Randomized trial of the canalith repositioning procedure

Abstract

Thirty-six subjects with confirmed, unilateral benign paroxysmal positioning vertigo of at least 2 months' duration were randomly assigned to one of two treatment groups. After complete informational counseling and explanation of the posttreatment instructions, subjects were randomly assigned to receive either Epley's canalith repositioning procedure or a placebo maneuver. All subjects completed a daily diary for 1 month to document any dizzy spells and their adherence to the posttreatment instructions. Follow-up Dix-Hallpike testing was performed after 1 month by an audiologist who was blinded to the patient's treatment group status. Analysis of Dix-Hallpike results confirmed that those who received the canalith repositioning procedure had significantly more negative responses (88.9%) than did those in the placebo group (26.7%).

Quantas manobras são necessárias para abolir o nistagmo na vertigem posicional paroxística benigna?

“…The index of spontaneous remission found in Lynn et al 24 was of 27%. According to Vrabec 9 , there may be spontaneous resolution of BPPV by absorption of statoconia, but the factors responsible for induction or prevention are very poorly known.…”

Restrições posturais não interferem nos resultados da manobra de reposição canalicular

“…Even considering the possibility of self-resolution when treated with canalith repositioning maneuver, BPPV progresses better in the first month after the procedure, a fact that benefits patients and minimizes the duration of symptomatology 1,18,25,28,40,43 . However, the performance of the maneuver does not show substantial benefits in the long-term follow-up, between 3 and 6 months, nor in relation to the possibility of recurrence, which seems to be more related with etiology of vestibular affections that are associated with BPPV than to the symptomatic treatment adopted 18,44,45 .…”

“…Among the care recommended, he suggested sleeping in a seated position or with 45 o elevation of the head for 48 hours after the maneuvers. Other authors 27,28 , who were stricter, recommended elevated head for 7 days after the maneuver, period in which sudden head movements and those that triggered dizziness would be avoided; not to sleep over the affected ear, and not to look up or down 29 . There were still others that instructed patients to wear a neck collar to prevent head movements 24,30,31 , a procedure not followed in our service owing to previous studies that suggested that neck collar and bone vibrator did not interfere in the outcomes of treatment 5,44 .…”

“…Among them, there are recommendations to sleep sitting up or with head inclination of 45 º (reclined armchair or the use of 2 pillows) for 48 hours after the maneuver. Some studies 5,28 recommend elevated lying down position after the maneuver for 7 days, period in which the patient should avoid sudden movements and those that trigger dizziness, not to sleep over the affected ear, and not to look up or down 29 . Some authors suggest that patients should wear a neck collar to prevent head movements 24,30,31 .…”

Collar Fixation as a Management Tool for Posterior Canal BPPV: Is it of Value

“…• Post-maneuver instructions (These instructions include avoidance of quick head movements or lying on the pathologic side, keeping the neck erect, sleeping at a 45° angle [15]). …”