AO Journal Group: Canalith Repositioning Therapy and BPPV

Do you want to stay up on the latest research related to hearing? Tune into the AO Journal Group where on a monthly basis our group of Contributing Editors will provide reviews of timely journal articles that relate to your clinical practice.

This article review was submitted Kamran Barin, Ph.D., who is the Director of Balance Disorders at the Ohio State University Medical Center a Contributing Editor for Audiology Online in the area of balance and dizziness.

Article:

Li, C.J., Epley, J. (2006). The 360-Degree Maneuver for Treatment of Benign Positional Vertigo. Otol Neurotol, 27, 71-77.
The website for the Journal is: www.otology-neurotology.com

Review:

Epley's canalith repositioning therapy (CRT) and its variations are currently the most commonly-used procedures for the treatment of posterior canal benign paroxysmal positional vertigo (BPPV). These procedures move the particles out of the semicircular canal so that they can no longer disrupt the normal flow of endolymph during head movements. Pathophysiology of BPPV suggests that another potential treatment method is to move the head 360 degrees in the plane of the involved canal. In this article, Li and Epley (2006) compared this maneuver to the standard CRT to determine if there was an advantage to the new treatment method, especially in the difficult-to-treat BPPV cases.

The maneuver was performed on a multiaxial positioning device that consisted of a globe-like apparatus with a chair mounted in the middle. The device was driven by two motors allowing it to rotate about different axes. The patient population consisted of 31 patients with posterior canal BPPV. Each patient was diagnosed by the Dix-Hallpike maneuver. All patients underwent a 360 degree rotation in the plane of the involved posterior canal using the multiaxial device. Following the procedure, the patients were given a questionnaire to evaluate the comfort and other patient-related issues. The Dix-Hallpike maneuver was repeated two weeks later to determine if the patients had any symptoms.

The results showed no significant difference between the success rates of the standard CRT and the new maneuver. Most patients found the comfort level and tolerability acceptable.

The take-home message for clinicians is that the standard CRT is still the treatment of choice for the majority of BPPV patients. It has a high success rate and requires no additional equipment. The 360-degree maneuver may be helpful in a small subset of patient who, for various reasons, can not undergo standard CRT.