From the Guidelines
Benign Paroxysmal Positional Vertigo (BPPV) should be treated with a canalith repositioning procedure, such as the Epley maneuver, as initial therapy, as it has a high success rate of around 80% with only 1-3 treatments 1.
Treatment Overview
The treatment of BPPV involves a series of head position changes that help relocate displaced otoconia crystals in the inner ear.
- The Epley maneuver is a commonly used technique for treating BPPV, which involves a series of specific head and body movements to help relocate the crystals.
- The procedure is typically performed by a healthcare professional, but patients can also be taught to perform self-repositioning maneuvers with supervision.
- The goal of treatment is to guide the crystals back to their original location in the inner ear, which can help alleviate symptoms of vertigo and dizziness.
Diagnosis and Treatment Considerations
- Diagnosis of BPPV is typically made through a combination of patient history, physical examination, and bedside testing, such as the Dix-Hallpike test or supine roll test 1.
- The Dix-Hallpike test involves quickly laying the patient back with their head turned 45 degrees to one side and watching for nystagmus and vertigo symptoms.
- Treatment with a canalith repositioning procedure is generally recommended as initial therapy for patients with posterior canal BPPV, as it has a high success rate and is a relatively simple and non-invasive procedure 1.
- Vestibular rehabilitation may also be offered as an option for patients with BPPV, although the evidence for its effectiveness is based on controlled observational studies and a balance of benefit and harm 1.
Important Considerations
- Patients with severe disabling symptoms, a history of falls or fear of falling, or difficulty moving around may require more intensive treatment and monitoring.
- Seniors are at higher risk for injury from falls and should seek professional help quickly to help resolve symptoms.
- Patients should be educated on the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up.
From the Research
Treatment Options for Benign Paroxysmal Positional Vertigo (BPPV)
- The Epley manoeuvre is a safe and effective treatment for posterior canal BPPV, with a high success rate in resolving vertigo symptoms 2.
- The Epley manoeuvre is comparable to other particle repositioning manoeuvres, such as the Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises 2.
- A practical approach for emergency physicians involves performing a bedside test (Dix-Hallpike test) and treating patients with a bedside positional (Epley) manoeuvre, which can reduce resource utilization and improve patient-centered outcomes 3.
- Canalith repositioning manoeuvres, including the Epley, Semont, and Gufoni's manoeuvres, are level 1 evidence treatments for BPPV, with the choice of manoeuvre depending on the clinician's preferences, failure of previous manoeuvres, or movement restrictions of the patient 4.
Assessment and Treatment Nuances
- Repeated testing and treatment of BPPV within the same session is a safe and effective approach, with a low risk of canal conversion 5.
- Vertigo and nystagmus throughout the Epley manoeuvre are not indicative of treatment success, and clinicians should remain vigilant for post-treatment otolithic crisis 5.
- The Epley manoeuvre can be used as an office-based treatment for BPPV, with a high success rate in resolving symptoms 6.
Key Findings
- The Epley manoeuvre is an effective treatment for BPPV, with a high success rate in resolving vertigo symptoms 2, 6.
- A practical approach for emergency physicians involves performing a bedside test and treating patients with a bedside positional manoeuvre 3.
- Canalith repositioning manoeuvres are level 1 evidence treatments for BPPV, with the choice of manoeuvre depending on various factors 4.
- Repeated testing and treatment of BPPV within the same session is a safe and effective approach, with a low risk of canal conversion 5.