From the Guidelines
Steroids are not a standard treatment for Benign Paroxysmal Positional Vertigo (BPPV). BPPV is best treated with specific repositioning maneuvers such as the Epley, Semont, or Brandt-Daroff exercises, which aim to move displaced calcium carbonate crystals (otoconia) from the semicircular canals back to the utricle where they belong. These physical maneuvers have high success rates of 70-80% after a single treatment session, as reported in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1. Steroids, whether oral or injectable, do not address the mechanical problem of displaced crystals that causes BPPV. In some cases, vestibular suppressant medications like meclizine (Antivert) may be prescribed for short-term symptom relief, but these don't treat the underlying cause either.
The diagnosis of BPPV is typically made through a combination of patient history and physical examination, including the Dix-Hallpike test and supine roll test, as outlined in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1. The guideline also recommends against the use of radiographic imaging, vestibular testing, or vestibular suppressant medications for the diagnosis and treatment of BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing 1.
Some key points to consider in the treatment of BPPV include:
- The use of repositioning maneuvers such as the Epley, Semont, or Brandt-Daroff exercises as the primary treatment for BPPV, with a high success rate of 70-80% after a single treatment session 1.
- The importance of patient education and shared decision making in the management of BPPV, as emphasized in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
- The need for reassessment and follow-up after initial treatment to confirm symptom resolution and to evaluate for potential underlying conditions that may be contributing to the patient's symptoms, as recommended in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
Overall, the treatment of BPPV should focus on addressing the underlying mechanical problem of displaced crystals, rather than relying on medications such as steroids. By using repositioning maneuvers and providing patient education and support, healthcare providers can help patients with BPPV to achieve symptom relief and improve their quality of life, as reported in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.
From the Research
Treatment of BPPV
- The primary evidence-based treatment strategy for BPPV is physical therapy through maneuvers, such as the Epley maneuver, Semont maneuver, and Gufoni's maneuver 2, 3, 4, 5.
- These maneuvers have been shown to be effective in treating posterior canal BPPV, with high success rates and low risk of adverse effects 6, 4, 5.
- The Epley maneuver, in particular, has been found to be associated with higher complete resolution of vertigo at 1 week and higher conversion to negative Dix-Hallpike at 1 week compared to control 4.
- There is no mention of steroids as a treatment for BPPV in the provided studies.
Steroids and BPPV
- None of the provided studies mention the use of steroids as a treatment for BPPV.
- The studies focus on physical therapy maneuvers, such as the Epley maneuver, as the primary treatment for BPPV 2, 3, 6, 4, 5.
- Therefore, there is no evidence to suggest that steroids are used to treat BPPV based on the provided studies.