Effective Treatments for Dizziness After BPPV: A Clinical Study

EVALUATION OF EFFECTIVE METHODS IN THE TREATMENT OF RESIDUAL DIZZINESS AFTER BPPV: A PARTIALLY RANDOMIZED CONTROLLED CLINICAL STUDY

This clinical study aimed to evaluate how effective vestibular rehabilitation therapy (VRT) and Theta Binaural Beats (T-BB) are in reducing dizziness and anxiety in patients who continue to feel unsteady after successful treatment for a common inner ear condition called BPPV. A total of 56 adult patients were divided into three groups, each receiving different types of home-based exercises: Cawthorne-Cooksey Exercises (CCE), Brandt-Daroff Exercises (BDE), or CCE combined with T-BB. The study measured both physical balance and emotional symptoms such as anxiety. Results showed that all treatments helped, but patients who received CCE with T-BB showed the most improvement in both balance and anxiety levels. The findings suggest that combining physical and audio-based therapy may be especially helpful for people with ongoing dizziness after BPPV.

Study Overview

• Status: Completed
• Conditions: BPPV; Vestibular Disease; Residual Disease
• Intervention / Treatment: Behavioral: Cawthorne-Cooksey Exercises; Other: Theta Binaural Beats; Behavioral: Brandt-Daroff Exercises

Detailed Description

Residual dizziness (RD) is a common yet often overlooked condition that can persist after successful canalith repositioning procedures (CRP) for benign paroxysmal positional vertigo (BPPV). Despite the resolution of vertigo, many patients continue to report imbalance and anxiety, which may affect their quality of life. This study investigated whether vestibular rehabilitation therapies-specifically Cawthorne-Cooksey Exercises (CCE), Brandt-Daroff Exercises (BDE), and CCE combined with Theta Binaural Beats (CCE+T-BB)-could improve balance and reduce anxiety in patients experiencing RD.

Fifty-six adults aged 18-60 who reported dizziness for at least 20 days after CRP were enrolled. Participants were assigned to one of the three intervention groups based on auditory sensitivity. The interventions were home-based, guided by digital content through the Moodle platform, and lasted four to six weeks depending on the protocol. The CCE+T-BB group also received 10-minute daily auditory stimulation designed to modulate brainwave activity and support emotional regulation.

The study used both objective (Sensory Organization Test - SOT) and subjective (Dizziness Handicap Inventory - DHI, State-Trait Anxiety Inventory - STAI) tools to assess outcomes before and after the interventions. All groups showed improvements, but the CCE+T-BB group demonstrated superior gains in balance, especially under visually and vestibular-dependent conditions. Both CCE-based groups had significant reductions in trait and state anxiety, while the BDE group only showed improvement in trait anxiety.

These findings suggest that structured vestibular rehabilitation improves balance and reduces anxiety in patients with residual dizziness. Furthermore, adding auditory neuromodulation (T-BB) to CCE may enhance postural adaptation and emotional regulation, supporting a multimodal, non-pharmacological approach to RD management. This research represents the first clinical evaluation of Theta Binaural Beats as an adjunct to vestibular therapy and offers a promising direction for personalized rehabilitation.

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Beykoz
    • İstanbul, Beykoz, Turkey, 34810
      • Istanbul Medipol University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosed with unilateral posterior canal benign paroxysmal positional vertigo (BPPV)
• Successfully treated with canalith repositioning procedures (CRP)
• Experiencing persistent dizziness or imbalance lasting at least 20 days after CRP
• Able and willing to perform home-based vestibular rehabilitation exercises
• Provided informed consent to participate in the study

Exclusion Criteria:

• Presence of other vestibular or neurological disorders (e.g., Meniere's disease, multiple sclerosis)
• History of psychiatric conditions that may interfere with participation
• Use of medications affecting vestibular function or anxiety within the last 4 weeks
• Conductive or sensorineural hearing loss
• Cognitive impairment or inability to follow digital instructions
• Previous participation in vestibular rehabilitation within the past 6 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cawthorne-Cooksey Exercises (CCE) Group; Participants in this group performed home-based Cawthorne-Cooksey vestibular rehabilitation exercises over a six-week period. Exercises were adjusted biweekly based on individual progress.	Behavioral: Cawthorne-Cooksey Exercises; A set of vestibular rehabilitation exercises aimed at improving balance and reducing dizziness through repeated head and body movements, delivered via home-based digital instructions.
Experimental: CCE with Theta Binaural Beats (CCE+T-BB); Participants followed the same six-week Cawthorne-Cooksey protocol as Arm 1, with an additional 10-minute daily Theta Binaural Beats audio session via stereo headphones.	Behavioral: Cawthorne-Cooksey Exercises; A set of vestibular rehabilitation exercises aimed at improving balance and reducing dizziness through repeated head and body movements, delivered via home-based digital instructions.; Other: Theta Binaural Beats; A digital auditory stimulation using two tones of slightly different frequencies to create a theta-frequency beat, intended to modulate anxiety and enhance vestibular rehabilitation effects.
Active Comparator: Brandt-Daroff Exercises (BDE) Group; Participants performed traditional Brandt-Daroff Exercises three times daily for four weeks. Exercises were done at home using video instructions and monitored weekly.	Behavioral: Brandt-Daroff Exercises; A traditional home-based vestibular exercise program for treating positional dizziness, involving repetitive lateral head movements performed daily.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Sensory Organization Test (SOT) Scores from Baseline to Post-Intervention	The Sensory Organization Test (SOT) is a computerized dynamic posturography tool used to assess balance performance under varying sensory conditions. The Composite Score is derived from multiple stance conditions that challenge somatosensory, visual, and vestibular input. Higher scores indicate better postural stability. Scores range from 0 to 100, where a score of 100 reflects perfect stability. The primary outcome is the change in Composite Score between the baseline (pre-intervention) and post-intervention assessments.	Baseline and Week 4/6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Dizziness Handicap Inventory (DHI) Total and Subscale Scores from Baseline to Post-Intervention	The Dizziness Handicap Inventory (DHI) is a 25-item questionnaire measuring the self-perceived impact of dizziness on daily life. It includes three subscales: Functional, Emotional, and Physical. Each item is scored from 0 (no handicap) to 4 (maximum handicap), and the total score ranges from 0 to 100. Higher scores indicate more severe dizziness-related disability. The outcome measure will capture changes in total and subscale scores from baseline to after the intervention.	Baseline and Week 4/6
Change in State-Trait Anxiety Inventory (STAI) Scores from Baseline to Post-Intervention	The STAI consists of two subscales measuring state anxiety (STAI-I) and trait anxiety (STAI-II), each containing 20 items scored on a 4-point Likert scale. Total scores for each subscale range from 20 to 80, with higher scores reflecting greater anxiety. This outcome measure assesses changes in both STAI-I and STAI-II scores between baseline and post-intervention evaluations.	Baseline and Week 4/6

Collaborators and Investigators

• Sponsor: Medipol University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2023
• Primary Completion (Actual): January 1, 2025
• Study Completion (Actual): January 1, 2025

Study Registration Dates

• First Submitted: April 13, 2025
• First Submitted That Met QC Criteria: April 13, 2025
• First Posted (Actual): April 20, 2025

Study Record Updates

• Last Update Posted (Actual): April 20, 2025
• Last Update Submitted That Met QC Criteria: April 13, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Vestibular Rehabilitation; Computerized Dynamic Posturography; Residual Dizziness; Theta Binaural Beats
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Otorhinolaryngologic Diseases; Sensation Disorders; Ear Diseases; Labyrinth Diseases; Vestibular Diseases; Vertigo; Dizziness
• Other Study ID Numbers: E-10840098-772.02-5857

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: There is no plan to share individual participant data (IPD) due to privacy concerns and the absence of institutional data-sharing agreements. Additionally, the nature of the intervention and follow-up data limits the feasibility of anonymized sharing.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No