comparable to the Epley maneuver in terms of efficacy and ease of performance 2.
- Gufoni maneuver: Used for horizontal canal BPPV, this maneuver is easier to perform than the BBQ roll and requires only identifying the side of weaker nystagmus 2.
- BBQ roll (Lempert 360 roll or log roll): Used for horizontal canal BPPV, this maneuver is an alternative to the Gufoni maneuver 2.
- Deep head hanging maneuvers: Used for anterior canal BPPV, these maneuvers can be effective in hastening recovery, although the evidence is weaker 2.
Efficacy and Recurrence
- The canalith repositioning procedure (CRP) has been shown to be an efficient and long-lasting noninvasive treatment for BPPV, with a high success rate and low recurrence rate 3.
- However, elderly people and those with a history of head trauma or vestibular neuropathy may have a higher recurrence rate 3.
- Repeating the Epley maneuver in the same session may improve treatment efficacy and reduce the risk of persistent or recurrent BPPV 5.
Comparison of Treatment Protocols
- Different treatment protocols, such as the Epley maneuver with or without subsequent Dix-Hallpike retesting, have been compared, and the results suggest that repeating the maneuver in the same session may be beneficial 5.