Comparison Between the Effectiveness of Physical Maneauer and Medicinal Therapy in the Treatment of Benign Paroxysmal Positional Vertigo

Background and

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Its pathophysiology is described by canalolithiasis theory. A safe and simple treatment has been proposed in recent years (canalith repositioning maneuver). This study has been performed to compare the effectiveness of physical maneuver and medical therapy in the treatment of BPPV.

The study was a clinical trial. Patients with BPPV (Being diagnosed based on positive Dix – Hallpike test and history) were randomized into 2 groups on first visit. They were matched for sex, age and cause of BPPV. 23 patients received Epley maneuver and 22 patients received Betahistine. Patients were evaluated at first week and first month after the beginning of the treatment.

After one week, 58.3 % of patients in drug group and 94.1 % of patients in maneuver group had negative Hallpike test. After 1 week, all patients were asked about the resolution of symptoms. After 1 week, 39.77% of patients in drug group and 81.52 % of patients in maneuver group improved. This difference between the 2 groups was statistically significant (2 = -4/338 p< 0/001). After 1 month, 56. 83 % of patients in drug group and 86.98 % of patients in maneuver group improved (z =- 3/ 305 p<0/01). The difference of subjective improvement was statistically significant between 1 week and 1 month follow up in drug group (z = -2/85 p<0.01), this difference however was not statistically significant in maneuver group (z= -1.5 NS).

In short term the Epley maneuver is much more effective than medical therapy to control symptoms of BPPV and is the best treatment for this disease.