What is the treatment for BPPV?
Medication is not effective in the treatment of BPPV.
The standard of care for treatment of BPPV of the posterior canal is to manipulate the head to attempt to move the otoconia backward through the semicircular canal to return to the utricle.
Several repositioning maneuvers have been developed to do this. The most common maneuver, the canalith repositioning maneuver (Epley maneuver), puts the patient in the Dix–Hallpike test position, then rotates the head contralaterally during supine lying, and then holds the head facing contralaterally while the patient sits up.
An alternative maneuver, the liberatory maneuver (Semont maneuver), puts the patient in the side lying position on the ipsilateral side but with the head facing contralaterally—so the nose is pointed diagonally upward.
Then the patient is moved rapidly through a 180° arc to lie nose downward on the contralateral side. Note that the last stage of the canalith repositioning and liberatory maneuvers are the same.
Three to five trials are often needed, and one to three treatment sessions on different days are often needed. The two maneuvers are equally effective. Vibration of the head is not needed, has been shown to be ineffective, and will probably annoy the patient.
Special instructions to sleep sitting up, limit head movement, or wear a cervical collar have also been shown to be ineffective.
Repositioning exercises that are similar to the repositioning maneuvers, three times per day, five repetitions per session, for at least 1 week are also effective, although somewhat less effective than the repositioning maneuvers themselves.
Practicing repositioning exercises after successful treatment, however, does not prevent the recurrence of another episode.
Repositioning treatments for lateral canal and anterior canal BPPV are also available. To treat lateral canal BPPV the log-rolling maneuver is used. Have the patient lie supine.
Rotate the head contralateral to the involved side, then, keeping the head still, have the patient roll contralaterally away from the involved side onto the contralateral shoulder, then rotate the head and body into prone lying, and then into side lying on the ipsilateral side.
The patient will have rolled 270°. Then have the patient sit up. Repeat three or four times if needed. To treat anterior canal BPPV use Semont’s maneuver in reverse: turn the face 45° toward the involved side, have the patient lie on that side; wait until the vertigo subsides, and then briskly move the patient 180° to the contralateral shoulder with the face looking upward.
After the vertigo has subsided, keep the head facing toward the ipsilateral side and have the patient sit up. Three or four trials may be needed.
A surgical procedure, canal plugging, is available but rarely used since most patients respond well to repositioning maneuvers and exercises.
