Modified Particle Repositioning Procedure

Abstract

Objectives: To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo. Study Design: Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal-repositioning techniques. Methods: Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360°along their longitudinal axis and head shaking on reaching each single position were evaluated. Results: Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360°along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) (P ‫؍‬ .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head-shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver (P ‫؍‬ .00011). Conclusions: The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head-shaking.

Benign Positional Vertigo Without Detectable Nystagmus

“…Complete recovery rates obtained by executing a repositioning maneuver in patients with BPPV without nystagmus are good (60.46%) if compared with results obtained in our study comprising BPPV with typical nystagmus (90%). 7 In light of these considerations, the incidence of BPPV is probably far higher than previously thought. In cases of failure to make a complete recovery (39.53% [17/43]) the repositioning maneuver has never been repeated because only preliminary data are available and preference has been given to seeking other possible causes of vertigo and excluding other concomitant diseases.…”

“…All 43 patients whose anamnesis reported the typical symptomology of dizziness or vertigo resulting from BPPV or the occurrence of symptoms of dizziness or vertigo during the positional and positioning tests even if a positional nystagmus was never evident, or both of these, underwent our modified canal repositioning maneuver for treatment of cupolo‐canalolithiasis of the PSC. 7 Involvement of a horizontal semicircular canal was excluded on the basis of the anamnesis and evaluation of the positions that triggered symptoms of vertigo.…”

“…In comparison with traditional repositioning maneuvers our maneuver was modified by dividing the procedure into seven positions and rotating the supine patient by 360° along the longitudinal axis and sagittal plane; on reaching each single position, head shaking was carried out. 7 …”

High-Resolution Three-Dimensional Magnetic Resonance Imaging of the Vestibular Labyrinth in Patients with Atypical and Intractable Benign Positional Vertigo

“…For this reason specific bedside maneuvers have been developed. Their purpose is to disperse the debris within the labyrinth (Brandt-Daroff exercises [1,16], liberatory maneuver of Semont [20,21]) or to relocate the particles floating within the canal back to the utricle through a sequence of head movements (canalith repositioning maneuvers [22][23][24][25][26]). In most cases there is a high success rate and instant and long-lasting relief.…”

Efficacy of Postural Restriction in Treating Benign Paroxysmal Positional Vertigo

“…Other authors perform the maneuver only once per session. 12,[14][15][16][17][18][19] We used a single maneuver per session to avoid patient fatigability and to minimize reentry of otoconial debris into the posterior SCC.…”