What is the treatment for Benign Paroxysmal Positional Vertigo (BPPV) as a symptom of long COVID?

Treatment of BPPV as a Long COVID Symptom

For BPPV occurring as a symptom of long COVID, canalith repositioning procedures (CRPs) are the recommended first-line treatment, with success rates of 80-96% after just 1-3 treatments. 1

Diagnosis

Before treatment, proper diagnosis is essential:

• Posterior canal BPPV: Diagnose when vertigo with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver 2
• Lateral canal BPPV: Perform supine roll test if Dix-Hallpike shows horizontal or no nystagmus 2

First-Line Treatment Options

For Posterior Canal BPPV:

1. Epley maneuver:

   • 90.7% success rate after initial maneuver
   • Increases to 96% after second attempt 1
   • Significantly more effective than no treatment (89% vs 10% improvement at 1 month) 3

2. Semont maneuver:

   • Comparable efficacy to Epley maneuver 4
   • May be preferred for patients with cervical spine limitations

For Lateral Canal BPPV:

1. Gufoni Maneuver: 93% success rate for geotropic type BPPV 1
2. Barbecue Roll Maneuver (Lempert): 75-90% effectiveness 1
   • Gufoni is easier to perform as it only requires identifying the side of weaker nystagmus 5

For Anterior Canal BPPV:

• Deep head hanging maneuvers are recommended, though evidence is weaker 5

Important Clinical Considerations

• Avoid medications: Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines 2
• No postural restrictions: Strong recommendation against postprocedural postural restrictions after canalith repositioning procedures 2
• Follow-up assessment: Patients should be reassessed within 1 month after treatment to document resolution or persistence of symptoms 2, 1
• Telehealth option: During pandemic conditions, teleconsultation and teletreatment are reasonable and feasible strategies for managing BPPV 6, 7

Self-administered Options

For patients unable to visit clinicians frequently:

• Self-administered Epley: 64% improvement rate 1
• Self-administered Semont: 58% resolution rate 1
• Brandt-Daroff exercises: 23% improvement rate (less effective than Epley) 1

Management of Treatment Failure

If symptoms persist:

1. Re-evaluate for correct BPPV canal variant diagnosis
2. Consider repeat CRP (successful in most cases that initially fail) 3
3. Evaluate for underlying peripheral vestibular or central nervous system disorders 2

Patient Education

Clinicians should educate patients about:

• Safety concerns related to BPPV
• Potential for disease recurrence (approximately 36%) 4
• Importance of follow-up 2, 1
• Keeping a symptom journal to track triggers and patterns 1

Vestibular Rehabilitation

• May be offered as a complementary treatment option 2
• Particularly beneficial for long-term outcomes and potentially decreasing recurrence rates
• More effective for elderly patients in preventing recurrence 2

By following this evidence-based approach, most patients with BPPV as a long COVID symptom can expect significant improvement or complete resolution of their vertigo symptoms.