From the Guidelines
The standard treatment for vertigo, specifically for Benign Paroxysmal Positional Vertigo (BPPV), is the canalith repositioning procedure, which involves a series of head movements to reposition displaced calcium crystals in the inner ear, as recommended by the American Academy of Otolaryngology—Head and Neck Surgery Foundation 1. This procedure has been shown to have a high success rate, with 90% to 98% of patients experiencing relief from symptoms after additional repositioning maneuvers are performed 1. The Epley maneuver is a type of canalith repositioning procedure that can be performed by a healthcare provider or taught for home use. Key points to consider in the treatment of vertigo include:
- Diagnosis of the underlying cause of vertigo, such as BPPV, Ménière's disease, or acute vestibular neuritis
- Use of the Dix-Hallpike test to diagnose posterior semicircular canal BPPV
- Performance of the Epley maneuver or other canalith repositioning procedures as first-line treatment for BPPV
- Consideration of vestibular rehabilitation therapy for persistent vertigo
- Avoidance of routine use of vestibular suppressant medications such as antihistamines and/or benzodiazepines for BPPV treatment 1
- Patient education on the impact of BPPV on safety, potential for disease recurrence, and importance of follow-up 1. It is essential to note that the treatment of vertigo should be individualized based on the underlying cause and patient-specific factors, and that the canalith repositioning procedure is not suitable for all types of vertigo. In cases where the Epley maneuver is not effective, other treatment options such as vestibular rehabilitation therapy or surgical interventions may be considered 1.
From the Research
Standard Treatment for Vertigo
The standard treatment for vertigo typically involves a combination of approaches, including:
- Vestibular rehabilitation therapy (VRT) 2, which is an exercise-based treatment program designed to promote vestibular adaptation and substitution
- Canalith repositioning procedure (CRP) 3, 4, 5, 6, a maneuver technique used to treat benign paroxysmal positional vertigo (BPPV)
- Vestibular rehabilitation exercises 3, 4, 6, which can be used in addition to CRP to improve symptoms and reduce recurrence
Key Components of Vestibular Rehabilitation Therapy
The key components of VRT include:
- Head-eye movements with various body postures and activities 2
- Maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks 2
- Repeating the movements provoking vertigo 2
- Exposing patients gradually to various sensory and motor environments 2
Effectiveness of Vestibular Rehabilitation
Studies have shown that vestibular rehabilitation can be effective in improving symptoms and reducing recurrence in patients with BPPV 3, 4. However, the evidence is inconsistent, and some studies have found no significant difference in vertigo intensity between groups 5, 6. Additionally, vestibular rehabilitation may have a synergic effect with CRP, especially in elderly patients 3.