Helen S Cohen1, Kay T Kimball. 1. Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas 77030, USA. hcohen@bcm.tmc.edu
Abstract
OBJECTIVE: To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Prospective, randomized, sham-controlled. PATIENTS: Patients (n = 124) with BPPV of the posterior semicircular canal. SETTING: Tertiary care center. INTERVENTIONS: Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later. MAIN OUTCOME MEASURES: Vertigo intensity and frequency. RESULTS: Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period. CONCLUSION: LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.
RCT Entities:
OBJECTIVE: To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Prospective, randomized, sham-controlled. PATIENTS: Patients (n = 124) with BPPV of the posterior semicircular canal. SETTING: Tertiary care center. INTERVENTIONS: Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later. MAIN OUTCOME MEASURES: Vertigo intensity and frequency. RESULTS: Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period. CONCLUSION: LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.
Authors: Maitreyi A Nair; Ajitkumar P Mulavara; Jacob J Bloomberg; Haleh Sangi-Haghpeykar; Helen S Cohen Journal: J Vestib Res Date: 2018 Impact factor: 2.435
Authors: Helen S Cohen; Jasmine Stitz; Haleh Sangi-Haghpeykar; Susan P Williams; Ajitkumar P Mulavara; Brian T Peters; Jacob J Bloomberg Journal: Laryngoscope Date: 2017-12-11 Impact factor: 3.325
Authors: Helen S Cohen; Ajitkumar P Mulavara; Brian T Peters; Haleh Sangi-Haghpeykar; Jacob J Bloomberg Journal: J Vestib Res Date: 2012-01-01 Impact factor: 2.435