Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal

Objective: To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV). Study Design: Prospective, randomized, sham-controlled. Patients: Patients (n = 124) with BPPV of the posterior semicircular canal. Setting: Tertiary care center. Interventions: Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later. Main Outcome Measures: Vertigo intensity and frequency. Results: Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period. Conclusion: LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.