From the Guidelines
The recommended initial treatment for Benign Paroxysmal Positional Vertigo (BPPV) is a canalith repositioning procedure, such as the Epley maneuver, which should be performed by a healthcare provider. This repositioning procedure is designed to reposition the displaced calcium carbonate crystals (otoconia) from the semicircular canals back to the utricle where they belong. The Epley maneuver typically takes about 15 minutes to complete and involves moving the head through four positions, holding each for about 30-60 seconds or until vertigo subsides. For posterior canal BPPV (the most common type), the Semont maneuver or Brandt-Daroff exercises may be alternatives. Medication is generally not recommended as first-line treatment since it doesn't address the underlying mechanical problem and may delay recovery by suppressing the central nervous system's ability to compensate.
- The Epley maneuver is highly effective, with success rates of 80-90% after one or two treatments, because it directly addresses the cause of BPPV by using gravity to guide the displaced crystals back to their proper location in the inner ear 1.
- The procedure is supported by strong recommendations based on systematic reviews of RCTs and a preponderance of benefit over harm 1.
- Patients should be educated regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up 1.
- Clinicians should assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling 1.
From the Research
Treatment for BPPV
The recommended initial treatment for Benign Paroxysmal Positional Vertigo (BPPV) includes:
- Canalith repositioning procedure (CRP) 2, 3, 4, 5, 6
- Modified liberatory maneuver (LM) 2
- Brandt and Daroff's exercise 2
Effectiveness of Treatments
Studies have shown that:
- CRP is an effective treatment for BPPV, with a high success rate 3, 4
- LM and Brandt and Daroff's exercise are also effective interventions for BPPV 2
- The efficacy of Epley's canalith repositioning procedure can be improved by repeating the maneuver in the same session 5
- The time course of recovery after Epley maneuvers can vary, with some patients experiencing persistent nystagmus at the first evaluation 6
Considerations
- Patient education and the sham maneuver can have a beneficial effect on BPPV symptoms 2
- Recurrence rates can be higher in elderly patients or those with a history of head trauma or vestibular neuropathy 4
- Close repetition of a single Epley CRM after the first effective one can reduce the risk of persistent/recurrent BPPV 5