No more postural restrictions in posterior canal benign paroxysmal positional vertigo

Objective: To establish if postural restrictions are useful after repositioning maneuvers in posterior canal benign paroxysmal positional vertigo (BPPV). Study Design: Prospective double-blind consecutive case study. Setting: This study was conducted at a tertiary referral hospital. Patients: Three hundred ninety-one consecutive patients diagnosed of posterior canal BPPV with a positive Dix-Hallpike test. Intervention: Two hundred seven patients diagnosed during the first year of our study were instructed to follow postural restrictions after repositioning maneuvers, and 184 patients who were diagnosed in the second year of our study did not receive any postural restriction after treatment. All of them were reevaluated 10 days later, and they were followed up until their symptoms resolved. Main Outcome Measures: We compared the success rates of each treatment analyzing the number of maneuvers needed until symptoms resolved, recurrence rate, and subjective recovery at the end of treatment between both groups. Results: There were no statistical differences in number of maneuvers needed to resolve symptoms between patients who restricted their movements (80.2% of success with 1 maneuver) and those who did not (72.3%). Recurrence rate was not statistically different among groups (2.3 and 3.1%), and almost all patients declared to feel better after treatment in both groups (97.1 and 98.9%). Conclusion: Efficacy of Epley maneuver is not improved by postural restrictions. Therefore, we do not recommend any postural restrictions to patients with posterior canal BPPV.