Skip to main content
SpringerLink
Log in

An Effective Home-Based Particle Repositioning Procedure for Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV)

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Patients with benign paroxysmal positional vertigo (BPPV) find it difficult to visit the hospital many times for a standard Epley’s maneuver performed only by a specialist. The aim of this study was to compare the efficacy of a home-based particle repositioning procedure (HBPRP) with the standard Epley’s maneuver in treating patients with posterior canal BPPV. A prospective non-blinded randomized controlled study was conducted. Patients were randomized into two groups, where one group received the standard treatment and other received a new HBPRP. The vertigo scale, duration of nystagmus during Dix-Hallpike test and frequency of vertigo, were documented on first, second and third visits, with complications noted during the second and third visits. These parameters were compared between both the groups following the treatment, during all visits. The patients were randomized into 2 arms with 15 each. Those belonging to group 1 received Epley’s maneuver and group 2 received HBPRP. There was no significant difference in the baseline characteristics of patients in both groups. Both groups of patients had significant improvement of symptoms at the end of the study. A comparison of both groups at 2nd and 3rd visits showed no differences in frequency of vertigo, reduction in vertigo scale and duration of nystagmus following Dix-Hallpike test between both groups. HBPRP is a safe and effective procedure and can be taught as a home-based treatment for patients diagnosed with posterior canal BPPV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S et al (2008) Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 139(5_supp):47–81. https://doi.org/10.1016/j.otohns.2008.08.022

    Article  Google Scholar 

  2. Froehling DA, Bowen JM, Mohr DN, Brey RH, Beatty CW, Wollan PC et al (2000) The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clin Proc 75(7):695–700. https://doi.org/10.4065/75.7.695

    Article  CAS  Google Scholar 

  3. Parnes LS, Agrawal SK, Atlas J (2003) Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 169(7):681–693 (PMID: 14517129; PMCID: PMC202288)

    Google Scholar 

  4. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al (2006) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78(7):710–715. https://doi.org/10.1136/jnnp.2006.100420

    Article  Google Scholar 

  5. Lynn S, Pool A, Rose D, Brey R, Suman V (1995) Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg 113(6):712–720. https://doi.org/10.1016/s0194-5998(95)70010-2

    Article  CAS  Google Scholar 

  6. Burton MJ, Eby TL, Rosenfeld RM (2012) Extracts from the cochrane library: modifications of the Epley (Canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 147(3):407–411. https://doi.org/10.1177/0194599812457134

    Article  Google Scholar 

  7. Gaur S, Awasthi SK, Bhadouriya SKS, Saxena R, Pathak VK, Bisht M (2015) Efficacy of Epley’s maneuver in treating BPPV patients: a prospective observational study. Int J Otolaryngol 2015:487160. https://doi.org/10.1155/2015/487160

    Article  Google Scholar 

  8. Moon SY, Kim JS, Kim B-K, Kim JI, Lee H, Son S-I et al (2006) Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study. J Korean Med Sci 21(3):539. https://doi.org/10.3346/jkms.2006.21.3.539

    Article  Google Scholar 

  9. Nuti D, Mandalà M, Salerni L (2009) Lateral Canal Paroxysmal Positional Vertigo Revisited. Ann N Y Acad Sci 1164(1):316–323. https://doi.org/10.1111/j.1749-6632.2008.03720.x

    Article  Google Scholar 

  10. Yetiser D, Ince D (2015) Demographic analysis of benign paroxysmal positional vertigo as a common public health problem. Ann Med Health Sci Res 5(1):50. https://doi.org/10.4103/2141-9248.149788

    Article  CAS  Google Scholar 

  11. Hornibrook J (2011) Benign paroxysmal positional vertigo (BPPV): history, pathophysiology, office treatment and future directions. Int J Otolaryngol 2011:835671. https://doi.org/10.1155/2011/835671

    Article  Google Scholar 

  12. Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 45(6):341–354. https://doi.org/10.1177/003591575204500604

    Article  CAS  Google Scholar 

  13. Davies RA, Luxon LM (1995) Dizziness following head injury: a neuro-otological study. J Neurol 242(4):222–230. https://doi.org/10.1007/BF00919595

    Article  CAS  Google Scholar 

  14. Balatsouras DG, Koukoutsis G, Aspris A, Fassolis A, Moukos A, Economou NC et al (2017) Benign paroxysmal positional vertigo secondary to mild head trauma. Ann Otol Rhinol Laryngol 126(1):54–60. https://doi.org/10.1177/0003489416674961

    Article  Google Scholar 

  15. Balatsouras DG, Koukoutsis G, Ganelis P, Economou NC, Moukos A, Aspris A et al (2014) Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol 271(5):919–924. https://doi.org/10.1007/s00405-013-2484-2

    Article  Google Scholar 

  16. Yetiser S (2020) Review of the pathology underlying benign paroxysmal positional vertigo. J Int Med Res 48(4):0300060519892370. https://doi.org/10.1177/0300060519892370

    Article  Google Scholar 

  17. Martens C, Goplen FK, Aasen T, Gjestad R, Nordfalk KF, Nordahl SHG (2020) Treatment of horizontal canal BPPV—a randomized sham-controlled trial comparing two therapeutic maneuvers of different speeds. Laryngoscope Investig Otolaryngol 5(4):750–757. https://doi.org/10.1002/lio2.420

    Article  Google Scholar 

  18. West N, Hansen S, Møller MN, Bloch SL, Klokker M (2016) Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Otorhinolaryngol 273(3):573–580. https://doi.org/10.1007/s00405-015-3583-z

    Article  Google Scholar 

  19. Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107(3):399–404. https://doi.org/10.1177/019459989210700310

    Article  CAS  Google Scholar 

  20. Semont A, Freyss G, Vitte E. Curing the BPPV with a Liberatory Maneuver. In: Barany Society, Pirodda E, editors. Advances in Oto-Rhino-Laryngology [Internet]. S. Karger AG; 1988 [cited 2021 Aug 17]. p. 290–3. Available from: https://www.karger.com/Article/FullText/416126. https://doi:https://doi.org/10.1159/000416126

  21. Amor-Dorado JC, Barreira-Fernández MP, Aran-Gonzalez I, Casariego-Vales E, Llorca J, González-Gay MA (2012) Particle repositioning maneuver versus brandt-daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome. Otol Neurotol 33(8):1401–1407. https://doi.org/10.1097/MAO.0b013e318268d50a

    Article  Google Scholar 

  22. Prim-Espada MP, De Diego-Sastre JI, Pérez-Fernández E (2010) Meta-analysis on the efficacy of Epley’s manoeuvre in benign paroxysmal positional vertigo. Neurología (English Edition) 25(5):295–299. https://doi.org/10.1016/S2173-5808(10)70056-0

    Article  CAS  Google Scholar 

  23. Herdman SJ, Tusa RJ, Zee DS, Proctor LR, Mattox DE (1993) Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 119(4):450–454. https://doi.org/10.1001/archotol.1993.01880160098015

    Article  CAS  Google Scholar 

  24. Teixeira LJ, Machado JNP (2006) Maneuvers for the treatment of benign positional paroxysmal vertigo: a systematic review. Braz J Otorhinolaryngol 72(1):130–138. https://doi.org/10.1016/s1808-8694(15)30046-x

    Article  Google Scholar 

  25. Gans RE, Harrington-Gans PA (2002) Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning maneuver and semont liberatory maneuver in 376 patients. Semin Hear 23(2):129–142. https://doi.org/10.1055/s-2002-33002

    Article  Google Scholar 

  26. Helminski JO, Zee DS, Janssen I, Hain TC (2010) Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 90(5):663–678. https://doi.org/10.2522/ptj.20090071

    Article  Google Scholar 

  27. Saberi A, Nemati S, Sabnan S, Mollahoseini F, Kazemnejad E (2017) A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial. Eur Arch Otorhinolaryngol 274(8):2973–2979. https://doi.org/10.1007/s00405-016-4235-7

    Article  Google Scholar 

  28. Foster CA, Ponnapan A, Zaccaro K, Strong D (2012) A comparison of two home exercises for benign positional vertigo: half somersault versus epley maneuver. Audiol Neurotol Extra 2(1):16–23. https://doi.org/10.1159/000337947

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful for the contributions from Dr. Tunny Sebastian in performing the statistical analysis for this study.

Funding

Limited funding was obtained from the institutional FLUID Research Grant.

Author information

Authors and Affiliations

  1. Department of ENT (Otology, Neurotology and Cochlear Implant Unit), Christian Medical College, Vellore, 632004, India

    R. L. Ranju, Anjali Lepcha, Manju Deena Mammen, Ann Mary Augustine & Ajay Philip

  2. Department of Physiotherapy (Vestibular Physiotherapy), Christian Medical College, Vellore, India

    Lenny T. Vasanthan

Authors
  1. R. L. Ranju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anjali Lepcha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manju Deena Mammen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lenny T. Vasanthan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ann Mary Augustine
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ajay Philip
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. AL conceptualised and designed the study. Material preparation, data collection and analysis were performed by Dr. RLR, Dr. AL, Dr. MDM and Mr. LV. The first draft of the manuscript was written by Dr. RLR and all authors commented on previous versions of the manuscript. The Title Page manuscript has been read and approved by all authors, and the requirements for authorship have been met. Each author believes that the manuscript represents honest work.

Corresponding author

Correspondence to Manju Deena Mammen.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare, that are relevant to the content of this article.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was conducted after obtaining approval from the institutional ethical committee and institutional review board (IRB No: 9642).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ranju, R.L., Lepcha, A., Mammen, M.D. et al. An Effective Home-Based Particle Repositioning Procedure for Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV). Indian J Otolaryngol Head Neck Surg 74, 516–523 (2022). https://doi.org/10.1007/s12070-021-03021-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-021-03021-w

Keywords

Search

Navigation