Treatments for Benign Paroxysmal Positional Vertigo (BPPV)

The purpose of this study was to determine the relative short- and long-term efficacy of several physical treatment paradigms commonly employed for the treatment of benign paroxysmal positional vertigo (BPPV), including the canalith repositioning (Epley) maneuver, the liberatory (Semont) maneuver, the Brandt-Daroff exercises and nonspecific vestibular habituation exercises. These procedures involve exercises and head manipulations. Vertigo intensity and frequency, the presence/absence of slow-phase eye movements, the degree of dizziness handicap and acts of daily living (ADL) were assessed. The study also ascertained the effects of co-morbid conditions on the response to treatment. While BPPV is a common and significant public health problem that has been recognized for several decades, this is the first systematic study of the relative treatment efficacy of different physical treatment modalities for this disorder.

Study Overview

• Status: Completed
• Conditions: Vertigo
• Intervention / Treatment: Behavioral: Canalith repositioning maneuver (Epley maneuver); Behavioral: Vestibular habituation exercises; Behavioral: ShamManeuver; Behavioral: Semont maneuver; Behavioral: Brandt-Daroff exercises

• Study Type: Interventional
• Enrollment (Actual): 150
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • Baylor College of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Patients may be eligible for this study if they:

• Are at least 21 years old.
• Have a diagnosis of unilateral posterior semicircular canal BPPV according to established clinical test criteria.
• Have functional to normal range of motion of the neck and the back.

Exclusion Criteria:

Patients will not be eligible for this study if they:

• Have a history of prior ear surgery or prior treatment for BPPV.
• Have an orthopedic or connective tissue disorder that impairs functional neck or trunk range of motion.
• Have a significant neurological disorder or spinal cord damage.
• Are on vestibular suppressant medications.
• Have Meniere's disease or acoustic neuromas.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Masking: Single

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Canalith repositioning maneuver; Repositioning treatment for posterior canal BPPV	Behavioral: Canalith repositioning maneuver (Epley maneuver); Standard passive motion of the head: Dix-Hallpike maneuver, turn head to opposite side, roll over, sit up.; Other Names: CRP; Epley maneuver
Experimental: Modified Epley maneuver	Behavioral: Vestibular habituation exercises; Head shaking exercises in pitch, roll, yaw and circumduction. Titrating from 2 repetitions per exercise to 20 repetitions per exercise, as tolerated.
Sham Comparator: Sham; The subject sat in a chair; the head was passively tilted downward, turned away from the involved side, turned back to center, upward, away from the involved side, twice, slowly.	Behavioral: ShamManeuver; Passive movement of the head
Active Comparator: Liberatory maneuver; The standard liberatory maneuver (also known as the Semont maneuver) was used.	Behavioral: Semont maneuver; Sidelying maneuver, flip over 180 deg, sit up.; Other Names: Liberatory maneuver
Active Comparator: Brandt Daroff exercise; Modified Brandt Daroff exercise performed as a self-liberatory exercise.	Behavioral: Brandt-Daroff exercises; Active exercise. Sidelying to involved side, sidelying to uninvolved side, sit up.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Vertigo	6 month s

Secondary Outcome Measures

Outcome Measure	Time Frame
Balance	6 months

Collaborators and Investigators

• Sponsor: Baylor College of Medicine
• Collaborators: National Institute on Deafness and Other Communication Disorders (NIDCD)
• Investigators: Principal Investigator: Helen Cohen, EdD, Baylor College of Medicine

Publications and helpful links

General Publications

• Cohen HS. Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. Otol Neurotol. 2004 Mar;25(2):130-4. doi: 10.1097/00129492-200403000-00008.
• Cohen HS, Kimball KT, Stewart MG. Benign paroxysmal positional vertigo and comorbid conditions. ORL J Otorhinolaryngol Relat Spec. 2004;66(1):11-5. doi: 10.1159/000077227.
• Cohen HS, Kimball KT. Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. Am J Otolaryngol. 2004 Jan-Feb;25(1):33-7. doi: 10.1016/j.amjoto.2003.09.010.
• Cohen HS, Kimball KT. Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol. 2005 Sep;26(5):1034-40. doi: 10.1097/01.mao.0000185044.31276.59.

Study record dates

Study Major Dates

• Study Start: October 1, 1998
• Primary Completion (Actual): June 1, 2003
• Study Completion (Actual): June 1, 2003

Study Registration Dates

• First Submitted: November 2, 1999
• First Submitted That Met QC Criteria: November 2, 1999
• First Posted (Estimate): November 3, 1999

Study Record Updates

• Last Update Posted (Estimate): July 26, 2012
• Last Update Submitted That Met QC Criteria: July 25, 2012
• Last Verified: July 1, 2012

More Information

Terms related to this study

• Keywords: rehabilitation; Physical Therapy; Vertigo; occupational therapy
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Otorhinolaryngologic Diseases; Labyrinth Diseases; Ear Diseases; Vestibular Diseases; Sensation Disorders; Vertigo; Benign Paroxysmal Positional Vertigo; Dizziness
• Other Study ID Numbers: NIDCD-1156; R01DC003602 (U.S. NIH Grant/Contract); 1R01DC003602-01A1 (U.S. NIH Grant/Contract)