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Home Treatment for Benign Positional Vertigo

On balance, the modified Epley procedure appears to be a winner.

Benign paroxysmal positional vertigo (BPPV) consists of brief episodes of vertigo that are provoked by changes in head position and are associated with torsional nystagmus. The presumed cause is movement of free-floating particles in the posterior semicircular canal of the vestibular labyrinth. To relocate these particles, experts have devised bedside maneuvers in which the body is moved sequentially into several positions. Although some patients improve after a single maneuver in the office, others require additional treatments.

In this German study, researchers randomized 70 patients with BPPV to receive instruction in either the modified Epley procedure or the modified Semont maneuver, to be done three times daily at home (video depictions of the maneuvers were available online at the time of publication). After 1 week, vertigo was abolished in 95% of patients in the Epley group and in 58% of those in the Semont group -- a significant difference.

Comment: Patients apparently can be taught to treat BPPV successfully at home. To do so properly, however, the clinician must first be able to diagnose BPPV correctly and to determine which ear is affected. A recent useful review article on BPPV illustrates how to diagnose BPPV in the office, using the Dix-Hallpike test (N Engl J Med 1999; 341:1590). At the time of publication, the full text of the original article, including sketches of the modified Epley and Semont maneuvers, was available free of charge.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 6, 2004

Citation(s):

Radtke A et al. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology 2004 Jul 13; 63:150-2.

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• Medline abstract (Free)