Are Postural Restrictions Necessary for Management of Posterior Canal Benign Paroxysmal Positional Vertigo?

Abstract

Objectives:

An important component of management of benign paroxysmal positional vertigo (BPPV) has been the application of postural restrictions after use of a canalith repositioning maneuver (CRM) to prevent the return of otolithic debris into the posterior semicircular canal (PSC). This study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC.

Methods:

Seventy-four adult patients with unilateral PSC BPPV were enrolled into this study. All patients were managed with a CRM — Either the modified Epley maneuver or the Semont maneuver. The patients were divided randomly into 2 groups: Group A, with postural restrictions, and group B, without postural restrictions. The statistical analysis was performed with χ² tests and t-tests.

Results:

No patients in either group showed positional nystagmus in the posttreatment evaluation under infrared videonys-tagmoscopy. No patients had symptoms of vertigo after the therapy. The results of follow-up vestibular tests were normal in both groups.

Conclusions:

In our experience, postural restrictions do not enhance the beneficial effect of the CRMs. They do not seem to have any protective role and therefore should not be recommended as an adjunct to the treatment of PSC BPPV.

Keywords

BPPV benign paroxysmal positional vertigo Epley maneuver posterior canal vertigo postural restriction Semont maneuver vertigo

References

Labuguen

. Initial evaluation of vertigo. Am Fam Physician 2006;73:244–51.

De Stefano

Dispenza

Di Trapani

Kulamarva

. Meningioma of the cerebellopontine angle mimicking benign paroxysmal positional vertigo. J Otolaryngol Head Neck Surg 2008;37:E46–E48.

Herdman

. Advances in treatment of vestibular disorders. Phys Ther 1997;77:602–18.

Marciano

Marcelli

. Postural restrictions in labyrintholithiasis. Eur Arch Otorhinolaryngol 2002;259:262–5.

Dix

Hallpike

. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med 1952;45:341–54.

McClure

. Horizontal canal BPV. J Otolaryngol 1985;14:30–5.

Schuknecht

. Cupulolithiasis. Arch Otolaryngol 1969;90:765–78.

Hall

Ruby

RRF

McClure

. The mechanics of benign paroxysmal vertigo. J Otolaryngol 1979;8:151–8.

Schuknecht

. Positional vertigo: Clinical and experimental observations. Trans Am Acad Ophthalmol Otolaryngol 1962;66:319–32.

10.

Epley

. The canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:399–404.

11.

Semont

Freyss

Vitte

. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988;42:290–3.

12.

Herdman

Tusa

Zee

Proctor

Mattox

. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1993;119:450–4.

13.

Parnes

Price-Jones

. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993;102:325–31.

14.

Harvey

Hain

Adamiec

. Modified liberatory maneuver: Effective treatment for benign paroxysmal positional vertigo. Laryngoscope 1994;104:1206–12.

15.

Welling

Parnes

O'Brien

Bakaletz

Brackmann

Hinojosa

. Particulate matter in the posterior semicircular canal. Laryngoscope 1997;107:90–4.

16.

Vital

Printza

Vital

Triaridis

Tsalighopoulos

. A new physical maneuver for the treatment of benign paroxysmal positional vertigo. Mediterr J Otol 2006;3:98–102.

17.

Cakir

Ercan

Cakir

Turgut

. Efficacy of postural restriction in treating benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 2006;132:501–5.

18.

Massoud

EAS

Ireland

. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 1996;25:121–5.

19.

Casqueiro

Ayala

Monedero

. No more postural restrictions in posterior canal benign paroxysmal positional vertigo. Otol Neurotol 2008;29:706–9.

20.

Jacobson

Newman

. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:424–7.

21.

Yimtae

Srirompotong

Sae-Seaw

. A randomized trial of the canalith repositioning procedure. Laryngoscope 2003;113:828–32.

22.

Hamid

. The maneuvers for benign positional vertigo. Oper Tech Otolaryngol Head Neck Surg 2001;12:148–50.

23.

Nunez

Cass

Furman

. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2000;122:647–52.

24.

Ganança

Simas

Ganança

Korn

Dorigueto

. Is it important to restrict head movement after Epley maneuver?. Braz J Otorhinolaryngol 2005;71:764–8.

25.

Haberkamp

Hamid

. The Epley or canalith repositioning maneuvers for classic benign positional vertigo. Oper Tech Otolaryngol Head Neck Surg 2001;12:151–3.

26.

Motamed

Osinubi

Cook

. Effect of mastoid oscillation on the outcome of the canalith repositioning procedure. Laryngoscope 2004;114:1296–8.

27.

Moon

Bae

Kim

Cho

. The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2005;262:408–11.

28.

Simoceli

Bittar

RSM

Greters

. Posture restrictions do not interfere in the results of canalith repositioning maneuver. Braz J Otorhinolaryngol 2005;71:55–9.

29.

Roberts

Gans

DeBoodt

Lister

. Treatment of benign paroxysmal positional vertigo: Necessity of postmaneuver patient restrictions. J Am Acad Audiol 2005;16:357–66.

30.

Fyrmpas

Rachovitsas

Haidich

. Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature. Auris Nasus Larynx 2009;36:637–43.

31.

Devaiah

Andreoli

. Postmaneuver restrictions in benign paroxysmal positional vertigo: An individual patient data meta-analysis. Otolaryngol Head Neck Surg 2010;142:155–9.