The American Academy of Neurology & Neurology (the journal) Offer Evidence-Based Analysis of BPPV Treatment
T.D. Fife MD (Barrow Neurological Institute and the University of Arizona College of Medicine) and colleagues* authored a new article titled "Practice Parameter: Therapies for Benign Paroxysmal Positional Vertigo (BPPV) - An Evidence Based Review" in the journal Neurology (May 27, 2008). The authors review and analysis is based on 925 articles published between 1966 and 2006. Fife et al define BPPV as having brief recurrent episodes of vertigo triggered by changes in head position with respect to gravity. They note BPPV is the most common cause of recurrent vertigo. BPPV can originate within any of the three semicircular canals (SCCs) but typically the posterior canal is the culprit. BPPV results when calcium carbonate crystals (otoliths) move about creating disturbances within the endolymph. The authors state the most common BPPV event occurs when the otoliths responding to gravity and fall/float from the macula of the utricle into the lumen of the posterior SCC. These displaced/ectopic optoliths are referred to as canaliths. The signs and symptoms of BPPV are elicited when the affected SCC is positioned vertically, allowing the canalith to fall/float, disrupting the inner ear's delicate balance, initiating vertigo and nystagmus. Repositioning maneuvers are thought to work by allowing the canaliths to leave (fall from) the SCC and relocate into the vestibule, where they are absorbed. The authors review quality ratings and outcomes for multiple repositioning techniques and they offer their findings and recommendations. Additionally, a "Summary of Evidence-Based Guidelines for Clinicians" on the specific topic of "Therapies for Benign Paroxysmal Positional Vertigo" has been published by the American Academy of Neurology, also in Neurology, 2008. The guidelines state there is strong evidence for the canalith repositioning procedure (CRP) as an effective and safe therapy and they state it should be offered to patients of any age diagnosed with posterior canal BPPV. Other therapies (Brandt-Daroff exercises, habituation exercises, self-administered treatment, medical treatment) did not do as well, as often. The Guidelines state there is only weak evidence to support mastoid oscillation/vibration and the protocol likely adds little to posterior canal BPPV treatment. The Guidelines also state there is insufficient evidence to support post-maneuver restrictions for patients treated with CRP.
* Authors: Fife, T.D., Iverson D.J., Lempert, T, Furman J,M., Baloh, R.W., Tusa R.J., Hain T.C., Herdman, S., Morrow, M.J. and Gronseth, G.S.
For More Information, References and Recommendations:
Neurology 70 May 27, 2008 (Part 1 of 2)
Demonstration of canalith repositioning http://www.msnbc.msn.com/id/21134540/vp/24781391#24781391