BENIGN PAROXYSMAL POSITIONAL VERTIGO

Controlled Treatment Trials

Timothy C. Hain, MD Page last modified: March 28, 2010

More than 400 patients have been reported in blinded studies comparing the Epley or Semont maneuver to either placebo or medical treatment. The results are clearly in favor of these maneuvers. The median response in treated patients was 81%, compared to 37.% in placebo or untreated subjects. The few instances where the Epley or Semont results were not compelling (e.g. Blakely et al, 1994), may have been instances where technique was not perfected.

Study	treated	Response	controls	Response
total	402	percent	217	percent	Response
median		81		37.5
Froehling, Bowen et al. 2000	50	67	26	38	67% vs. 38% at 2 weeks
Li 1995	37	70	23	0	70% vs 0% at 1 week
Lynn, Pool et al. 1995	36	88	18	27	88% vs. 27% at 1 month
Blakley 1994	38	86	19	94	No statistical difference at 1 month
Wolf, Hertanu et al. 1999	41	75	10	50	75% response vs. 50% at 1 week
Fujino, Tokumasu et al. 1994	61	62	20	30	62% response vs. 30% at 2 weeks (p<.05)
Sherman and Massoud 2001	71	81	25	60	81% response v.s. 60% at 2 weeks
Sherman and Massoud 2001	71		25		(no statistical difference)
Simhadri et al (2003)	20	95	20	5	More recurrence in controls
Seo et al (2007)	18	67	16	6
Salvanelli et al, 2003	40	92.5	40	37.5	Semont maneuver

Helminski et al (2010) recently published a meta-analysis of CRP in posterior canal BPPV. They concluded that there was very good evidence for efficacy of the Epley maneuver.

References

Blakley, B. W. (1994). "A randomized, controlled assessment of the canalith repositioning maneuver." Otolaryngol Head Neck Surg110(4): 391-6.
Froehling, D. A., J. M. Bowen, et al. (2000). "The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial." Mayo Clin Proc75(7): 695-700.
Fujino, A., K. Tokumasu, et al. (1994). "Vestibular training for benign paroxysmal positional vertigo. Its efficacy in comparison with antivertigo drugs." Arch Otolaryngol Head Neck Surg120(5): 497-504.
Helminski JO, Zee DS, Janssen I, Hain TC. (2010). Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Physical Therapy 90(5) 1-16
Li, J. C. (1995). "Mastoid oscillation: a critical factor for success in canalith repositioning procedure." Otolaryngol Head Neck Surg112(6): 670-5.
Lynn, S., A. Pool, et al. (1995). "Randomized trial of the canalith repositioning procedure." Otolaryngol Head Neck Surg113(6): 712-20.
Salvinelli, F., M. Casale, et al. (2003). "Benign paroxysmal positional vertigo: a comparative prospective study on the efficacy of Semont's maneuver and no treatment strategy." Clin Ter154(1): 7-11.
Seo, T., A. Miyamoto, et al. (2007). "Immediate efficacy of the canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo." Otol Neurotol 28(7): 917-9.
Sherman, D. and E. A. Massoud (2001). "Treatment outcomes of benign paroxysmal positional vertigo." J Otolaryngol30(5): 295-9.
Simhadri, S., N. Panda, et al. (2003). "Efficacy of particle repositioning maneuver in BPPV: a prospective study." Am J Otolaryngol24(6): 355-60.
Wolf, J. S., K. P. Boyev, et al. (1999). "Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo." Laryngoscope109(6): 900-3.