Efficacy of Postural Restriction in Treating Benign Paroxysmal Positional Vertigo

Abstract

To investigate the efficacy of postural restriction after canalith repositioning in treating benign paroxysmal positional vertigo (BPPV).Design: Prospective trial of patients with postural restriction vs those without postural restriction after treatment.Patients: Patients with classic BPPV and with BPPV without nystagmus were treated using the modified Epley canalith repositioning procedure. Patients were randomly separated into 2 groups. The first group was instructed to wear a cervical collar and to maintain an upright head position for 2 days. The second group had no motion restriction. After 5 days, the patients were followed up and evaluated using the Dix-Hallpike test.Results: In the first group, 56 of 62 ears healed after the first maneuver, and the remaining ears healed after the second. In the second group, 45 of 57 ears healed after the first maneuver, 6 after the second, and 5 (with subsequent postural restriction) after the third (1 ear did not improve). Five patients in the first group and 3 patients in the second group had BPPV without nystagmus; all of these patients healed after a single maneuver. The difference between the 2 groups in the number of maneuvers required for treatment was statistically significant (PϽ.05). The number of patients who required a third maneuver was significantly higher in the second group (PϽ.05). Conclusions:Postural restriction enhances the therapeutic effect of canalith repositioning in the treatment of posterior semicircular canal BPPV. The long-term efficacy of postural restriction in preventing BPPV recurrence has not been demonstrated.

Are Postural Restrictions Necessary for Management of Posterior Canal Benign Paroxysmal Positional Vertigo?

“…[10][11][12][13][14][15][16] An important component of the management of BPPV has been the application of postural restrictions after a CRM to prevent the return of otolithic debris into the PSC. 17 Patients are instructed to adhere to postural restrictions for some days. They are to avoid head and trunk movements and are asked to sleep in a semi-seated position with the head inclined at 45° from the horizontal plane for 2 days.…”

“…[17][18][19] The present study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC.…”

Understanding benign paroxysmal positional vertigo: the management of lateral canal involvement

“…28 We found that postural restrictions do not enhance the beneficial effects of physical treatment with manoeuvres. 29 There is no statistical evidence that restrictions have any role in preventing recurrences, but they often cause neck stiffness, so for these reasons, we do not recommend any restriction to our patients.…”

The Influence of Sleep Position on Benign Paroxysmal Positional Vertigo

“…However, Cakir et al reported that such postural restrictions enhanced the effect of canalith repositioning, when the posterior semicircular canal is involved, especially in resistant cases [16]. This recent prospective study came to a conclusion that seems to be in controversy with all other similar studies.…”