Physical therapy for benign paroxysmal positional vertigo.

We treated 67 patients with the symptoms of benign paroxysmal positional vertigo (BPPV) by challenging them with the precipitating head positions on a repeated and serial basis. Sixty-six of the patients experienced complete relief of the vertigo within three to 14 days; in two patients, the vertigo recurred but responded to a second course of therapy. The one patient whose condition did not respond was found to have a perilymphatic fistula that mimicked BPPV. The presumed mechanism for this therapy is the loosening and ultimate dispersion of degenerated otolithic particles from the cupula of the posterior semicircular canal.