Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial

Abstract

IntroductionBenign paroxysmal positional vertigo (BPPV) is recognised as the leading cause of peripheral vertigo in adults. The canalith repositioning procedure (CRP) can be used for effective treatment of BPPV. However, some patients experience residual dizziness (RD) even after successful CRP, resulting in a significant negative impact on their daily function and quality of life. Exercise-based vestibular rehabilitation (VR) has been proven as an effective method for managing dizziness and has been applied in patients with various vestibular disorders. However, the efficacy of VR to specifically target RD post-BPPV is unknown. This study aims to investigate the efficacy of VR, compared with betahistine or VR plus betahistine treatment, in the treatment of patients experiencing RD after successful CRP.Methods and analysisA randomised single-blinded controlled trial will be carried out to determine the efficacy of VR compared with betahistine or VR plus betahistine treatment in mitigating RD and improving balance function. Patients with BPPV who experience RD after successful CRP will be recruited. Participants will be randomised into one of three groups to receive VR, betahistine or VR plus betahistine. There will be 61 participants in each group. The primary outcomes will be changes in the patient’s daily function as measured by the Vestibular Activities and Participation questionnaire and balance ability assessed by computerised dynamic posturography. The secondary outcomes will be dizziness-related handicap, otolith function and duration of RD symptoms. Outcome measures will be noted at baseline and at 2, 4 and 8 weeks post-randomisation. This study has the potential to reduce unnecessary anti-vertigo drug prescriptions and may lead to a general consensus regarding the use of VR as a first-line treatment for RD in patients with BPPV.Ethics and disseminationThis trial received ethical approval from the Institutional Review Board of Eye and ENT Hospital of Fudan University (reference number 2017046). The study results will be disseminated via peer-reviewed journals and conferences.Trial registration numberNCT03624283; Pre-results.

Recovery of Regular Daily Physical Activities Prevents Residual Dizziness after Canalith Repositioning Procedures

“…Although RD is mostly a self-limiting condition, patients can sometimes develop enough discomfort and disabling symptoms to require physical treatment and vestibular rehabilitation, in combination with medications if needed [ 31 ].…”

“…Several medications have been proposed to approach RD, but nothing has yet been proven to provide relief for this disorder compared to placebo [ 13 ]. Albeit with conflicting results, the most commonly used molecule to approach RD is betahistine [ 22 , 24 , 31 ]. According to a randomized controlled trial, dimenhydrinate is a vestibular suppressant that could help prevent RD.…”

“…Vestibular rehabilitation has been developed to treat patients with chronic vestibular symptoms through a tailored exercise-based program. Vestibular rehabilitation, thanks to the development of vestibular habituation, adaptation, and substitution to enhance gaze and postural stability, is proven to improve daily functional performance [ 31 , 33 ].…”

Expert opinions regarding neuro-microcirculatory, vestibular and labyrinthine dynamics in benign paroxysmal positional vertigo

“…RD is associated with significant anxiety, disabling dizziness even after the resolution of the acute vertigo and in the absence of otolithic or vestibular dysfunction. 1 The cause of RD remains unknown, but it has been proposed that otolith dysfunction or co-existing vestibular disease may lead to incomplete central adaptation. The movement of otoconia, returning to the utricle, has also been postulated to be the cause of RD after CRP.…”

“…The reported prevalence of BPPV is about 10.7-64 per 1,00,000 people, and BPPV has a lifetime prevalence of 2.4%. 1 A multicenter study conducted in India reported that BPPV accounted for a considerable percentage of the overall burden of vertigo. It was reported that peripheral causes were predominant in majority of patients (74%), with BPPV being the most frequent (68%).…”