From the Guidelines
The best treatment for benign paroxysmal positional vertigo (BPPV) is the canalith repositioning procedure, specifically the Epley maneuver, as it has been shown to be highly effective in resolving symptoms. This recommendation is based on the strongest and most recent evidence, including a clinical practice guideline update from the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1. The Epley maneuver is a repositioning technique that moves displaced calcium crystals in the inner ear back to their proper location, and it can be performed by a healthcare provider or taught for home use.
Key Points
- The Epley maneuver is a highly effective treatment for BPPV, with a strong recommendation from the clinical practice guideline update 1.
- Vestibular rehabilitation therapy may also be offered as an option for the treatment of BPPV, based on controlled observational studies and a balance of benefit and harm 1.
- Medical therapy, such as vestibular suppressant medications, is not recommended as a routine treatment for BPPV, as it has been shown to be ineffective in resolving symptoms 1.
- Education and counseling are important components of BPPV treatment, as they can help patients understand the condition and its management, and reduce the risk of recurrence 1.
Treatment Approach
The treatment approach for BPPV should prioritize the use of the Epley maneuver, with vestibular rehabilitation therapy offered as an option. Medical therapy should be avoided, and education and counseling should be provided to all patients. The goal of treatment is to resolve symptoms and improve quality of life, while minimizing the risk of recurrence and adverse events. As stated in the clinical practice guideline update, clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure 1.
From the Research
Treatment Options for Benign Paroxysmal Positional Vertigo (BPPV)
- The Epley maneuver is a widely recognized and effective treatment for BPPV, with studies showing its superiority over sham maneuvers or control groups 2, 3, 4, 5.
- Other particle repositioning maneuvers, such as the Semont and Gans maneuvers, have also been shown to be effective in treating BPPV, although the evidence is not as strong as for the Epley maneuver 2, 5.
- Betahistine has been investigated as an add-on therapy to the Epley maneuver, with some studies suggesting its potential benefit in improving outcomes for BPPV patients 6.
- Surgical canal plugging may be considered in selected cases of intractable BPPV, although this is typically reserved for severe cases that do not respond to other treatments 2.
Efficacy of the Epley Maneuver
- Studies have consistently shown that the Epley maneuver is effective in resolving vertigo symptoms and converting a positive Dix-Hallpike test to a negative result 3, 4, 5.
- The Epley maneuver has been shown to be safe, with few adverse effects reported, although some patients may experience nausea or be unable to tolerate the maneuver due to cervical spine problems 4, 5.
- The recurrence rate of BPPV after treatment with the Epley maneuver is relatively high, at around 36% 5.
Comparison of Treatment Options
- The Epley maneuver has been compared to other treatment options, including sham maneuvers, other particle repositioning maneuvers, and control groups 4, 5.
- The evidence suggests that the Epley maneuver is superior to sham maneuvers and control groups, and comparable to other particle repositioning maneuvers such as the Semont and Gans maneuvers 5.
- The Epley maneuver has been shown to be more effective than Brandt-Daroff exercises in one study 5.