A Review of the Efficacy of Therapeutic Maneuvers in Posterior Canal Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is associated with significant functional impairment with the change of head position with respect to gravity. Therapeutic maneuvers provide relief of symptoms; however, some patients may have persistent symptoms and can be significantly disabled. The aim of this study is to review the critical factors that may have an impact on outcome. Six main categories that may possibly affect the outcome of therapeutic maneuvers in patients with posterior canal (PC) BPPV were selected. A review of the 1095 articles on therapeutic maneuvers in patients with PC BPPV was conducted by means of a search in PubMed, Embase, and Scopus databases between 1989 and 2020. We documented 14 articles about the comparative analysis of success rate of Semont and Epley maneuvers, 7 articles about the comparative analysis of success rate of therapeutic maneuvers and no treatment or sham maneuver, 7 articles about the comparison of success rate in treatment of traumatic and idiopathic cases, 12 articles about the comparison of outcome of repositioning maneuvers with or without postural restrictions, 12 articles about the comparison of success rate of medication and therapeutic maneuvers, and 9 articles about the comparison of vestibular exercises and therapeutic maneuvers. In conclusion, therapeutic maneuvers provide better outcome as compared to no treatment or sham maneuver. Epley maneuver has greater success rate than Semont maneuver. Traumatic cases are prone to develop more recurrences than idiopathic cases and have lower rate of symptom resolution. Body restrictions following successful repositioning maneuver has no impact on recurrence. Medical therapy or vestibular exercise alone is not an alternative to therapeutic maneuvers. However, the rate of residual dizziness is low when the vestibular exercises are combined.