This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Treatment

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Patients may be offered the option of observation or “watchful waiting” as initial management since BPPV is often a self limiting condition and the symptoms may subside or disappear within 6 months of onset (1,2).

  • according to several studies the rate of spontaneous symptomatic resolution was between 15 to 85 % at one month
  • patients may be advised to avoid provocative (vertigo-producing) positions or activities till the resolution of symptoms
  • due to the longer duration of symptoms, patients may be exposed to an increased risk of falls and lost days of work when compared to other interventions (1)

There are two medical approaches to treatment:

  • vestibular sedatives/anti-emetics
    • the symptoms of an acute vestibular episode can be treated with either
      • an anti-emetic (e.g. prochlorperazine or promethazine or cyclizine) or
      • vestibular sedatives (e.g. the calcium channel antagonist* cinnarizine (adult dose 30mg tds) or the histamine analogue betahistine)
      • during the first days of the illness (3)
    • although these vestibular suppressant medications are commonly used, there is no evidence in literature to suggest that these are effective in the treatment of BPPV or as a substitute for repositioning manoeuvres (1)
  • particle repositional manoeuvres – the aim of this treatment is to redirect the otoconial particles back to the utricle (4)
    • office treatment
      • Epley manoeuver
      • Semont manoeuver (5)
    • home treatment
      • modified Epley manoeuver (2,6)
      • Brandt-Daroff exercises (5)

*Cinnarizine is an antihistamine and calcium channel blocker of the diphenylmethylpiperazine group

Patients should be reassessed within a month’s time to confirm the resolution of symptoms (1).

Surgical options:

  • although now rarely done, surgery may be considered for patients with longstanding BPPV who have failed to respond to appropriate and repeated repositioning procedures (4)
  • two possible surgical procedures for benign paroxysmal positional vertigo (BPPV) are:
    • singular neurectomy which deafferentates the posterior semicircular canal (PSCC)
    • occlusion of the PSCC which defunctions it

Reference:


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.