Systematic approach to benign paroxysmal positional vertigo in the elderly

OBJECTIVE: We evaluated the effectiveness of a management approach that combines the canalith repositioning maneuver (CRM) and vestibular rehabilitation (VR) in the treatment of benign positional paroxysmal vertigo (BPPV) in elderly persons. STUDY DESIGN AND SETTING: Forty-seven patients (≥70 years old) with the diagnosis of unilateral posterior semicircular canal BPPV formed the study population. This study has 2 parts. In the first part, patients were randomly assigned to 1 of 2 groups: the CRM and avoidance (no treatment). Patients were evaluated 1 month after the first visit. Those patients not responding to treatment were enrolled in the second part of the study, treated with an individualized combination of CRM and VR, and then reevaluated 3 months later. RESULTS: Statistically significant improvement of vertigo and provoked nystagmus in 64% of patients in the CRM group compared with the no-treatment group. After the addition of VR, 77% of all patients improved. CONCLUSION: A combination of CRM and VR improves BPPV in the elderly. SIGNIFICANCE: These findings suggest that although CRM is more effective than no treatment, VR can be added to improve the results in the treatment of BPPV.