Success with the Most Common Form of Vertigo in Two Treatments

The Vestibular Disorders Association estimates that 42% of the adult population reports episodes of dizziness or vertigo to their physicians and that in 85% of those cases, vestibular disfunction causes the patient’s problems.  Left unaddressed, the occassional dizziness or dysequilibrium can lead to injury falls, auto accidents, work accidents, or fear of performing normal activities of daily living.  Benign Paroxysmal Positional Vertigo (BPPV) has been described as the most prevalent form of vertigo1, with incidence rates estimated as high as 50% in the age 70+ population.2  Combined Therapy Specialties efficiently improves most types of peripheral and central vestibular disorders and effectively treats BPPV with conservative positioning maneuvers.   

Impressive Results: Numerous studies have demonstrated the efficacy of physical therapy approaches for BPPV.3-10  Noteworthy among these studies for the large number of patients treated is the work of Gans and Harrington-Gans, which followed 376 patients with confirmed diagnoses of BPPV-posterior canal.  Seventy-nine percent of their patients required only one treatment and 17% required two treatments.  Between 2% and 7% experienced recurrence.  Most other investigators using similar diagnostic criteria similarly report success rates greater than 90%.  Combined Therapy Specialties uses the evaluations and treatments described by Gans and enjoys similar outcomes.

Pathophysiology & Diagnosis: BPPV is caused when otolith debris degenerates within the utricle and migrates into the semi-circular canals – predominantly the posterior canal.  The material either adheres to the cupula (cupulolithiasis) or lies within the long process of the canal (canalalithiasis) and causes deflection of the cupula with changes in head position.  In younger patients, other ear dysfunctions often precede BPPV.  Diagnosing PC-BPPV involves identifying four classic criteria:

1. Transient rotatory-torsional nystagmus toward the undermost ear when side- leaning or lying
2. Subjective vertigo that parallels the nystagmus
3. Latency of onset of nystagmus
4. A possible reversal of nystagmus upon return to sitting position

Combined Therapy Specialties treats BPPV with a modified Canalith Repositioning Maneuver and/or a Semont Liberatory Maneuver.  The head repositioning techniques work to mobilize debris in the posterior canal so that it can return to the utricle and dissolve. 

Vertebral compression of the artery contraindicates some maneuvers in vestibular rehabilitation.  Combined Therapy Specialties will pre-screen all patients with a Vertebral Artery Test.  When tested positive, CTS will report to the referring practitioner and avoid neck hyperextension positions.  Combined Therapy Specialties will also screen for orthopedic and neurologic conditions that may contraindicate evaluation or treatment.  Complications from the BPPV repositioning maneuvers occur rarely but include horizontal canal migration and canalith jam.  Additional repositioning maneuvers can correct both of these complications.

REFERENCES

1. Bath AP, Walsh RM,  Ranalli P, et al. Experience from a multidisciplinary “dizzy” clinic. Am J Otol 2000; 21:92-97.
2. Oghalai JS, Manolidis S, Barth J, Stewart M, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg 2000;122;5:630-634.
3. Norre ME, De Weerdt W. Treatment of vertigo based on habituation, 2: technique and results of habituation training. J Laryngol Otol. 1980;94:971-977.
4. Herdman SJ, Tusa RJ, Zee DS, et al. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. 1993;119:450-454.
5. Hrdman SJ. Physical therapy in the treatment of patients with benign paroxysmal positional vertigo. Neurology Report. 1996;20:46-53.
6. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980;106: 484-485.
7. Semont A, Freyss G, Vitte E. Curing the BPPV with a Liberatory maneuver. Adv Otorhinolaryngol. 1988;42:290-293.
8. Norre ME, Beckers A. Exercise treatment for paroxysmal positional vertigo: comparison of two types of exercises. Arch Otorhinolaryngol. 1987;244:291-294.
9. Norre ME, Beckers A. Comparative study of two types of exercise treatment for paroxysmal positioning vertigo. Adv Otorhinolaryngol. 1988;42:287-289.
10. Ruckenstein MJ. Therapeutic efficacy of the Epley canalith repositioning maneuver. Laryngoscope. 2001;111:940-945.

 

©BMA 2005