Benign paroxysmal positional vertigo and canalith repositioning: Clinical correlations

Objective: To correlate patient response and recurrence rate after canalith repositioning to clinical presentation and cause of BPPV. Study Design: This was a retrospective chart review. Setting: This study was performed at a tertiary referral center. Patients: The study included patients with a diagnosis of benign paroxysmal positional vertigo based on history and the presence of a positive: response to the Dix-Hallpike maneuver (affected ear down) who were treated at the University of Arkansas for Medical Sciences between January 1993 and February 1997 using canalith repositioning. There were 52 patients (13 men, 39 women) with an average age of 63 years. Intervention: Canalith repositioning was performed without the use of vibration, with the maneuver repeated up to three times as necessary at the initial session until vertigo and nystagmus were abolished. Main Outcome Measure: Initial response, defined as complete response (elimination of nystagmus and symptoms), improved response (elimination of nystagmus but with some residual symptoms), or no response (continued nystagmus and symptoms), as well as recurrence rate. Results: initial complete response was seen in 66% of patients, and 33% showed improved response. This difference was believed to be caused by the pathophysiology. Recurrence rates appeared to be correlated to cause, with higher rates reflecting ongoing inner ear injury, such as with Meniere disease. Conclusions: Canalith repositioning was effective in 99% of patients based on elimination of nystagmus. Partial responders probably experienced resolution naturally over time because of a difference in pathophysiology. Higher recurrence rates can be expected when the cause is thought to involve an ongoing process.