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Benign Positional Paroxysmal Vertigo Treatment: a Practical Update

  • Neurologic Ophthalmology and Otology (RK Shin and DR Gold, Section Editors)
  • Published:
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Abstract

Purpose of the review

To define the best up-to-date practical approach to treat benign paroxysmal positional vertigo (BPPV).

Recent findings

Both posterior and horizontal canal BPPV canalith repositioning maneuvers (Semont, Epley, and Gufoni’s maneuvers) are level 1 evidence treatment for evidence-based medicine. The choice of maneuver (since their efficacy is comparable) is up to the clinician’s preferences, failure of the previous maneuver, or movement restrictions of the patient. Maneuvers for controversial variants, such as anterior canal and apogeotropic posterior canal BPPV, have weaker evidence of efficacy. Despite this, these variants are increasingly diagnosed and treated. Maneuvers also play a role in the differential diagnosis with central vestibular disorders. Chair-assisted treatment may be of help if available while surgical canal plugging should be indicated in selected same-canal, same-side intractable severe BPPV.

Summary

The primary evidence-based treatment strategy for BPPV should be physical therapy through maneuvers. Despite the high success rate of liberatory maneuvers, there is a low percentage of subjects who have unsatisfactory outcomes. These patients need to be investigated to identify recurrences, multiple canal involvement, associated comorbidities (migraine, persistent postural perceptual dizziness), or risk factors for recurrences (low vitamin D serum level). Future research should also identify the optimum maneuvers for variants whose diagnosis and treatment are still a matter of some debate.

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Acknowledgments

The scientific illustrator Stefano Ricci, Department of Physical, Earth and the Environmental sciences, R.U. of Prehistory and Anthropology, University of Siena realized the figures.

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  1. Otolaryngology Department, University of Siena, Azienda Ospedaliera Universitaria Senese, V.le Bracci, 11, 53100, Siena, Italy

    Marco Mandalà MD, PhD, Lorenzo Salerni MD, PhD & Daniele Nuti MD

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  1. Marco Mandalà MD, PhD
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  2. Lorenzo Salerni MD, PhD
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Correspondence to Marco Mandalà MD, PhD.

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Mandalà, M., Salerni, L. & Nuti, D. Benign Positional Paroxysmal Vertigo Treatment: a Practical Update. Curr Treat Options Neurol 21, 66 (2019). https://doi.org/10.1007/s11940-019-0606-x

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