Treatment of Vertigo

Diagnosis and Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends the Canalith Repositioning Procedure (Epley maneuver) as the treatment of choice for benign paroxysmal positional vertigo (BPPV), with success rates of 90-98% when performed correctly 1
BPPV is diagnosed when vertigo with characteristic nystagmus is provoked by the Dix-Hallpike maneuver (for posterior canal) or the supine roll test (for lateral canal) 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends the Canalith Repositioning Procedure (Epley maneuver) as first-line treatment for posterior canal BPPV 1, 2
For lateral canal BPPV, the Gufoni maneuver or barbecue roll maneuver has an 86-100% success rate 1
Patients with BPPV should be reassessed within 1 month after initial treatment to confirm symptom resolution 1, 2
For persistent BPPV, reevaluation should include examination for involvement of other semicircular canals 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends treatment goals for Ménière's disease to include reducing severity and frequency of vertigo attacks, relieving associated symptoms, and improving quality of life 3
Non-ablative procedures are preferred for patients with usable hearing, while ablative treatments may be considered for patients without useful hearing 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends evaluating patients with initial treatment failures for persistent vertigo or underlying peripheral vestibular or CNS disorders 2
Canal conversion occurs in approximately 6% of cases and requires appropriate repositioning for the newly affected canal 1, 4

The American Academy of Otolaryngology-Head and Neck Surgery recommends vestibular rehabilitation therapy (VRT) as an exercise-based treatment program that should be implemented as a series of progressive exercises focusing on habituation, adaptation, and compensation for vestibular deficits to improve symptoms and quality of life in patients with vestibular disorders 5
Cawthorne-Cooksey exercises, which consist of eye, head, and body movements in a hierarchy of increasing difficulty, should be implemented to provoke vestibular symptoms 5, 6
These exercises should be performed until symptoms fatigue, forcing the central nervous system to compensate through habituation 5, 7
For BPPV specifically, Brandt-Daroff exercises can be implemented, involving rapid lateral head/trunk tilts to promote debris dispersion toward the utricular cavity 5, 6

VRT is safe with no serious adverse events reported in clinical trials 7, 8
Home-based therapy appears equally effective as clinician-supervised therapy, though initial instruction is important 7, 9
VRT may be particularly beneficial for elderly patients, potentially decreasing recurrence rates of symptoms 7, 9

VRT demonstrates superior treatment outcomes compared to placebo for BPPV 7
While initially less effective than repositioning maneuvers for BPPV, long-term effectiveness approaches that of repositioning procedures 7, 8