Question
Editor's Note: Dr. Akin co-presented a seminar with Owen Murnane, Ph.D. on Tests of Otolith Functioning. To register, visit the Audiology Online library.
Can you tell me if there are any contraindications for performing a canalith repositioning procedure (CRP) maneuver on a patient with benign paroxysmal positional vertigo (BPPV) -like symptoms who presents with a negative Dix-Hallpike and negative roll test bilaterally? Also, is there any harm in performing a CRP on both sides during the same visit?
Answer
If a patient has no cervical spine involvement and is able to safely move his or her head, then there are no contraindications for performing canalith repositioning therapy (CRT) on a patient with subjective BPPV (positive symptoms but negative test findings). It is well established that CRT is an effective treatment for patients with objective BPPV (positive symptoms and positive test findings), and there is some evidence that suggests CRT might be effective for some patients with subjective BPPV (Haynes et al., 2002;Tirelli et al., 2001). The resolution of symptoms following CRT in patients with subjective BPPV suggests a false negative Dix-Hallpike or roll test. Because motion-provoked dizziness can be related to other disorders involving the peripheral or central vestibular system, further assessment is indicated if a patient with subject BPPV is still symptomatic following CRT.
If a patient has bilateral posterior canalithiasis, then performing CRT on both sides in the same visit may not be effective. During CRT on the second side, the canalith particles in the first side treated may move from the vestibule back into the limb of the posterior canal, therefore only the second side would be treated. The standard treatment for bilateral canalithiasis is CRT on the side with the stronger vertigo and nystagmic response, then CRT on the other side at a follow-up visit (Kaplan et al., 2005).
References:
Haynes DS, Resser JR, Labadie RF. (2002). Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus, Laryngoscope, 112(5):796-801.
Kaplan DM, Nash M, Niv A, Kraus M. (2005). Management of bilateral benign paroxysmal positional vertigo, Otolaryngology-Head and Neck Surgery, 133, 769-773.
Tirelli G, D'Orlando E, Giacomarra V, Russolo M. (2001). Benign positional vertigo without detectable nystagmus. Laryngoscope, 111(6):1053-6.
Faith W. Akin, Ph.D. is the director of the vestibular laboratory at VA Medical Center, Mountain Home, TN and an associate professor in the Department of Communicative Disorders at East Tennessee State University. Her research in the area of vestibular assessment is funded by the Rehabilitation Research and Development Service of the Veterans Health Administration.
