Treatment Efficacy of Benign Paroxysmal Positional Vertigo (BPPV) with Canalith Repositioning Maneuver and Semont Liberatory Maneuver in 376 Patients

 

 Buy Article Permissions and Reprints

ABSTRACT

Canalith Repositioning and Semont Liberatory Maneuvers have been shown to be highly efficacious in the successful treatment of Benign Paroxysmal Positional Vertigo (BPPV). The differentiation of canalalithiasis, cupulolithiasis, and correct identification of canal involvement, particularly through the use of Video-oculography, have enhanced treatment decisions and outcomes.

Since 1994, approximately 700 BPPV patients have been treated at the authors' clinical facility. An anecdotal study of 376 of these patients followed over a 7-year period is presented. The patients in the historical study all presented with BPPV- PC and were treated with modified Canalith Repositioning Maneuver and Semont Liberatory Maneuver treatment procedures. The review indicated no significant differences in treatment outcomes between the two procedures. Seventy-nine percent of the patients required only one treatment, while 17% required two treatments, 3.5% required three treatments, and 0.05% required four treatments. The average number of treatments was 1.3. The SLM did show a reduced recurrence rate compared to the CRP method.

REFERENCES

• 1 Bath A P, Walsh R M, Ranalli P. Experience from a multidisciplinary ``dizzy'' clinic.  Am J Otol . 2000;  21 92-97
  PubMedGoogle Scholar
• 2 Li J C, Li C J, Epley J, Weinberg L. Cost-effective management of benign positional vertigo using canalith repositioning.  Otolaryngol Head Neck Surg . 2000;  122 334-339
  CrossrefPubMedGoogle Scholar
• 3 Barany R. Diagnose von Krankeitserschernungenin Bereiche des Otolithenapparaten.  Acta Otolaryngol (Stockh) . 1921;  2 434-437
  PubMedGoogle Scholar
• 4 Dix M R, Hallpike C S. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system.  Ann Otol Rhinol Laryngol . 1952;  61 987-1016
  CrossrefPubMedGoogle Scholar
• 5 Schuknecht H F. Cupulolithiasis.  Arch Otolaryngol . 1969;  90 113-126
  PubMedGoogle Scholar
• 6 Baloh R W. Harold Schuknecht and pathology of the ear.  Otology and Neurotology . 2001;  22 113-122
  PubMedGoogle Scholar
• 7 Parnes L S, McClure J A. Free-floating endolymph particles: a new operative finding during posterior canal occlusion.  Laryngoscope . 1992;  102 988-992
  PubMedGoogle Scholar
• 8 Hall S F, Rudy R RF, McClure J A. The mechanics of benign paroxysmal positional vertigo.  J Otolaryngol . 1979;  8 151-158
  PubMedGoogle Scholar
• 9 Gans R E. Overview of BPPV: pathophysiology and diagnosis.  The Hearing Review . 2000;  7(8) 38-43
  PubMedGoogle Scholar
• 10 Brandt T, Daroff R B. Physical Therapy for Benign Paroxysmal Positional Vertigo.  Arch Otolaryngol . 1980;  106 484
  CrossrefPubMedGoogle Scholar
• 11 Semont A, Freyss G, Vitte E. Curing the BPPV with a Liberatory Maneuver.  Adv Otorhinolaryngol . 1988;  42 390-393
  PubMedGoogle Scholar
• 12 Epley J M. The Canalith Repositioning Procedure for treatment of benign paroxismal positional vertigo.  Arch Otolaryngol . 1993;  119 450-454
  PubMedGoogle Scholar
• 13 Herdman S J, Tusa R J, Zee D S. Single treatment approaches to benign paroxysmal positional vertigo.  Arch Otolaryngol . 1993;  119 450-454
  PubMedGoogle Scholar
• 14 Steenerson R L, Cronin G W. Comparison of the Canalith Repositioning Procedure and Vestibular Habituation Training in forty patients with benign paroxysmal positional vertigo.  Otolaryngol Head Neck Surg . 1996;  114 61-64
  PubMedGoogle Scholar
• 15 Coppo C F, Singarelli S, Fracchia P. Benign paroxismal positional vertigo: follow-up of 165 cases treated by Semont's Liberating Maneuver.  Acta Otorhinolgaryngol Ital . 1996;  16 508-512
  PubMedGoogle Scholar
• 16 Lempert T, Wolsley C, Davies R, Gresty M A, Bronstein A M. Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: a placebo-controlled trial.  Neurology . 1997;  49 729-733
  PubMedGoogle Scholar
• 17 Cohen H S, Jerabek J. Efficacy of treatments for posterior canal benign paroxysmal positional vertigo.  Laryngoscope . 1999;  109 584-590
  CrossrefPubMedGoogle Scholar
• 18 Gall R M, Ireland D J, Robertson D D. Subjective visual vertical in patients with benign paroxysmal positional vertigo.  J Otolaryngol . 1999;  28 162-165
  PubMedGoogle Scholar
• 19 Wolf J S, Boyev K P, Manokey D E. Success of the modified Epley Maneuver in treating benign paroxysmal positional vertigo.  Laryngoscope . 1999;  109 900-903
  PubMedGoogle Scholar
• 20 Dornhoffer J L, Colvin G B. Benign paroxysmal positional vertigo and Canalith Repositioning : clinical correlations.  Am J Otol . 2000;  21 230-233
  CrossrefPubMedGoogle Scholar
• 21 Macias J D, Lambert K M, Massingale S, Ellensohn A, Fritz J A. Variables affecting treatment in benign paroxysmal positional vertigo.  Laryngoscope . 2000;  110 1921-1924
  PubMedGoogle Scholar
• 22 Nunez R A, Cass S P, Furman J M. Short and long term outcomes of Canalith Repositioning for benign paroxysmal positional vertigo.  J Otolaryngol . 2000;  122 647-652
  CrossrefPubMedGoogle Scholar
• 23 O'Reilly R, Elford B, Slater R. Effectiveness of Particle Repositioning Maneuver in subtypes of benign paroxysmal positional vertigo.  Laryngoscope . 2000;  110 1385-1388
  PubMedGoogle Scholar
• 24 Tirelli G, D'Orlando E, Zarcone O, Giacomarro V, Russolo M. Modified Particle Repositioning Procedure.  Laryngoscope . 2000;  100 462-467
  PubMedGoogle Scholar
• 25 Oghalai J S, Manolidis S, Barth J, Stewart M, Jenkins H A. Unrecognized benign paroxysmal positional vertigo in elderly patients.  Otolaryngol Head Neck Surg . 2000;  122(5) 630-634
  CrossrefPubMedGoogle Scholar
• 26 Gans R E, Crandall C. Overview of BPPV: evaluating treatment outcomes with clinimetrics.  The Hearing Review . 2000;  7(11) 50-54
  PubMedGoogle Scholar
• 27 Ware J E. How to Score the Revised MOS Short Form Health Scales (SF-36) Boston: The Health Institute, New England Medical Center Hospitals; 1988 . 
  Google Scholar
• 28 Herdman S J, Tusa R J. Complications of the Canalith Repositioning Procedure.  Arch Otolaryngol Head Neck Surg . 1996;  122(3) 281-286
  CrossrefPubMedGoogle Scholar
• 29 Li J C. Mastoid Oscillation: a critical factor for success in Canalith Repositioning Procedure.  Otolaryngol Head Neck Surg . 1995;  112 670-675
  PubMedGoogle Scholar
• 30 Sargent E W, Bankaitis A E, Hollenbeak C S, Currens J W. Mastoid oscillation in canalith reporitioning for paroxysmal positional vertigo.  Otology and Neurotology . 2001;  22 205-209
  PubMedGoogle Scholar
• 31 Gans R E. Overview of BPPV: treatment methodologies.  The Hearing Review . 2000;  7(9) 34-39
  PubMedGoogle Scholar
• 32 Zucca G, Valli S, Valli P, Perin P, Mira E. Why do benign paroxysmal positional vertigo episodes recover spontaneously?.  J Vestib Res . 1998;  8 325-329
  CrossrefPubMedGoogle Scholar
• 33 Nuti D, Nati C, Passali D. Treatment of benign paroxysmal positional vertigo: no need for post-maneuver restrictions.  J Otolaryngol . 2000;  122 440-444
  CrossrefPubMedGoogle Scholar
• 34 Appiani G C, Catania G, Gagliardi M. A liberatory maneuver for the treatment of horizontal canal paroxysmal positional vertigo.  Otology and Neurotology . 2001;  22 66-69
  PubMedGoogle Scholar
• 35 Fife T D. Recognition and management of horizontal canal benign positional vertigo.  Am J Otol . 1998;  19 345-351
  CrossrefPubMedGoogle Scholar
• 36 Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo.  J Vestib Res . 1997;  7 1-6
  CrossrefPubMedGoogle Scholar
• 37 DelaMeilleure G, Dehaene I, Depondt M. Benign paroxysmal positional vertigo of the horizontal canal.  J Neurol Neurosurg Psychiatry . 1996;  60 68-71
  PubMedGoogle Scholar
• 38 Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features.  J Vestib Res . 1996;  6 173-184
  CrossrefPubMedGoogle Scholar
• 39 Steddin S, Ing D, Brandt T. Horizontal canal benign paroxysmal positional vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis.  Ann Neurol . 1996;  40 918-922
  CrossrefPubMedGoogle Scholar
• 40 Strupp M, Brandt T, Steddin S. Horizontal canal benign paroxysmal positional vertigo: reversible ipsilateral caloric hypoexcitability caused by canalolithiasis.  Neurology . 1995;  45 2072-2076
  PubMedGoogle Scholar
• 41 Lempert T, Tiel-Wick K. A positional maneuver for treatment of horizontal canal benign positional vertigo.  Laryngoscope . 1996;  106 476-478
  CrossrefPubMedGoogle Scholar
• 42 Baloh R W, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo.  Neurology . 1993;  43 2542-2549
  CrossrefPubMedGoogle Scholar
• 43 McClure J A. Horizontal canal BPPV.  J Otolaryngol . 1985;  14 30-35
  PubMedGoogle Scholar
• 44 Herdman S J, Tusa R J. Complications of the Canalith Repositioning Procedure.  Arch Otolaryngol Head Neck Surg . 1996;  122(3) 281-286
  CrossrefPubMedGoogle Scholar
• 45 Norre M E, Beckers A. Benign Paroxysmal Positional Vertigo in the elderly.  J Am Geratr Soc . 1988;  36 425-429
  PubMedGoogle Scholar
• 46 Troost B T, Patton J M. Exercise therapy for Positional Vertigo.  Neurology . 1992;  42 1441-1444
  PubMedGoogle Scholar
• 47 Blatt P J, Gergakakis G A, Herdman S J, Clendaniel R A, Tusa R J. The effect of the Canalith Repositioning Maneuver on resolving postural instability in patients with Benign Paroxysmal Positional Vertigo.  Am J Otol . 2000;  21 356-363
  CrossrefPubMedGoogle Scholar
• 48 Gross E M, Ress B D, Viirre E S, Nelson J R, Harris J P. Intractable Benign Paroxysmal Positional Vertigo in patients with Meniere's disease.  Laryngoscope . 2000;  110 655-659
  CrossrefPubMedGoogle Scholar

1 Patients are provided with a soft cervical collar.