New Guideline Evaluates Therapies for Benign Paroxysmal Positional Vertigo

May 23, 2008

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A new AAN guideline evaluates the treatment of patients with benign paroxysmal positional vertigo (BPPV).

The guideline, published in the May 27, 2008, issue of Neurology®, found strong evidence supporting the canalith repositioning procedure (CRP) as a safe and effective treatment that should be offered to patients of all ages with posterior semicircular canal BPPV. Semont's maneuver is possibly effective.

There was insufficient evidence to establish the relative efficacy of the Semont maneuver to CRP, nor was there enough evidence to recommend a specific maneuver for horizontal or anterior canal BPPV.

There is not enough evidence to determine the efficacy of post-maneuver activity restrictions after CRP. The guideline determined that mastoid oscillation is probably of no added benefit to patients treated with CRP.

Self-administered Brandt-Daroff exercises or habituation exercises are less effective than CRP. There is insufficient evidence to recommend or refute self-treatment using the Semont maneuver or CRP.

There is no evidence to support or refute a recommendation on medication use for routine treatment of BPPV. There is insufficient evidence to recommend or refute posterior semicircular canal occlusion or singular neurectomy as treatment for BPPV.