Physical treatment of benign paroxysmal positional vertigo

Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs

OBJECTIVE

To determine the longitudinal relationship between beliefs about the consequences of dizziness and handicap levels in dizzy patients, and the effect of therapy on beliefs.

METHODS

Symptoms, beliefs, and handicap were assessed at baseline and 6 months follow up in 76 primary care patients complaining of dizziness or vertigo, of whom 33 were assigned to treatment (i.e., vestibular rehabilitation).

RESULTS

At baseline most patients believed that dizziness would have negative consequences such as falling, fainting, or losing control. Handicap levels at follow-up were predicted by baseline beliefs that dizziness would have negative consequences. Significant reduction in negative beliefs at follow-up was observed in the patients who received treatment, whereas there was no reduction in negative beliefs in the untreated patients.

CONCLUSIONS

Negative beliefs about the consequences of dizziness sustain long-term restriction of activity, and can be modified by therapy.

Efficacy of treatments for posterior canal benign paroxysmal positional vertigo

OBJECTIVE

This study was performed to determine the relative effectiveness of several passive head maneuvers for treating benign paroxysmal positional vertigo.

STUDY DESIGN

This prospective study used 87 subjects diagnosed by their physicians with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal.

METHODS

Subjects were randomly assigned to three treatment groups: modified Epley maneuver, modified Epley maneuver with augmented head rotations, and modified Semont maneuver. They were interviewed 1 week after receiving one maneuver. If subjects desired further treatment, they were treated again with the same maneuver, a methodology repeated until subjects desired no further treatment; they were telephoned 3 and 6 months after the last treatment.

RESULTS

The groups did not differ significantly, but subjects decreased significantly on vertigo intensity and frequency and improved significantly on independence in activities of daily living. Before treatment, tasks requiring pitch rotations of the head induced vertigo; common comorbid conditions were osteoporosis, cervical spine problems, and head trauma.

CONCLUSIONS

These data suggest that augmented head rotations are unnecessary and that the modified Epley and Semont maneuvers are equally effective in the remediation of vertigo in this population.

A review of management of benign paroxysmal positional vertigo by exercise therapy and by repositioning manoeuvres

Benign paroxysmal positional vertigo (BPPV) is a common condition that often resolves spontaneously, but can cause significant distress to a patient. Management of this condition includes no intervention, medication, surgery, physical exercises and more recently 'particle repositioning' manoeuvres. Repositioning manoeuvres aim to relocate free-floating particles from the posterior semicircular canal into the utricle where they will no longer cause vertiginous symptoms. This article describes the different exercises and repositioning manoeuvres in use and examines their efficacy. In the light of this review a management strategy for BPPV is suggested.