Dizziness is one of the most common medical complaints affecting older adults, with10-20 percent of such complaints resulting from Benign Paroxysmal Positional Vertigo (BPPV). Many research studies have stated that without medical treatment, some 30 percent of BPPV patients will recover on their own. Now, a new evidence-based review has found that a single ten minute in-office treatment, based on a series of head and body turns, is highly effective in resolving this disorder, with an overall effectiveness of 70-80 percent.
Benign Paroxysmal Positional Vertigo is thought to develop when crystalline particles of calcium carbonate and a protein in the inner ear break off and float into the delicate nerves that sense position. Approximately 94 percent of BPPV cases involve particles in the posterior semicircular canal. This causes a sensation of spinning (vertigo) during certain changes in head and body position such as lying back, bending over, arising quickly or turning in bed. The vertigo usually lasts about a minute. This disorder affects the ability to control our balance and is a risk factor for falls, the leading cause of morbidity and mortality in older adults. The cause of BPPV is usually unknown but the condition can occur after head trauma or in association with other ear disorders such as vestibular neuritis or labyrinthitis.
Initially, BPPV treatments were exercise-based and emphasized compensation and habituation. In the last 15 years, specific body repositioning maneuvers have evolved and are now the standard of treatment for this disorder. These include the Semont, Epley, and the particle repositioning maneuvers, the latter of which is a modified Epley maneuver without mastoid vibration. A commonly used term for the modified Epley maneuver is “Canalith Repositioning Maneuver.”
All of the maneuvers can be performed in the office within approximately ten minutes. At the start of a typical treatment session, a patient is placed in a side lying position. The physician then guides them through a series of specific head and body maneuvers designed to affect flow of inner ear fluid in the posterior canal. During these maneuvers, the patient is moved from the affected side to the unaffected side and is then returned to a sitting position.
The effectiveness of the “Canalith Repositioning Maneuver” has been addressed in some research studies but the findings were often based on anecdotal information. A new evidenced-based research effort set out to evaluate the efficacy of Canalith Repositioning Maneuvers (Semont, Epley and modified maneuvers) in the treatment of posterior canal benign paroxysmal positional vertigo (BPPV) and compared the resolution rate in an untreated control cohort.
The authors of “Canalith Repositioning for Benign Paroxysmal Positional Vertigo: An Evidence- Based Review,” are Judith White MD PhD, Neil Cherian MD, and John Oas MD, all from the Cleveland Clinic, Cleveland, OH; and Panos Savvides MD PhD MPH, at University Hospital, Case Western Reserve School of Medicine, Cleveland, OH. Their findings are being presented at the annual meeting of the American Neurotology Society http://www.otology-neurotology.org/ANS/ans-main.html being held May 1, 2004, at the JW Marriott Desert Ridge Resort & Spa, Phoenix, AZ.
Methodology Evidence-based research encompasses a variety of data sources and methods.
The researchers reviewed 84 published studies, conducted an electronic Medline search, perused references from identified primary review articles, controlled trials and case reports, interviewed colleagues, and examined selected meeting abstract reviews.